Quality Improvement Project:

Process Improvement
🙠 🙢
Alyson Seall, Courtney Waisath, Himani Sullhan, Jillian Gunderson, & Sonia
Garcia

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Overview of Patient Care Delivery System

❏ Banner University Medical Center

❏ Adult Emergency Department

❏ Focus: Process improvement related to

handoff communication and report

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 Microsystem Model:
Leadership
“Leaders are in the front, moving forward, taking risks, and
challenging the status quo” (Marquis & Huston, 2017, pp. 40)
Examples of Leaders in ED:
❏ Charge Nurse/Nurse Manager ❏ Radio Room
❏ Floats: extra support from ED nurses ❏ Unit Clerk
Servant Leadership:
❏ Emphasis on “we”, promotes collaboration, team work
Leadership influencing care:
❏Increases patient safety
❏Accountability of staff & autonomy of patients
❏Highlight improvements needed & made
Marquis, B. L., & Huston, C. J. (2017). Leadership roles and management functions in nursing: Theory and
application (9th ed. p. 40). Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins.
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 Microsystem Mode
Organizational Culture and Support
� “..expectations, experiences, philosophy, and the values that
hold it together and is expressed in its self-image, inner
workings, interactions with the outside world, and future
expectations” (Marquis & Huston, 2017, pp. 306).
� Banner values: Customer obsessed, relentless improvement,
courageously innovating, disciplined focus, fostering
accountability, continuously earning trust
� Support in the ED:
o SWAT, chaplains, case management, security
o “Huddle” at every shift change

Marquis, B. L., & Huston, C. J. (2017). Leadership roles and management functions in nursing: Theory and application (9th ed. p.
306). Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins.

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 Microsystem Model:
Patient Focus & Staff Focus
Patient focus in the ED: “the nurse’s primary commitment is
to the patient…” (Marquis & Huston, 2017)
❏ Satisfaction surveys
❏ Health education: discharge teaching
❏ Responding to special requests
❏ Establish relationships

Staff focus in the ED:

❏ Continuing education
❏ Shift differentials
❏ Self scheduling
❏ Staff meetings to address any concerns
❏ ED nurses week
Marquis, B. L., & Huston, C. J. (2017). Leadership roles and management functions in nursing: Theory and
application (9th ed. p. 138). Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins. 5
Microsystem Model:
Interdependence of Care Team

“...more than one entity working together to accomplish a

shared goal..” (Huth, Kelly, & VanSell, 2017).

Benefits:
○ mutualism
○ well-rounded team→ better patient outcomes
○ allows care team to be more competent and
resourceful in the care they provide
Examples of interdependence in the ED:
o “Doc Box,” Respiratory, Pharmacy, Tele monitor room
surveillance & communication, Radio room manager

Huth, C., Kelly, B., & VanSell, L. S. (2017). Interdependence: A concept analysis. International
Journal of Nursing & Clinical Practices, 4(225). doi: https://doi.org/10.15344/23944978/2017/225 6
 Microsystem Model:
Use of Information and Healthcare Technology

� Healthcare technology increases patient safety, strengthens

the interaction between patients and healthcare providers,
and decreases medical errors.
Use of healthcare information in the ED:
� Close communication with ICU
� Doc box
Healthcare Technology in the ED:
� Phones/Pages
o wifi would go down and pages wouldn’t go through;
resorted to intercom over entire hospital
� Cerner
Marquis, B. L., & Huston, C. J. (2017). Leadership roles and management functions in nursing: Theory and
application (9th ed. p. 510-511 ). Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins.
OpenMRS. (2016). The Importance of Health Information Technology in Developing Areas. Retrieved from
https://openmrs.org/2017/07/the-importance-of-health-information-technology-in-developing-areas/.
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Microsystem Model:
Process for Healthcare Delivery Improvement

� Purpose of Delivery-Improvement Techniques

� “… to identify inefficiencies, ineffective care, and
preventable errors to then influence changes
associated with systems” (Hughes, 2008, pp. 2).

� Performance & Improvement:

o Evals from nurse managers
o Mandatory quarterly staff meetings

o Mock JCAHO days

Hughes, G. R. (2008). Chapter 44: Tools and strategies for quality improvement and patient safety. In
R.G. Hughes, Patient Safety and Quality: An Evidence-Based Handbook for Nurses. Rockville, MD:
Agency for Healthcare Research and Quality. 8
 Microsystem Model:
Staff Performance Patterns
� “Quality measures are used in an effort to better standardize
its valid, reliable, and evidenced-based data sets” (Marquis
& Huston, 2017, p. 626)
� Quality measures
o Sepsis control compliance

o Stroke protocol compliance

• Time from ED to cath lab

o Falls

o Compliance with scanning meds

� “Report cards” from lab/other units

Marquis, B. L., & Huston, C. J. (2017). Leadership roles and management functions in nursing: Theory and
application (9th ed. p. 626). Philadelphia, PA: Wolters Kluwer Health/Lippincott Williams & Wilkins.
Specific Aspect Targeted for Improvement:
Process Improvement

� Evidence-Based: An estimated 80% of serious medical

errors involve miscommunication during hand-off
between medical providers
� Nurses noted that the implementation of bedside handoff
helped reduce the number of poor patient outcomes
� Nurses found the SBAR handoff method was easy to
use and prevented the loss of patient information

Campbell, D. & Dontje, K. (2019). Implementing bedside handoff in the emergency department: A practice
improvement project. Journal of emergency nursing, 45(2), 149-154. doi:
https://doi.org/10.1016/j.jen.2018.09.007
Johnson, A., Guirguis, E., Grace, Y. (2015). Preventing medication errors in transitions of care: A patient case
approach. Journal of the american pharmacists association, 55(2), 264-276. doi: 10.1331/JAPhA.2015.15509

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Specific Aspect Targeted for Improvement
(continued)

� Proposed intervention: improve bedside handoff in

the Emergency Department with standardized report
sheet
� Bedside report
o Allows nurses to provide accurate information about
patient, treatments or services, and any recent or
anticipated changes
� Standardized report sheet
o Ensures nurses are discussing key points of patient
plan of care and assessment
o Consistency of communication and continuity of
treatment
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 Specific Aspect Targeted for Improvement
(continued)

� Integrative Nursing Principle IV: Integrative

nursing is patient-centered & relationship based
o The modality is a bedside handoff to

incorporate patients and families along with

nurses in the safe transition of care
o This modality fosters a nurse-patient

relationship and builds trust

Campbell, D. & Dontje, K. (2019). Implementing bedside handoff in the emergency

department: A practice improvement project. Journal of emergency nursing, 45(2),
149-154. doi: https://doi.org/10.1016/j.jen.2018.09.007
12
 Leading the Plan for Healthcare Delivery
Improvement

� Plan
o PDSA model, unit leader forms committee,
standardized report sheet is finalized, handouts and
poster created, PowerPoint class is created
� Introduce to staff
o Intervention is introduced to staff, handouts are
given, told deadline to complete education within 3
months
� Start to Implement
o Deadline for all nurses to complete PowerPoint
Education and begin to use in practice
� Fully Integrated & Track Outcomes
o New report process should be fully integrated into
practice within 3 months, begin to look at outcomes

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Timeline of Events

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 References

� Campbell, D. & Dontje, K. (2019). Implementing bedside handoff in the

emergency department: A practice improvement project. Journal of
Emergency Nursing, 45(2), 149-154. doi:
https://doi.org/10.1016/j.jen.2018.09.007
� Johnson, A., Guirguis, E., & Grace, Y. (2015). Preventing medication errors in
transitions of care: A patient case approach. Journal of the American
Pharmacists Association, 55(2), 264-276. doi: 10.1331/JAPhA.2015.15509
� Hughes, G. R. (2008). Tools and strategies for quality improvement and patient
safety. In R.G. Hughes, Patient Safety and Quality: An Evidence-Based
Handbook for Nurses. Rockville, MD: Agency for Healthcare Research and
Quality.
� Huth, C., Kelly, B., & VanSell, L. S. (2017). Interdependence: A concept analysis.
International Journal of Nursing & Clinical Practices, 4(225). doi:
https://doi.org/10.15344/23944978/2017/225
� Marquis, B. L., & Huston, C. J. (2017). Leadership roles and management
functions in nursing: Theory and application (9th ed. p. 40). Philadelphia, PA:
Wolters Kluwer Health/Lippincott Williams & Wilkins.

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References

� Marquis, B. L., & Huston, C. J. (2017). Leadership roles and management

functions in nursing: Theory and application (9th ed. p. 138).
Philadelphia, PA: Wolters Kluwer Health/Lippincott Williams &
Wilkins.
� Marquis, B. L., & Huston, C. J. (2017). Leadership roles and management
functions in nursing: Theory and application (9th ed. p. 306).
Philadelphia, PA: Wolters Kluwer Health/Lippincott Williams & Wilkins.
� Marquis, B. L., & Huston, C. J. (2015). Leadership roles and management
functions in nursing: Theory and application (9th ed. p. 510-511).
Philadelphia, PA: Wolters Kluwer Health/Lippincott Williams & Wilkins.
� Marquis, B. L., & Huston, C. J. (2017). Leadership roles and management
functions in nursing: Theory and application (9th ed. p. 626).
Philadelphia, PA: Wolters Kluwer Health/Lippincott Williams & Wilkins.
� OpenMRS. (2016). The Importance of Health Information Technology in
Developing Areas. Retrieved from https://openmrs.org/2017/07/the-
importance-of-health-information-technology-in-developing-areas/.
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