Healthcare Delivery Systems

Improvement Project

Erin Krening, Caitlin Meaney, Rachel Naftulin, Samantha Rabb, & Sydney Reid
Wednesday November 29th, 2017

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Overview of Patient Care Delivery System

Banner University Medical Center

Labor and Delivery Unit

Focus: Education and Training related to

Cultural Sensitivity, and Patient Centered Care

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 Microsystem Model:
Leadership
Authoritarian Leadership: - strong control over the work group, motivating others
through coercion, directing others with commands, communication flows
downward, decision making does not involve others, criticism is punitive, and
emphasis is on difference in status.
oPatient wristbands
Decisions made quickly
Lack of quality communication in changes, & poor follow through
oCommittees
Centralized
oSelf Scheduling
Concerns not heard Safety Compromised

Marquis, B.L., & Huston, C.J. (2015b). Leadership roles and management functions in nursing theory and application (8th
ed., pp. 40-41). Philadelphia, PA:Wolters Kluwer health/ Lippincott Williams & Wilkins. 3
Microsystem Model:
Organizational Culture and Support
Inconsistent and unpredictable in providing recognition,
information, and resources needed to enhance the nurses
work
Reliance on informal structure and communication
oLimited information sharing amongst levels of hierarchy
Limited human resources for staffing with centralized
system
Learning environment that supports a strong team unity
Marquis, B.L., & Huston, C.J. (2015c). Leadership roles and management functions in nursing theory and application (8th ed., pp.
260-286). Philadelphia, PA: Wolters Kluwer health/ Lippincott Williams & Wilkins.
Institute for Healthcare Improvement.(2015). Clinical microsystem assessment tool. Retrieved from
http://www.ihi.org/resources/pages/tools/clinicalmicrosystemassessmenttool.aspx 4
 Microsystem Model:
Patient Focus & Staff Focus
Patient Focus
o Patient-centered culturally sensitive health is associated with positive health
behaviors and outcomes for both minority and majority patients
o Patient advocate, welcome visitation, designated refrigerator
o Lack of sensitivity toward patients with unfamiliar cultures
Staff Focus
o Staff development is a cost-effective method of increasing productivity
o Tuition reimbursement, awards for achievements, benefits, orientation to unit,
committee opportunities, role transition encouragement
o Understaffed, poor communication, centralized decision making

Marquis, B.L., & Huston, C.J. (2015). Leadership roles and management functions in nursing theory and application (8th ed., pp. 366). Philadelphia, PA:
Wolters Kluwer health/ Lippincott Williams & Wilkins.
Tucker, C. M., Marsiske, M., Rice, K., Jones, J. D., & Herman, K. C. (2011). Patient-centered culturally sensitive health care: Model testing and refinement.

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Health Psychology, 30(3), 342-350. doi: 10.1037/a0022967
 Microsystem Model: Interdependence of Care Team
- Interdependence among the healthcare team is an important
aspect to promote positive patient outcomes
- Focus becomes all on patient
- Patient comfort
- Decreased stress and increased job satisfaction
- Effective communication between a team can lead to more
discussions, ideas and solutions that may lead to improved
patient care.
- A decline in management communication with staff can lead
to a breakdown of the team interdependence
Youngwerth, J., & Twaddle, M. (2011). Cultures of interdisciplinary teams: How to foster good dynamics. Journal of palliative medicine, 14(5), 650-654. doi: 10.1089/jpm.2010.0395
Institute for Healthcare Improvement.(2015). Clinical microsystem assessment tool. Retrieved from
http://www.ihi.org/resources/pages/tools/clinicalmicrosystemassessmenttool.aspx
Use of Information and Healthcare Technology
- Banner provides and utilizes a large amount of different technology to provide
services to patients.
- Technology is not always used to its full benefit
- Lack of knowledge or instruction of the technology
- Staff dont know how to access it
- Lack of resource
- Change to Cerner computer program
- Time consuming
- Confusion & frustration
- Slow patient care
- Banner offers many beneficial, extra services to patients
- Additional education still required on important hospital technology, like the
computer programs and translator phone
Institute for Healthcare Improvement.(2015). Clinical microsystem assessment tool. Retrieved from http://www.ihi.org/resources/pages/tools/clinicalmicrosystemassessmenttool.aspx
Marquis, B.L., & Huston, C.J. (2015d). Leadership roles and management functions in nursing theory and application (8th ed., pp. 452-456). Philadelphia, PA: Wolters Kluwer health/ Lippincott Williams & Wilkins.
 Process for Healthcare Delivery Improvement

Benchmarking
Staff empowerment
Auditing
Safety record keeping
o Safety is considered the first domain in
quality
Staff satisfaction
Marquis, B.L., & Huston, C.J. (2015). Leadership roles and management functions in nursing theory and application (8th ed., pp. 547). Philadelphia, PA:
Wolters Kluwer health/ Lippincott Williams & Wilkins.
 Staff Performance Patterns

Baby-to-breast: Golden Hour

Incentives for month without falls
Safety and Quality Committees
o JCAHO National Patient Safety Goal:
Prevent infection
Programs for charge nurses
Team member of the month
Surveys: staff satisfaction
Marquis, B.L., & Huston, C.J. (2015). Leadership roles and management functions in nursing theory and application (8th ed., pp. 559). Philadelphia, PA:
Wolters Kluwer health/ Lippincott Williams & Wilkins.
Specific Aspect Targeted for Improvement

Tucson is a culturally diverse place

o BUMC L&D receives patients of many different
cultures
Lack of education around cultural sensitivity
Studies found
o Lack of education in the workplace
o Lack of comfortability interacting with patients of
different cultures
Goal: improve education for nursing staff on cultural 10
Leading the Plan for Healthcare Delivery
Improvement
Continued Computerized Cultural Sensitivity Education
Literature: continued education on cultural competency
empowers nurses to deliver culturally appropriate care to
their patients.
One year timeline:
oDevelop Committee: 1-2 mo
oDevelop Education: 3-5 mo
oEducate Nurses: 6-7 mo
oTime to Allow Education in Practice: 8-9 mo
oEval: 10-11 mo
oIntroduce Housewide: 12 mo 11
References

Blegen, M. A., Goode, C. J., Spetz, J., Vaughn, T., & Park, S. H. (2011). Nurse staffing effects on

patient outcomes: Safety-net and non-safety-net hospitals. Medical Care, 49(4), 406-414.

Chan, T. C., Killeen, J. P., Vilke, G. M., Marshall, J. B., & Castillo, E. M. (2010). Effect of mandated

nursepatient ratios on patient wait time and care time in the emergency department. Academic

Emergency Medicine, 17(5), 545-552.

Institute for Healthcare Improvement.(2015). Clinical microsystem assessment tool. Retrieved from

http://www.ihi.org/resources/pages/tools/clinicalmicrosystemassessmenttool.aspx

Marquis, B.L., & Huston, C.J. (2015). Leadership roles and management functions in nursing theory12