Healthcare Delivery SystemsImprovement Project Stefany Barriga, Sara Dacquisto, Chelsey Earnhart, Suzanna Jeffries, Marissa Lizarraga December 2, 2015 1 Overview of Patient Care Delivery System Hospital Unit Focus: Performance Patterns related to Nurse-Patient Ratio 2 Microsystem Model: Leadership “Leaders struggle to find the right balance between reaching performance goals and supporting and empowering the staff.” Authoritarian leadership Centralized RN feedback not valued 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. 3 Microsystem Model: Organizational Culture and Support “Inconsistent and unpredictable in providing recognition, information, and resources needed to enhance the nurse’s work” Fear of communication with organizational leaders Limited information sharing amongst levels of hierarchy Limited fiscal and human resources to support change Marquis, B.L., & Huston, C.J. (2015c). Leadership roles and management functions in nursing theory and application (8th ed., pp. 260-286). Philadelphia, PA: Wolters Kluwer health/ Lippincott Williams & Wilkins. 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 Provide care “that is respectful of and responsive to individual patient preferences, needs, and values, and ensuring that patient values guide all clinical decisions” o Patient Centered Care - Nurses, Patient Ambassadors Staff Focus o An organization “...is responsible in part for the growth in staff development programs.” o Continuing Education - Unit Specific Marquis, B.L., & Huston, C.J. (2015). Leadership roles and management functions in nursing theory and application (8th ed., pp. 366). Philadelphia, PA: Wolters Kluwer health/ Lippincott Williams & Wilkins. Warren, N. (2012). Involving patient and family advisors in the patient and family-centered care model. MEDSURG Nursing, 21(4), 233-239. 5 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” Unit team provides effective interdisciplinary teamwork o Medics, Nurses, and Doctors Youngwerth, J., & Twaddle, M. (2011). Cultures of interdisciplinary teams: How to foster good dynamics. Journal of palliative medicine, 14(5), 650-654. doi: 10.1089/jpm.2010.0395 Institute for Healthcare Improvement.(2015). Clinical microsystem assessment tool. Retrieved from http://www.ihi.org/resources/pages/tools/clinicalmicrosystemassessmenttool.aspx 6 Microsystem Model: Use of Information and Healthcare Technology “Patients have access to standard information that is available to all patients- we’ve 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. 7 Microsystem Model: Process for Healthcare Delivery Improvement “Benchmarking is the process of measuring products, practices, and services against best-performing organizations.” Improvement projects implemented o Not taken seriously Marquis, B.L., & Huston, C.J. (2015). Leadership roles and management functions in nursing theory and application (8th ed., pp. 547). Philadelphia, PA: Wolters Kluwer health/Lippincott Williams & Wilkins. 8 Microsystem Model: Staff Performance Patterns We often collect data on the outcomes of the care we provide and on some processes of care. Research indicates that patient safety is linked to nurse staffing. Lower patient-nurse ratio markedly improves patient outcomes in a good work environment Safe staffing is linked to lower rates of readmission because RNs are able to spend more time on patient education Blegen, M. A., Goode, C. J., Spetz, J., Vaughn, T., & Park, S. H. (2011). Nurse Staffing effects on patient outcomes: Safety-net and Non-safety-net hospitals. Medical Care, 49(4), 406-414. Twigg, D., Duffield, C., Thompson, P. L., & Rapley, P. (2010). The impact of nurses on patient morbidity and mortality - the need for a policy change in response to the nursing shortage. Australian Health Review, 34(3), 312-316. 9 Specific Aspect Targeted for Improvement Large corporation bought out Hospital Budget cuts: Staffing and Increased nurse-patient ratio Studies found o Increased length of stay and wait times o Increased mortality rates and unit related complications Goal: Decrease adverse patient outcomes and mortality Blegen, M. A., Goode, C. J., Spetz, J., Vaughn, T., & Park, S. H. (2011). Nurse Staffing effects on patient outcomes: Safety-net and Non-safety-net hospitals. Medical Care, 49(4), 406-414. Chan, T. C., Killeen, J. P., Vilke, G. M., Marshall, J. B., & Castillo, E. M. (2010). Effect of mandated nurse– patient ratios on patient wait time and care time in the emergency department. Academic Emergency Medicine, 17(5), 545-552. Shekelle, P. G. (2013). Nurse-patient ratios as a patient safety strategy. Annals of Internal Medicine, 158(5), 404-410. Twigg, D., Duffield, C., Thompson, P. L., & Rapley, P. (2010). The impact of nurses on patient morbidity and 10 mortality - the need for a policy change in response to the nursing shortage. Australian Health Leading the Plan for Healthcare Delivery Improvement National Safe Patient Ratio Bills Literature: increased RN staffing is cost-effective. But, low recognition among organizational leaders of RNs’ impact on patient safety Two year timeline Morale 3-5 mo Education 6-12mo Hiring 12mo Eval 18mo House-wide 24mo National Nurses United (2015). National campaign for safe RN-to-patient staffing ratios. Retrieved from http://www.nationalnursesunited.org/issues/entry/ratios Marquis, B.L., & Huston, C.J. (2015a), Leadership roles and management functions in nursing theory and application (8th ed., p. 8). Philadelphia, PA: Wolters Kluwer health/ Lippincott Williams & Wilkins. Twigg, D., Duffield, C., Thompson, P. L., & Rapley, P. (2010). The impact of nurses on patient morbidity and mortality - the need for a policy change in response to the nursing shortage. Australian Health Review, 34(3), 312-316. 11 References Blegen, M. A., Goode, C. J., Spetz, J., Vaughn, T., & Park, S. H. (2011). Nurse staffing effects on patient outcomes: Safety-net and non-safety-net hospitals. Medical Care, 49(4), 406-414. Chan, T. C., Killeen, J. P., Vilke, G. M., Marshall, J. B., & Castillo, E. M. (2010). Effect of mandated nurse–patient ratios on patient wait time and care time in the emergency department. Academic Emergency Medicine, 17(5), 545-552. 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. 8, pp. 40-41, pp. 260-286, pp. 366, pp. 452-456, pp. 547). Philadelphia, PA: Wolters Kluwer health/Lippincott Williams & Wilkins. 12 References National Nurses United (2015). National campaign for safe RN-to-patient staffing ratios. Retrieved from http://www.nationalnursesunited.org/issues/entry/ratio Shekelle, P. G. (2013). Nurse-patient ratios as a patient safety strategy. Annals of Internal Medicine, 158(5), 404-410. Twigg, D., Duffield, C., Thompson, P. L., & Rapley, P. (2010). The impact of nurses on patient morbidity and mortality - the need for a policy change in response to the nursing shortage. Australian Health Review, 34(3), 312-316. Warren, N. (2012). Involving patient and family advisors in the patient and family-centered care model. MEDSURG Nursing, 21(4), 233-239. Youngwerth, J., & Twaddle, M. (2011). Cultures of interdisciplinary teams: How to foster good dynamics. Journal of palliative medicine, 14(5), 650-654. doi: 10.1089/jpm.2010.0395 13