Concept Application Project:

Healthcare Delivery

Ana Hopkins, Brittany Dollarhide, Emma Randall,

Kristina Arnold, Natalie Alwin

Overview of Patient Care Delivery System

Hospital: St. Josephs
Unit: Labor & Delivery
Focus: Staff compliance of new protocols to
enhance patient care

Microsystem Model:
Leadership
Leaders maintain constancy of purpose, establish clear
goals and expectations, and foster a respectful positive
culture. Leaders take time to build knowledge, review
and reflect, and take action about microsystems and the
larger organization.

Leaders on the Unit:

o 1 Unit Manager
o 1 Charge Nurse
o 1 Clinical Nurse Leader
o 1 Nurse Educator
Democratic Leadership style

(Johnson, 2001) (Marquis & Huston, 2014)

Microsystem Mode
Organizational Culture and Support

The larger organization is inconsistent and

unpredictable in providing the recognition,
information, and resources needed to enhance
my work.

Frequent changes in larger organization:

o Tenet
o Director for Womens Health
o Fiscal Resources

(Johnson, 2001) (Stanford University, n.d.)

Microsystem Model:
Patient Focus & Staff Focus
Patient Focus
oWe are actively working to provide patient centered
care and we are making progress toward more
effectively and consistently learning about and
meeting patient needs.
oNew policies in place to meet patient needs.
oEducation and support for staff needed to make these
changes and provide consistent care.

(Johnson, 2001) (J. Rodriguez, personal communication, November 18th, 2016)

Microsystem Model:
Patient Focus & Staff Focus Cont.
Staff Focus
oI am a valued member of the microsystem and what
I say matters. This is evident through staffing,
education and training, workload, and professional
growth.
oSuggestions box in the break room
oAnnual evaluation with incentives
oFrequent education
oOpen door policy

(Johnson, 2001) (J. Rodriguez, personal communication, November 18th, 2016)

Microsystem Model:
Interdependence of Care Team
Care is provided by an interdisciplinary team
characterized by trust, collaboration, appreciation of
complementary roles, and a recognition that all
contribute individually to a shared purpose.
Methods:
o Functional Nursing model during delivery
o Communication/availability of health care provider

(Johnson, 2001) (OConnell, 2016)

Microsystem Model:
Use of Information and Healthcare Technology

Integration of Information with:

oPatients: Patients have a variety of ways to get the
information they need and it can be customized to
meet their individual learning styles
oProviders and Staff: The information I need to do my
work is available when I need it.
oTechnology: Technology facilitates a smooth linkage
between information and patient care by providing
timely, effective access to a rich information
environment

(Johnson, 2001) (De Grood, Wallace, Friesen, White, Gilmour, & Lemaire, 2012)

Microsystem Model:
Process for Healthcare Delivery Improvement

Some resources are available to support

improvement work, but we dont use them as
often as we could. Change ideas are
implemented without much discipline.

Resources:
o L&D Resource Book
o Iconnect
o Education Binder

(Johnson, 2001) (Duffield, Diers, OBrien-Pallas, Aisbett, Roche, King, & Aisbett, 2011)

Microsystem Model:
Staff Performance Patterns

Outcomes (clinical, satisfaction, financial,

technical, safety) are routinely measured, we
feed data back to staff, and we make changes
based on data.

Feedback
o Patient Satisfaction Surveys
o Safety Reports/Safety Huddles

(Johnson, 2001) (Kylor, 2016) (L. Johnson, personal communication, October 20th, 2016)

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Specific Aspect Targeted for Improvement

St.

Josephs - Labor & Delivery Unit

oNursing noncompliance to policy regarding skin-toskin contact

Studies have found:
o Mother and baby physical and psychological benefits
o Reduced crying, grimacing, and heart rate surges
o Stabilization of newborns temperature

Goal: Increase nursing compliance related to

skin-to-skin contact policy

(Piscotty & Kalisch, 2014) (Haxton, Doering, Gingras, & Kelly, 2010)

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Leading the Plan for Healthcare Delivery

Improvement
Electronic Nursing Care Reminders
Literature: Nurses who use higher levels of reminders
have decreased reports of missed nursing care
Timeline: Approximately one month

Present issue to staff during huddle

Program Electronic Reminder (ER) to Cerner
Implement Electronic Reminder for one month
Conduct unit-wide survey
Analyze survey results
Determine success rate of ER
(Piscotty & Kalisch, 2014) (IHI, 2016)

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References
De Grood, J., Wallace, J., Friesen, S., White, D., Gilmour, J., & Lemaire, J. (2012). Evaluation of a hands-free communication
device in an acute care setting: A study of healthcare providers perceptions of its performance. The Journal of Computers,
Informatics, Nursing, 30(3), 148-156. doi: 10.1097/NCN.0b013e31823eb62c
Duffield, C., Diers, D., OBrien-Pallas, L., Aisbett, C., Roche, M., King, M., & Aisbett, K. (2011). Nursing staffing, nursing
workload, the work environment, and patient outcomes. Applied Nursing Research, 24, 244-255.
doi:10.1016/j.apnr.2009.12.004
Haxton, D., Doering, J., Gingras, L., & Kelly, L. (2012). Implementing skin-to-skin contact at birth using the iowa model:
Applying evidence to practice. Nursing for Women's Health. doi:10.1111/j.1751-486X.2012.01733.x [doi]
Institute for healthcare Improvement (2016). How to Improve. Retrieved from
http://www.ihi.org/resources/Pages/HowtoImprove/default.aspx
Johnson, J. (2001). Clinical assessment tool. [PDF file]. Retrieved from:
https://d2l.arizona.edu/d2l/le/content/503710/viewContent/4093753/View
Kylor, C. (2016). Implementation of the safety huddle. Critical Care Nurse, 36(6), 80-82. doi:10.4037/ccn2016768

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References (Contd)

Marquis, B.L. & Huston, C.J. (2014) Classical views of leadership and management. Leadership roles and managements functions
in nursing : Theory and application (pp. 32-52). Philadelphia, PA: Lippincott Williams and Wilkins.
OConnell, M. (2016). Nursing: Care delivery models. [PowerPoint slides]. Retrieved from
https://d2l.arizona.edu/d2l/le/content/503710/Home
Piscotty, R. J.,Jr, & Kalisch, B. (2014). The relationship between electronic nursing care reminders and missed nursing care.
doi:10.1097/CIN.0000000000000092 [doi]
Stanford University. (n.d.). Organizational change & stress. Retrieved from
https://cardinalatwork.stanford.edu/faculty-staff-help-center/resources/work-related/organizational-change-stress

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