Quality Improvement Project:
Healthcare Delivery
Jacob Early, Duncan Shaw, Daniel Hermosillo, Alejandro Dominguez
& Cadence Williams
1
Overview of Patient Care Delivery System
Analyze current charting system and implement
streamlined charting protocols to avoid entry
redundancies by improving existing charting
software.
Banner University Medical Center
Surgical/ Trauma ICU
Focus: Use of information technology
2
Microsystem Model:
Leadership
Decentralized decision making diffuses decision
making throughout the organization and allows
problems to be solved by the lowest practical
managerial level.
Leadership of the Trauma/Surgical ICU
o Democratic Leadership
o Decentralized Decision Making
o RN Feedback Highly Valued
Marquis, B.L., & Huston, C.J. (2015b). Leadership roles and management functions in nursing theory and application
(8th ed., p. 273). Philadelphia, PA:Wolters Kluwer health/ Lippincott Williams & Wilkins.
3
Microsystem Model
Organizational Culture and Support
Resources are readily available and teamwork is
utilized between nurses and other
interdisciplinary team members.
Communication is strongly encouraged
Teamwork allows for safe patient care
Impact: Effective, safe and timely and overall
improved delivery of care.
Institute for Healthcare Improvement.(2015). Clinical microsystem assessment tool. Retrieved from
[Link]
4
Microsystem Model:
Patient Focus & Staff Focus
Patient Focus
Making health care easier so life can be better
Provide safe quality care that is patient
centered
Staff Focus
Staff input valued for patient assignments
Continuing Education is recommended
o ACLS, CRRT, CCRN, Ultrasound IV
Banner Health. (2017). Our non-profit mission. Retrieved from [Link] Accessed on November 27,2017.
5
Microsystem Model:
Interdependence of Care Team
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
Interdisciplinary Members
RNs, MDs, RTs, OTs, PTs, PCTs
o Interdependence between health care team
6
Microsystem Model:
Use of Information and Healthcare Technology
MyBanner HealtheLife - Patient access
Cerner - Recent switch from EPIC
Electronic Charting Benefits
Access to information
Safety checks
Electronic Charting Negatives
Less time spent with patients
Task oriented vs. Patient oriented
Banner Health. (2017). MyBanner/MyChart Patient Portal. Retrieved from
[Link]
7
Microsystem Model:
Process for Healthcare Delivery Improvement
Benchmarking
Dual RN sign off for CLABSIs
Current Improvement Projects
4 hour oral care vs 2 hour oral care
Curos caps on all central lines
Is the Foley still necessary?
8
Microsystem Model:
Staff Performance Patterns
Excessive nursing workload was the main risk
factor for HAI, when evaluated together with
other invasive devices such as those in an ICU.
Has staff performance changed since Cerner
Staff attitudes
Time management
Patient safety
Daud-Gallotti, R. M., Costa, S. F., Guimares, T., Padilha, K. G., Inoue, E.N., & Vasconcelos, T.N. (2012). Nursing workload as a risk factor for
healthcare associated infections in ICU: A prospective study. Retrieved from: [Link]
Specific Aspect Targeted for Improvement
Going from a Porche to a Pinto
UMC Banner UMC
Switch to Cerner from Epic
o charting patient time
Goal: Decrease amount of time spent charting
on repetitive information. Chart by exception to
increase time at patient bedside.
10
Leading the Plan for Healthcare Delivery
Improvement
Ask the staff for suggestions, consider all
proposals & implement time saving mechanisms
7-month Timeline
Day 1 1 Month 7 Months Policy
Analyze EHR Charting Policies Assess Changes Hospital Wide
11
References
Institute for Healthcare Improvement.(2015). Clinical microsystem assessment tool. Retrieved from
[Link]
Marquis, B.L., & Huston, C.J. (2015b). Leadership roles and management functions in nursing theory and application(8th ed., p.
273). Philadelphia, PA:Wolters Kluwer health/ Lippincott Williams & Wilkins.
Daud-Gallotti, R. M., Costa, S. F., Guimares, T., Padilha, K. G., Inoue, E.N., & Vasconcelos, T.N. (2012). Nursing workload as a
risk factor for healthcare associated infections in ICU: A prospective study. Retrieved from:
[Link]
Banner Health. (2017). MyBanner/MyChart Patient Portal. Retrieved from [Link]
patient-portal
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