Healthcare Delivery Systems

Improvement Project

Dalina Alvizo, Elizabeth Crose, Trudy Morrison, Corey Suzukawa

12/9/15

Overview of Patient Care Delivery System

Pediatric Intensive Care Unit (PICU) at Banner University
Medical Center is a 24 bed unit.
Matrix organization: Structure is designed to focus on
both product and function. This structure has a formal
vertical and horizontal chain of command
Pros/cons of a matrix organization:
o Distribution of power
o Slower decision making process

Microsystem Model:
Leadership
A leader must have:
oAbility to balance reaching collective goals,
while simultaneously empowering staff
individuals,
oFoster a positive unit culture
oBuild knowledge
oReview and reflecting staff job status.

Quantum Leadership Style

oLeaders must work together with subordinates
oIdentify common goals
oExploit opportunities
oEmpower staff to make decisions for organizational
productivity

Microsystem Mode
Organizational Culture and Support
Culture
o Mission: to make a difference in peoples lives
through excellent patient care
o Vision: We will be a national leader recognized for
clinical excellence and innovation, preferred for a
highly coordinated patient experience, and
distinguished by the quality of our people.

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:
Patient Focus & Staff Focus
Patient-centered care
oMeeting patient needs
oCommitment to Quality and Safety

Staff Focus
oSelective Hiring
oValued members
oNot supportive enough with:
Education, training, and professional growth

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

Multidisciplinary Care Team

oCollaboration
oAppreciation of roles
oRespect

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:
Use of Information and Healthcare Technology
Use of Information
oMyChart for patients
oHealthLink for physicians
oElectronic Medical Records

HealthCare Technology
oMedication Scanning,
oAlaris Pumps
oAsCom Phones
oElectronic Pyxis
oElectronic Charting
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Microsystem Model:
Process for Healthcare Delivery Improvement

New Graduate Nurses

oTraining/education

Staff Nurses
oLess opportunities

University HealthSystem Consortium

Microsystem Model:
Staff Performance Patterns

CAUTI/CLABSI Board
oCurrent/Past Percentages
oUpdated Annually

Yearly Staff Evaluations

o Patient Satisfaction Surveys
Person of the Month Award
oNomination Based
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Specific Aspect Targeted for Improvement

Organizational support of nursing staff by the

provision of continuing education (CE).
oContinuing education is necessary to improve
patient outcomes
oIf microsystems are supported, there is a
greater sense of job satisfaction

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Specific Aspect Targeted for Improvement

(cont.)
Organizational Support
Observational study of 20 high performing microsystems,
using interviews and direct observation to gather information.
Larger organization provides recognition, information, and
resources to enhance the work of the microsystem.
o Continuing education designed into staff plans for
professional growth.
o The larger organization should look for ways to connect
to and facilitate the work of the microsystem.
o ...when we need something we get it. The larger
organization is very supportive in that we get what we
want, mostly in terms of resources.
(Nelsen, Batalden, Mohr, Godfrey, Headrick, & Wasson,
2002)
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Leading the Plan for Healthcare Delivery

Improvement
CCRN Exam Fee: $298 ($220 CCRN exam fee + $78 AACN annual
member fee) (AACN, 2015).
oAssessment Center located in Tucson
oAverage RN Salary in Tucson: $56,000 (Indeed, 2015).
About $29 an hour, $348 for a paid 12 hour shift
On average one day in an ICU is $3,200
o One study suggested an additional length of stay of 2.3 days for
every adverse event. 4.3 days if related to medication errors.
o Adverse events can cost between $6,000-$9,000 per event, and
over $200,000 per year.
o Can be prevented with further education and improved quality of
care.
(Kane, Jacobi, Rothschild, 2010)
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References
American Association of Critical Care Nurses. (2015). Frequently Asked Questions about CCRN Certification. Retrieved

from http://www.aacn.org/wd/certifications/content/faqsccrn.pcms?menu=
Indeed. (2015). Registered Nurse Salary in Tucson, AZ | Indeed.com. Retrieved from

http://www.indeed.com/salary/q-Registered-Nurse-l-Tucson,-AZ.html

Kane-Gill, S. L., Jacobi, J., & Rothschild, J. M. (2010). Adverse drug events in intensive care units: risk factors, impact,
and the role of team care. Critical care medicine, 38, S83-S89.
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.
Nelson, E. C., Batalden, P. B., Homa, K., Godfrey, M. M., Campbell, C., Headrick, L. A., ... & Wasson, J. H. (2003).
Microsystems in health care: Part 2. Creating a rich information environment. Joint Commission Journal on Quality and
Patient Safety, 29(1), 5-15.
Godfrey, M. M., Nelson, E. C., Wasson, J. H., Mohr, J. J., & Batalden, P. B. (2003). Microsystems in health care: Part 3.
Planning patient-centered services. Joint Commission Journal on Quality and Patient Safety, 29(4), 159-170.
Wasson, J. H., Godfrey, M. M., Nelson, E., Mohr, J. J., & Batalden, P. B. (2003). Microsystems in health care: Part 4.
Planning patient-centered care. Joint Commission Journal on Quality and Patient Safety, 29(5), 227-237.

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References

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