Healthcare Delivery Systems

Improvement Project

Dominic Colella, Morgan Frank, Johnathan Mougin, Rachel Lima & Caroline Sethney
11/30/16

Overview of Patient Care Delivery System

St. Josephs Emergency Department
Demographics
o 486 bed acute care hospital
o 44 emergency department beds, including 6
advanced life support designated beds
o Ratios of 1:3 in advanced life support care area and
1:4 in all other areas
(Registered nurse, personal communication, 2016)
(Carondelet Health Network, 2016)

Microsystem Model:
Leadership
Leaders work to balance setting and reaching collective
goals, and use the strategies of building knowledge,
respectful action, reviewing, and reflecting to empower
individual autonomy and accountability
Mixture of Authoritarian and Democratic
o Emergency Department Director
o Clinical Lead
o Clinical Educator
o Charge Nurse
(Marquis and Huston, 2015)
(Registered nurse, personal communication, 2016)
3

Microsystem Model:
Organizational Culture and Support
The larger organization looks for ways to support the
work of the microsystem and coordinate the hand-offs
between microsystems
Organizational Structure
o Organization undergoing numerous budgetary
changes
o Increased staff turnover, loss of essential support
staff, lack of updated equipment
(Marquis and Huston, 2015)
(Registered nurse, personal communication, 2016)

Microsystem Model:
Patient/Staff Focus of healthcare delivery
Patient Focus: Patient centered care - Innovative
approach to planning, delivery, and evaluation
oHCAHPS (patient satisfaction survey)
Staff focus
o New nurses are given six months of training in the
emergency department
o Hire new graduates
o Annual performance appraisals
(Marquis and Huston, 2016)
(Registered nurse, personal communication, 2016)
5

Microsystem Model:
Interdependence of Care Team
Care Team Interactions
o Nurses receive report from other nurses during
change of shift
o Care team does not round on patients - should
information be required, individual consultation occurs
on a case by case basis
o Communication between providers and nurses, or
between departments, is occasionally lacking
(Registered nurse, personal communication, 2016)
(Marquis and Huston, 2015)
6

Microsystem Model:
Use of Information and Healthcare Technology
Technology has dramatically changed how information is
transferred and accessed.
Safeguards to protect the patient population.
Technology used
o Cerner (some paper charting)
o No barcode drug administration used on this unit
o Internet and Intranet with access to programs such as
Micromedex
(Registered nurse, personal communication, 2016)
(Marquis and Huston, 2015)
7

Microsystem Model:
Process for Healthcare Delivery Improvement
The ways in which learning is supported on the unit
o Monthly mandatory continuing education modules
o ACLS and PALS requirement-hospital provides
compensation for required classes
o Staff leaders remind staff during huddle to remain up
to date on continuing education courses
o Information on patient satisfaction and emphasis on
proper hand hygiene placed in staff breakroom
o Benchmarking

(Registered nurse, personal communication, 2016)

8

Microsystem Model:
Staff Performance Patterns
The ways in which the staffs performance is measured
o Length of stay, amount of time triaged, etc.
o Performance reviews - is the nurse meeting the
requirements of the job?
o Volume of patients seen
o Assessment of patient outcomes
o Streamlining delivery
o HCAHPS (patient satisfaction survey)
(Registered nurse, personal communication, 2016)
9

Specific Aspect Targeted for Improvement

Information and Healthcare Technology: No barcode
scanning for medication administration
Barcode-assisted medication administration (BCMA)
reduces medication errors in hospitalized patients
BCMA is not routinely used in emergency departments,
including St. Josephs ED.
Research shows that EDs would benefit from the use of
BCMA because medication administration in the ED is
often complex and error-prone
(Bonkowski et al, 2013)

10

Leading the Plan for Healthcare Delivery

Improvement: Plan, Do, See, Act PDSA
Plan: Discuss plan with Emergency Department
leadership committee and care teams
Do: Adapt the barcode scanner medication
administration system already used in other units in the
hospital
See: Study to see if there is a decrease in the number of
medication administration errors after implementation of
the new plan.
Act: Reevaluate as necessary.
(Institute for Healthcare Improvements, 2016)

11

References
Bonkowski, J., Carnes, C., Melucci, J., Mirtallo, J.,
Prier, B., Reichert, E., . . . Weber, R. (2013).
Effect of barcode-assisted medication
administration on emergency department
medication errors. Academic Emergency
Medicine : Official Journal of the Society for
Academic Emergency Medicine, 20(8), 801- 806.
doi:10.1111/acem.12189

12

References
Marquis, B. L., & Huston, C. J. (2015). Classical Views
of Leadership and Management. In Leadership
Roles and Management Functions of Nursing (8th ed.,
pp. 32-52). Philadelphia, PA: Wolters Klower.
Marquis, B. L., & Huston, C. J. (2015). Organizational
Structure. In Leadership Roles and Management
Functions of Nursing (8th ed., pp. 260-286).
Philadelphia, PA: Wolters Klower.

13

References
Marquis, B. L., & Huston, C. J. (2015). Organizational,
Interpersonal, and Group Communication. In
Leadership Roles and Management Functions of
Nursing (8th ed., pp. 436-465). Philadelphia, PA:
Wolters Klower.
Scientific of Improvement: Testing Changes. (2016).
Retrieved November 16, 2016, from
http://www.ihi.org/resources/Pages/HowtoImprove/S
cienceofImprovementTestingChanges.aspx