Healthcare Delivery Systems

Improvement Project
Christen Bowen, Adela Gonzales,
Kiersten Patterson, and Christine Walsh
November 18th, 2020
Overview of Patient Care Delivery System
Banner University Medical Center - Tucson
• Cardiovascular Intensive Care Unit (CVICU)
• 24-bed unit. Interdisciplinary team consisting of RN house
supervisor, charge RN, staff RNs, critical care physicians,
RTs, pharmacy, and students.
• Focus:
• Impaired education of new graduates related to short
program length, lack of implementation of training of
cardiac equipment, and lack of preparedness in
emergencies. Johnson, J.K. (2001). Clinical microsystem assessment. Retrieved
from
https://clinicalmicrosystem.org/uploads/documents/ microsystem_a
2 ssessment.pdf
 Microsystem Model: Leadership
CVICU Leadership
• Charge RN leads in a • Strong leadership role in
democratic style times of emergencies
• Strong emphasis on • Unit manager involved in
teamwork unit needs
• Decisions involves others • Bedside support
• Upward and downward • Educational support
communication
• Constructive criticism Johnson, J.K. (2001). Clinical microsystem assessment. Retrieved
from h
• Praise and rewarding ttps://clinicalmicrosystem.org/uploads/documents/ microsystem_asses
sment.pdf
 
Marquis, B. L., & Huston, C. J. (2017). Leadership roles and
3
Microsystem Model: Organizational Culture and Support
Unit Management
• Mix of Democratic and Transformational Leadership to support
team to enhance delivery of care
• Preceptor use of transformational leadership: encourage,
motivate, and innovate
• Working with new graduate for 6-12 months 
• Resources of support for new graduate nurses: charge nurse,
unit nurse manager, fellow staff nurses
• Unit focus on teamwork, communication, interdisciplinary
coordination of care
Johnson, J.K. (2001). Clinical microsystem assessment. Retrieved from
ttps://clinicalmicrosystem.org/uploads/documents/ microsystem_assessment.pdf 
Marquis, B. L., & Huston, C. J. (2017). Leadership roles and management functions in nursing: Theory and application (9th ed, pg. 76,
339). Philadelphia: Wolters Kluwer Health
4
 Microsystem Model: Patient Focus & Staff Focus
Culture and Work Roles
• ICU manager involved in • Patient Safety
new hires • Bedside report for
• Six months of new graduate increased communication
program • Collaboration with other
• Orientation to RNs to deliver efficient
postoperative patients patient care
• Continuing education
• Staff ratio varies 
• 1:1, 1:2, 1:3 Johnson, J.K. (2001). Clinical microsystem assessment. Retrieved
from
• Raises assessed twice a year https://clinicalmicrosystem.org/uploads/documents/
ssessment.pdf
microsystem_a
5
Microsystem Model: Interdependence of Care Team
Trust and Collaboration
• High staff-to-patient ratio allowing for 24/7 observation and
collaboration

• Interdisciplinary care among doctors, nurses, PCTs, respiratory

therapists, dieticians, physical therapists, pharmacists, and
case managers

• Trust amongst co-workers to collaborate patient needs

Johnson, J.K. (2001). Clinical microsystem assessment. Retrieved
from
https://clinicalmicrosystem.org/uploads/documents/ microsystem_a
6 ssessment.pdf
Microsystem Model: Use of Information and Health Technology
Available Technology
• Communication devices
• Ascom

• Cerner EMR
• Reduced ICU central line infections (Banner Health, 2020)
• PowerNote, Clindoc, PharmNet

• Patient portal
• My Care Johnson, J.K. (2001). Clinical microsystem assessment. Retrieved
from
https://clinicalmicrosystem.org/uploads/documents/ microsystem_a
7 ssessment.pdf
Microsystem Model: Process for Healthcare Delivery Improvement
Process for Improvement
• Resources to support continual improvement:
• Annual modules
• EKG courses

• Required nurse certifications:

• BLS & ACLS
• CRRT
• ECMO
Johnson, J.K. (2001). Clinical microsystem assessment. Retrieved
from
https://clinicalmicrosystem.org/uploads/documents/ microsystem_a
8 ssessment.pdf
Microsystem Model: Staff Performance Patterns
Performance Measures and Results
• Quarterly and monthly measured patient outcomes
• Unit performance outcomes shared in morning huddle by
charge nurse
• Responsibility of all staff nurses to uphold standard of care 
• Current data and goals on patient outcomes held by unit
nurse manager 

Johnson, J.K. (2001). Clinical microsystem assessment. Retrieved

from
https://clinicalmicrosystem.org/uploads/documents/ microsystem_a
9 ssessment.pdf
Specific Aspect Targeted for Improvement
Vizient and American Association of Colleges of Nursing
Residency Program
• 1-year nurse residency program (NRP)
• Monthly seminars
• Small group guided sessions
• Complete an evidence-based project with a formal poster
presentation
➔ Use led to effective decision making skills, leadership and
communication through training and EBP through education
Goode, C. J., Glassman, K. S., Ponte, P. R., Krugman, M., & Peterman, T. (2018). Requiring a nurse residency for newly licensed registered
nurses. American Academy of Nursing on Policy, 66(3) 329-332.https://doi.org/10.1016/j.outlook.2018.04.004.

10
Integrative Nursing Principle
Integrative Nursing Principle #5
• “Integrative nursing is informed by evidence and uses the full
range of therapeutic modalities to support/augment the
healing process, moving from least intensive and invasive to
more, depending on need and context”
• Education to new graduates of evidence-based practices to
improve patient outcomes 
• Improving education helps to select most appropriate
intervention
Kreitzer, M. J. (2015). Integrative nursing: Application of principles
across clinical settings. Rambam Maimonides Medical Journal, 6(2).
doi: 10.5041/ RMMJ.10200
11
Leading the Plan for Healthcare Delivery Improvement
• Plan for implementation: November 18, 2020- March 1, 2022 
• M 0-1: HR will inform the new nurse residents of the new NRP
and expectations. CVICU manager and nurse educator will began
planning and implementing education by 12/31/20
• M 2: Banner Health and CVICU manager will approve/change new
NRP & curriculum by 1/31/21
• M 3: Implementation will begin with new cohort 2/1/21
• M 3-15: 12 Seminars , 6 sessions and 1 EBP w/poster
• M 15: New grads training and education completed by 2/1/22
• Data collection will be completed & analyzed by 2/28/22
• M 16: Evaluation outcomes of new NRP & implement hospital
wide by 3/1/22 Goode, C. J., Glassman, K. S., Ponte, P. R., Krugman, M., & Peterman, T. (2018). Requiring a
nurse residency for newly licensed registered nurses. American Academy of Nursing on Policy, 66(3) 3
332.https://doi.org/10.1016/j.outlook.2018.
12 04.004.
 References

Banner Health. (2020). Information Technology Careers. 

https://www.bannerhealth.com/careers/profiles/infor
mation-technology 
Goode, C. J., Glassman, K. S., Ponte, P. R., Krugman, M., &
Peterman, T. (2018). Requiring a nurse residency for newly
licensed registered nurses. American Academy of Nursing on
Policy, 66(3) 329-332. https://doi.org/10.1016/j.outlook.2018.
04.004.

14
 References
Integrative nursing: Application of principles across clinical
settings. Rambam Maimonides Medical Journal, 6(2). doi:
10.5041/RMMJ.10200
Johnson, J.K. (2001). Clinical microsystem assessment. 
https://clinicalmicrosystem.org/uploads/documents/
microsystem_assessment.pdf Kreitzer, M. J. (2015).
Marquis, B. L. & Huston, C. J. (2017). Leadership roles 
and management functions in nursing: Theory and
application (9th ed). Philadelphia: Wolters Kluwer Health.