5/1/2016

Overview of Patient Care Delivery System

Unit: Medical Surgical / Orthopedic

Healthcare Delivery
Systems Improvement Project:
Patient Focus

Focus: Patient focus related to nurse-to-patient ratio

Our Question: "When the nurse-to-patient ratio is 1:7,

is the patient focus limited?

Microsystem Model:
Leadership

Microsystem Mode
Organizational Culture and Support

Effective leaders know that there is no one best

leadership style. Instead, they adapt their leadership
style to the needs of the situation (Marquis and Huston,
2014).

ICARE (Integrity, Commitment, Advocacy, Respect,

and Excellence)

Nurse Manager: both Authoritarian and Democratic

leadership

Educational support
Nurses support each other in completing duties

RN feedback is valued

Protection from the unions

Certain interventions are enforced with no exceptions

Marquis, B.L. & Huston, C.J. (2014). Leadership roles and management functions in nursing: Theory and application (8th Edition). Lippincott
Williams and Wilkins. ISBN Number: 13: 978-1-4511-9281-0.

Nurses encouraged to voice their concern

Microsystem Model:
Patient Focus & Staff Focus

Institute for Healthcare Improvement.(2016). 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. 274-276). Philadelphia, PA: Wolter Kluwer Health.

Microsystem Model:
Interdependence of Care Team

Patient Focus:
o Patient centered care is not wasting patients time, offering
easy access to care, and meeting patients needs for
information, education, and preventive care.
o Delivered by engaged, collaborative teams in an integrated
environment that supports learning, discovery, and
continuous improvement.
Staff Focus:
o Continuing education courses
o Career development
o Safety of staff (no lifting more than 40 pounds)
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Effective collaboration and teamwork among the

interdisciplinary team
The interdisciplinary team consists of physicians, charge
nurse, nurse manager, clinical nurse lead, nurses, and
nursing assistants.
Excellent communication between team members
Team structure and collaboration benefits:
o Positive environment
o Higher quality interactions
o Emphasizes patient centered care
Weinberg, D. B., Cooney-Miner, D., Perloff, J. N., Babington, L., & Avgar, A. C. (2011). Building collaborative capacity: Promoting
interdisciplinary teamwork in the absence of formal teams. Medical Care, 49, 716-723. doi: 10.1097/MLR.0b013e318215da3f

5/1/2016

Microsystem Model:
Use of Information and Healthcare Technology

Microsystem Model:
Process for Healthcare Delivery Improvement

One of the first hospitals to move towards complete electronic

charting
o HIT - staff
CPRS- documentation
BCMA- medication administration

Benchmarking is the process of comparing a practices

performance with an external standard (Agency for
Healthcare Research and Quality, 2016).

Improvement project implemented: Yellow Fall Blanket

o Benchmark
o Quality gap

o My HealtheVet - patient

o Resistance

Issues:
o Double charting
o Lack of computers in every room
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Agency for Healthcare Research and Quality., (2016). Practice Facilitation Handbook. Retrieved from
http://www.ahrq.gov/professionals/prevention-chronic-care/improve/system/pfhandbook/mod7.html
M. Neuss and M. Daly, personal communication, April 18, 2016

Microsystem Model:
Staff Performance Patterns

Specific Aspect Targeted for Improvement

Staff performance models should meet the goals of the

population health focused model and ensure all eligible
veterans have access to high quality, timely care.

Unbalanced nurse-to-patient ratio of 1:7 on MedSurg

floor
Staff Shortage
Studies/literature states:
o Increased mortality and poor outcomes
o Increased length of stay and wait times
o Decreased staff satisfaction and increased burnout

Staff quality improvement measures:

o Yearly performance evaluations
o Monthly peer evaluations - Daisy award
o Staff accepts feedback to improve care based on
evaluations

G
oal: Find an optimal nurse-to-patient ratio in order to
improve care and staff satisfaction.

Patient outcomes are frequently measured.

McGahan, M., Kucharski, G., & Coyer, F. (2012). Nurse staffing levels and the incidence of mortality and morbidity in the adult intensive care
unit: A literature review. Australian Critical Care, 25(2), 64-77. doi:10.1016/j.aucc.2012.03.00
Patterson, J. (2011). The effects of nurse to patient ratios. Nurs Times, 107(2), 22-25. Retrieved from
http://www.ncbi.nlm.nih.gov/pubmed/21366010
Petrucci, C., Calandro, M. T., Lancia, L., Tresulti, F., & Baldacchini, A. (2015). Relationship between nurse staffing and nursing outcomes: a

TIPS Newsletters published quarterly

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Specific Aspect Targeted for Improvement

(cont.)

narrative review of literature. Prof Inferm, 68(4), 195-202. doi:10.1037/e556872006-028

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Leading the Plan for Healthcare Delivery

Improvement

Arizona Nurses Association (2016) mandate that RN in Arizona

hospitals:
1:2 ratio for ICU
Other nurse staffing requirements based on an individual
patient's acuity

Nurse Reinvestment Act

Year and half timeline
o Management: hospital policy changes to determine
minimum nurse-to-patient ratio
o Better nurse staffing
Retain nurses

Nurses feel more comfortable of 1:5 ratio

Prevent over fatigue

Positive impact when adequate nurse patient ratio

Improve recruitment
Stanton, M. W. (2004, March). Hospital Nurse Staffing and Quality of Care: AHRQ Archive. Retrieved

AznA, AZHHA, AzONE Joint Statement on National Nurse Staffing Ratios. (2016). Arizona Nurses Association. Retrieved from
http://www.aznurse.org/page/AV01/Advocacy-AzNA-AzONE-AzHHA-Joint-Statement.htm
Cho, S., Kim, Y., Yeon, K. N., You, S., & Lee, I. D. (2015). Effects of increasing nurse staffing on missed nursing
care. International Nursing Review, 62(2), 267-274. doi:10.1111/inr.12173

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from http://archive.ahrq.gov/research/findings/factsheets/services/nursestaffing/nursestaff.html

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5/1/2016

Leading the Plan for Healthcare Delivery

Improvement (cont.)

References

Timeline

Agency for Healthcare Research and Quality. (2016). Practice Facilitation Handbook. Retrieved from

American Nurses Association. (2016). Nurse Reinvestment Act Background. Retrieved from

AznA, AZHHA, AzONE Joint Statement on National Nurse Staffing Ratios. (2016). Arizona Nurses Association.
Retrieved from http://www.aznurse.org/page/AV01/Advocacy-AzNA-AzONE-AzHHA-Joint-Statement.htm

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.
doi:10.1097/MLR.0b013e318202e129

Cho, S., Kim, Y., Yeon, K. N., You, S., & Lee, I. D. (2015). Effects of increasing nurse staffing on missed nursing
care. International Nursing Review, 62(2), 267-274. doi:10.1111/inr.12173

Duffield, C., Diers, D., O'Brien-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(4), 244-255.
doi:10.1016/j.apnr.2009.12.004

Liang, Y. W., Chen, W. Y., Lee, J. L., & Huang, L. C. (2012). Nurse staffing, direct nursing care hours and patient
mortality in Taiwan: the longitudinal analysis of hospital nurse staffing and patient outcome study. BMC
Health Serv Res, 12(44). doi:10.1186/1472-6963-12-44

Marquis, B.L. & Huston, C.J. (2014). Leadership roles and management functions in nursing: Theory and
application (8th Edition). Lippincott Williams and Wilkins. ISBN Number: 13: 978-1-4511-9281-0

http://www.ahrq.gov/professionals/prevention-chronic-care/improve/system/pfhandbook/mod7.html

http://www.nursingworld.org/NurseReinvestmentAct.aspx

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References

McGahan, M., Kucharski, G., & Coyer, F. (2012). Nurse staffing levels and the incidence of mortality and morbidity

Patterson, J. (2011). The effects of nurse to patient ratios. Nurs Times, 107(2), 22-25. Retrieved from

Petrucci, C., Calandro, M. T., Lancia, L., Tresulti, F., & Baldacchini, A. (2015). Relationship between nurse staffing

in the adult intensive care unit: A literature review. Australian Critical Care, 25(2), 64-77.
doi:10.1016/j.aucc.2012.03.003
http://www.ncbi.nlm.nih.gov/pubmed/21366010

and nursing outcomes: a narrative review of literature. Prof Inferm, 68(4), 195-202.
doi:10.1037/e556872006-028

Stanton, M. W. (2004, March). Hospital Nurse Staffing and Quality of Care: AHRQ Archive. Retrieved from

Weinberg, D. B., Cooney-Miner, D., Perloff, J. N., Babington, L., & Avgar, A. C. (2011). Building collaborative
capacity: Promoting interdisciplinary teamwork in the absence of formal teams. Medical Care, 49, 716723. doi: 10.1097/MLR.0b013e318215da3f

http://archive.ahrq.gov/research/findings/factsheets/services/nursestaffing/nursestaff.html

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