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Overview of Patient Care Delivery System

Adult Intensive Care Unit at Carondelet St.
Josephs Hospital, Tucson, AZ
o32 beds; 3 wings: ICU 3N, ICU 3E, ICU 3W
oNurse to patient ratio 1:2 or 1:1

Healthcare Delivery Systems

Improvement Project

Delivery of Care
oTotal Patient Care
oDifferentiated practice

Kaitlin Allen, Jenna Coakley, Paige Kivi, Katelyn Tamaray, Lauren Griffin
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Microsystem Target Area: Staff Focus

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Microsystem Model:
Leadership

Microsystem Mode
Organizational Culture and Support

Quantum Leadership

Organizational culture
othe ways of thinking, behaving, and believing of the
unit
overy efficient
oclose staff, family feel

Team Leadership
Critical Care thinkers
oIntuitive, knowledgeable, assertive, and willing to take
action

Marquis, B. L., & Huston, C. J. (2015). Leadership roles and management functions in nursing: Theory and application (8th Edition). Philadelphia, PA:
Lippincott Williams & Wilkins.

Marquis, B. L., & Huston, C. J. (2015). Leadership roles and management functions in nursing: Theory and application (8th Edition). Philadelphia, PA:
Lippincott Williams & Wilkins.

Microsystem Model:
Patient Focus & Staff Focus

Nelson, E. C., Batalden, P. B., Mohr, J. J., Godfrey, M. M., Headrick, L. A., & Wasson, J. H. (2002). Microsystems in health care: Part 1. Learning from
highperforming front-line clinical units. Joint Commission Journal on Quality and Patient Safety, 28(9), 472-493.

Microsystem Model:
Interdependence of Care Team
How does the team of care providers function
within the microsystem?

Patient Focus
oprimary focus is to meet all patient needs
oprimary focus on supporting the families

oTrust
oCollaboration
oWillingness to help each other
oAppreciation/recognition/respect of each individual

Staff Focus
o selective hiring
o high expectations
o continuous education
Nelson, E. C., Batalden, P. B., Mohr, J. J., Godfrey, M. M., Headrick, L. A., & Wasson, J. H. (2002).
Microsystems in health care: Part 1. Learning from highperforming front-line clinical units. Joint Commission
Journal on Quality and Patient Safety, 28(9), 472-493.

Organizational Support
o larger organization facilitates work of the microsystem
o provides resources & information
o At St. Joes, house supervisor oversees the entire
hospital

CarondeletHealthAZ. (n.d.). This is my St. Josephs [YouTube Video]. Retrieved from https://www.youtube.com/watch?v=g7f9u2d-7cY

How does the team support patient-centered

care?
oPatient needs
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oMission Statement
oVision Statement
o Interdisciplinary rounding

Carondelet Health Network. (2015b). Welcome to carondelet careers. Retrieved from http://www.carondelet.org/about/careers.aspx

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Microsystem Model:
Use of Information and Healthcare Technology

Microsystem Model:
Process for Healthcare Delivery Improvement

How is information and healthcare

technology used to support the functioning
of the microsystem?
o Cerner
o MyCarondeletHealth
o Practice evidence-based care
o Modern technology
ICU technology

What is the best process for healthcare delivery

improvement?

An atmosphere for learning and redesign

supported by:
o Continuous monitoring of care
o Use of benchmarking
o Frequent tests of change
o Staff empowerment

Carondelet Health Network. (2015a). Mission, vision & values. Retrieved from http://www.carondelet.org/about/mission-vision-values.aspx

Microsystem Model:
Staff Performance Patterns

Nelson, E. C., Batalden, P. B., Mohr, J. J., Godfrey, M. M., Headrick, L. A., & Wasson, J. H. (2002). Microsystems in health care: Part 1. Learning from
highperforming front-line clinical units. Joint Commission Journal on Quality and Patient Safety, 28(9), 472-493.

Specific Aspect Targeted for Improvement

Performance patterns focus on multiple areas

Outcomes are measured, data fed back into the
microsystem, and further changes are made
based on:
o Patient Outcome
o Avoidable Costs
o Streamlining delivery
o Data Feedback
o Positive Competition
o Performance Discussions

Staff focus
oICU nurses need to continue education
Equipment is specialized in the ICU
o The unit has the highest acuity patients with
advanced machinery
o Example: EKOS machine
(N. Patze, Personal Communication, November 11, 2015).

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Nelson, E. C., Batalden, P. B., Mohr, J. J., Godfrey, M. M., Headrick, L. A., & Wasson, J. H. (2002). Microsystems in health care: Part 1. Learning from
highperforming front-line clinical units. Joint Commission Journal on Quality and Patient Safety, 28(9), 472-493.

Specific Aspect Targeted for Improvement

(cont.)

Leading the Plan for Healthcare Delivery

Improvement

Educating ICU nurses

Research articles
oHigh-fidelity training exercises
oNight shift clinical nurse specialist

oNurses should be educated in a way that

increases confidence and understanding

oThere should be educational sessions

available for night nurses to complete during

their regularly scheduled breaks
(N. Patze, personal communication, November 11,
2015).

Promoting change: rational-empirical method

oSupported with research
oLittle resistance expected
(Marquis & Huston, 2015; Boling & Hardin-Pierce, 2015; Becker,
2014).

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References

References

Becker, Dawn M. (2014). Implementing a night-shift clinical nurse

specialist. Clinical Nurse Specialist, 27(1), 26-30. doi: 10.1097/NUR.
0b013e3182777029
Boling, B., & Hardin-Pierce, M. (2015).The effect of high-fidelity
simulation on knowledge and confidence in critical care training: An
integrative review. Nurse Education in Practice, doi: 10.1016/j.nepr.
2015.10.004
CarondeletHealthAZ. (n.d.). This is my St. Josephs [YouTube
Video]. Retrieved from
https://www.youtube.com/watch?v=g7f9u2d-7cY
Carondelet Health Network. (2015a). Mission, vision & values.
Retrieved from
http://www.carondelet.org/about/mission-vision-values.aspx
Carondelet Health Network. (2015b). Welcome to carondelet
careers. Retrieved from
http://www.carondelet.org/about/careers.aspx
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Nelson, E. C., Batalden, P. B., Mohr, J. J., Godfrey, M. M.,

Headrick, L. A., & Wasson, J. H. (2002). Microsystems in health
care: Part 1. Learning from highperforming front-line clinical units.
Joint Commission Journal on Quality and Patient Safety, 28(9),
472-493.
Marquis, B. L., & Huston, C. J. (2015). Leadership roles and
management functions in nursing: Theory and application (8th
Edition). Philadelphia, PA: Lippincott Williams & Wilkins.

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