Improving Organizational Culture and
Support in Med-Surg at Northwest
Juliana Aldrich, Chelsea Lovitt, Ashley Nickell, Maddie Schaeffer &
Bailee Thompson
December 2nd, 2020
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Overview of Patient Care Delivery System
Northwest Medical Center- Tucson
o Orthopedic Medical Surgical Unit- 80 bed unit
• Population mostly consists of post-surgical patients
including orthopedic, bariatric, and general surgery
• Ratio: up to 6:1
o Focus: Inadequate organizational support related to poor RN
to manager relationships secondary to impaired
communication, emotional strain, and burnout as evidenced
by nurses stating having a poor relationship with
management (K. Hesser, personal communication, November 20, 2020) 2
Microsystem Model: Leadership
Ortho-Med Surg Leadership
o Charge RN leads in a democratic style
• “Less control, directed through suggestions
and guidance, communication flows up and
down, decision making involves others”
o Charge RN works to give constructive criticism
o Emphasis on team
Lacroix, D. (2020) Management and Leadership [Powerpoint slides]. Retrieved from
https://d2l.arizona.edu/d2l/le/content/906079/viewContent/8775559/View 3
Microsystem Model:
Organizational Culture and Support
Culture:
o Democratic leadership
o Nurses help and respect each other
Support:
o Charge RN always available
o Morning/night huddles
o House supervisors available
o Management not very approachable
Lacroix, D. (2020) Management and Leadership [Powerpoint slides]. Retrieved from 4
Microsystem Model:
Patient Focus & Staff Focus
Patient Focus:
o Acuity tools used to help determine ratios
o Hourly rounding
o Patient care plans
Staff Focus:
o New grad RN program
o Professional development encouraged
o Staff encouraged to further education
Johnson, J. K. (2001). Clinical microsystem assessment tool [PDF]. Retrieved from
http://clinicalmicrosystem.org/uploads/documents/microsystem_assessment.pdf
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Microsystem Model:
Interdependence of Care Team
Large emphasis on trust, collaboration, willingness to
help, and respect
o Nurses felt safe asking others for help when
needed
Mutual trust and respect between care team
o Nurses felt comfortable interacting with physicians
o Strong delegation process between nurses and
techs
Johnson, J. K. (2001). Clinical microsystem assessment tool [PDF]. Retrieved from
http://clinicalmicrosystem.org/uploads/documents/microsystem_assessment.pdf 6
Microsystem Model:
Use of Information and Healthcare Technology
Information with patients
o Patient portal, CareNotify
Information with providers, staff, and technology
o Cerner EHR system, Omnicell
o WOWs, phones
o Communication via phone, Cerner, Omnicell
Johnson, J. K. (2001). Clinical microsystem assessment tool [PDF]. Retrieved from
http://clinicalmicrosystem.org/uploads/documents/microsystem_assessment.pdf 7
Microsystem Model:
Process for Healthcare Delivery Improvement
Process Improvement
o Bedside hand-off/report
o Interprofessional rounds with surgeons,
physicians, PT/OT, respiratory, nutrition and
case management as necessary
o Lack of support and opportunity for continuing
education and seeking higher certifications
Johnson, J. K. (2001). Clinical microsystem assessment tool [PDF]. Retrieved from
http://clinicalmicrosystem.org/uploads/documents/microsystem_assessment.pdf 8
Microsystem Model:
Staff Performance Patterns
Performance Monitoring
o Yearly self-evaluations
• Completed by unit RN on themselves and
reviewed/discussed with charge/nursing manger
o Positive recognition among staff members
o Weekly emails from nursing manger to unit
RNs
Johnson, J. K. (2001). Clinical microsystem assessment tool [PDF]. Retrieved from
http://clinicalmicrosystem.org/uploads/documents/microsystem_assessment.pdf 9
Specific Aspect Targeted for Improvement
Monthly check-in through an anonymous survey
with questions to facilitate expression of nurse’s
opinions on what the current unit needs are
Necessary to have an outlet for nurses to feel
heard and supported
Integrative Principle: Human beings are whole
systems inseparable from their environments.
Kreitzer, M.J. & Koithan, M. (2019). Integrative nursing. New York: Oxford Press.
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Specific Aspect Targeted for Improvement
Allows for nurse’s voices to be heard without
fear of judgement
Patient-centered care will improve because
when nurses are better supported, they will be
better equipped for providing quality care
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Leading the Plan for Healthcare Delivery
Improvement
1 year plan
1st-7th of each month: Survey
o After each check-in, the unit manager will
evaluate implementation of top request from
nurses
15th of each month: Intervention for following
month announced
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References
Lacroix, D. (2020) Management and Leadership [Powerpoint slides]. Retrieved from
https://d2l.arizona.edu/d2l/le/content/906079/viewContent/8775559/View
Johnson, J. K. (2001). Clinical microsystem assessment tool [PDF]. Retrieved from
http://clinicalmicrosystem.org/uploads/documents/microsystem_assessment.pdf
Kreitzer, M.J. & Koithan, M. (2019). Integrative nursing. New York: Oxford Press.
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