Healthcare Delivery Systems

Improvement Project

Improving Interdependence of Banner Cardiac

ICU Healthcare Team
Leyla Eskenazi, Yael Eskanazi, Emily Healy, Marissa Jones, & Natali Knight

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Overview of Patient Care Delivery System

Banner Hospital
CardiacICU Department
Focus: How Banner health professionals communicate
and collaborate together to deliver safe patient care

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Microsystem Model:
Leadership
The art of communication is the language of
leadership.
Democratic leadership
Distributive power
RN holds most of autonomy in decision making

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.
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 Microsystem Model:
Organizational Culture and Support

The larger organization is inconsistent and unpredictable in

providing the recognition, information and resources needed
to enhance [nurses] work.
Organizational support for professional nursing proficiency
and autonomy is inconsistent
Clear communication and support from charge RNs
Informational resources available: Micromedex, UptoDate,
clinical decision tools in EHR
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 Nurses are effective in learning about and meeting patient
needs caring, listening, educating, and responding to
special requests
Staff Focus
o Health-care science and technology change so rapidly that
without adequate teaching--learning skills and educational
services, organizations will be left behind.
Marquis, B.L., & Huston, C.J. (2015). Leadership roles and management functions in nursing theory and application (8th ed., pp. 383). Philadelphia,
PA: Wolters Kluwer health/ Lippincott Williams & Wilkins.
Institute for Healthcare Improvement.(2015). Clinical microsystem assessment tool. Retrieved from 5
 Microsystem Model:
Interdependence of Care Team
The care approach is interdisciplinary, but we are not
always able to work together as an effective team
The medical team often makes decisions that are not
communicated effectively or promptly to the nurses
Different medical teams often do not communicate
with each other, leading to confusion among the team
and delayed treatment
Institute for Healthcare Improvement.(2015). Clinical microsystem assessment tool. Retrieved from
http://www.ihi.org/resources/pages/tools/clinicalmicrosystemassessmenttool.aspx
Nancarrow, S. A., Booth, A., Ariss, S., Smith, T., Enderby, P., & Roots, A. (2013). Ten principles of good interdisciplinary team
work. Human Resources for Health, 11, 19. doi: 10.1186/1478-491-11-19

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 Microsystem Model:
Use of Information and Healthcare Technology
Patients have access to standard information that is
available to all patients- weve started to think about how to
improve the information they are given to better meet their
needs
Technology facilitates a smooth linkage between
information and patient care by providing timely, effective
access to a rich information environment-the information
environment has been designed to support the work of the
clinical unit.
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.
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 Microsystem Model:
Process for Healthcare Delivery Improvement
Outcome Audits: outcomes reflect the end result of care
or how the patients health status changed as a result of
an intervention.
There are ample resources to support continual
improvement work. Studying, measuring and improving
care in a scientific way are essential parts of our daily
work
Banner has organizational-wide quality improvement
committees which nurses are encouraged to be a part of
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 theory and application (8th ed., pp. 524). Philadelphia, PA:
Wolters Kluwer health/Lippincott Williams & Wilkins.
8
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.
Banner has created evidence based protocols and care
bundle checklists to increase quality control
Nursing staff has a culture of teamwork, however, this
does not always carry through with interprofessional
relationships
Institute for Healthcare Improvement.(2015). Clinical microsystem assessment tool. Retrieved from
http://www.ihi.org/resources/pages/tools/clinicalmicrosystemassessmenttool.aspx
9
Specific Aspect Targeted for Improvement

Interdependence in the Cardiac ICU needs improvement

Teamwork between nurses and physicians and between
different medical teams is poor
-poor communication/poor conflict resolution
According to the World Health Organization (2012),
effective health care teams improve care coordination,
health outcomes, and quality of care and reduce errors.
Effective teams also improve job satisfaction.
World Health Organization. (2012). Patient safety. Retrieved from
http://www.who.int/patientsafety/education/curriculum/course4_handout.pdf
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Leading the Plan for Healthcare Delivery
Improvement
Implement daily multidisciplinary rounds
Effective multidisciplinary rounds provide a formal
mechanism for: Coordinating care among disciplines,
reviewing current patient status,clarifying patient goals
and desired outcomes, and creating a comprehensive
plan of care
Morale Education Implementation Eval Organization
2 weeks 1 month 3 months daily/at 4 months 5 months
Institute for Healthcare Improvement. (2015). How-to Guide: Multidisciplinary rounds. Retrieved from
IHIHowtoGuideMultidisciplinaryRounds.pdf
 References
Banner Health (2017). Our non-profit mission. Retrieved from https://www.bannerhealth.com/about/mission

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

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

Institute for Healthcare Improvement. (2015b). How-to Guide: Multidisciplinary rounds. Retrieved from

IHIHowtoGuideMultidisciplinaryRounds.pdf

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

application (8th ed., pp. 8, pp. 40-41, p. 120, p. 446, pp. 452-456, p. 524). Philadelphia, PA: Wolters Kluwer

health/Lippincott Williams & Wilkins.

Nancarrow, S. A., Booth, A., Ariss, S., Smith, T., Enderby, P., & Roots, A. (2013). Ten principles of good

interdisciplinary team work. Human Resources for Health, 11, 19. doi: 10.1186/1478-491-11-9
References

Peters, B. (2013). The success characteristics of clinical microsystem teams

World Health Organization. (2012). Patient safety. Retrieved from

http://www.who.int/patientsafety/education/curriculum/course4_handout.pdf

Zweig, M. (2015). Hear from Banner Health leaders on achieving system-wide clinical standardization.

Retrieved from

https://www.advisory.com/research/physician-executive-council/prescription-for-change/2015/02/bann

er-videos.

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