Qip Slides

12/6/2015
Reference: (Marquis & Huston, 2015, p. 271)
o Strong control
o Decision making at the top/ I and you status

o Motivates others by coercion
o Criticism is punitive
Authority-Power Gap
o The gap that sometimes exists between a position of
authority and subordinate response. Right to

command does not ensure that employees will follow
orders. Organizational chaos may develop.
Reference: (Marquis & Huston, 2015, p. 288-292)
Patient
Focus
Reference: (W. Larson, October 21, 2015)
Reference: (Marquis & Huston, 2015, p. 274)
Interdisciplinary Care Approach in the ED:

with team members and patients
o This involvement is essential in providing
patient-centered care (Godfrey et al., 2003)
o Most effective approach in emergency
situations
Clear outline of responsibilities
Ensures more timely care
No Pass Approach
o All are working towards providing patient
centered care and are making progress

toward more effectively and consistently
learning about patient needs.
Staff Focus
o A majority of the staff feel like a valued
member of the microsystem but they dont
feel the microsystem is doing all that it could
to support education and training of staff,
workload, and professional growth
According to staff nurse (personal communication,

October 21, 2015) the staff in the microsystem feel
that the organization is inconsistent and unpredictable
in providing the recognition, information, and
resources needed to enhance their work.
A microsystems culture is based on shared
attitudes, beliefs, customs, and written and unwritten
rules that have been developed over time and are
considered valid
In means of building a support system, the
employees have developed different subcultures
Authoritarian Leadership
o Communication flows downward
Microsystem Model: Matrix

Organization
o Focus: product & function
o Formal vertical &
horizontal chain of
command
o Fewer formal rules &
fewer levels of the
hierarchy
o Possibility for slow
decision making
o Can produce confusion &
frustration for workers
Interdependent
12/6/2015
Purpose: Everyone gets the right information at the

right time to do his or her work, connects staff to
patients and staff to staff (Nelson et al., 2002)
Access to information and information technology to
support staff
o Ascom phones to communicate with all staff
o UpToDate and other resources in electronic
charts
Not all staff or patients utilize information technology
available - lack of education and/or too busy to
use.
New
management is introducing the

standardized way of how their other campus
emergency department operates, therefore the
department is undergoing many improvement
projects. In response to this, the staff is
experiencing change fatigue. Institute of
Healthcare Improvement ([IHI], 2015a) reaffirms
the importance of staff opinion.
o How is improvement currently being handled?
o New management improvement as compared
to IHI strategy.
It is critical to be able to quickly and correctly triage

patients in the Emergency Department and then
immediately initiate appropriate treatment. We asked
our preceptors the following questions in order to
guide us in our decision-making.
o What is missing from current triage process?
o What knowledge are you lacking that is hindering
your ability to deliver the best care possible?
There
are various standards to measure

performance patterns of the department
including: Left without being seen, wait times,
throughput times, and meeting timed criteria of
various protocols.
o Plan-Do-Study-Act as reported in IHI (2015b)
o Increased resistance to change
o Linking would be helpful to this department
Burns Best Practice
Most nurses expressed lack of confidence while caring

for severely burned patients
Process Improvement - better prepared and more

comfortable and confident treating patients with
burns
10
Godfrey, M. M., Nelson, E. C., Wasson, J. H., Mohr, J. J., Batalden, P. B. (2003).
Microsystems in health care: Part 3. planning patient-centered services. Joint
Commission Journal on Quality and Safety, 29, 159-70. Retrieved from
https://d2l.arizona.edu/d2l/le/content/434224/viewContent/3597333/View
Institute For Healthcare Improvement. (2015a). How to improve. Retrieved
from http://www.ihi.org/resources/Pages/HowtoImprove/default.aspx
Institute For Healthcare Improvement. (2015b). Science of improvement: Linking tests of
change. Retrieved from
http://www.ihi.org/resources/Pages/HowtoImprove/ScienceofImprovementLinki
ngTestsofChange.aspx
Marquis, B.L. & Huston, C.J. (2015). Leadership roles and management functions in
nursing: Theory and application. Philadelphia, PA: Wolters Kluwer Health/
Lippincott Williams & Wilkins.
Nelson et al. (2002). Microsystems in healthcare: Part 1. learning from high performing
frontline clinical units. Joint Commission Journal on Quality Improvement,
28 (9). 472-493. Retrieved from
https://d2l.arizona.edu/d2l/le/content/434224/viewContent/3597299/View
Poster
presentation
during morning huddle
Poster to remain in
centralized location after
Yearly competency
11
12
12/6/2015
Marquis, B.L. & Huston, C.J. (2015). Leadership roles and

management functions in nursing: Theory and
application. Philadelphia, PA: Wolters Kluwer Health/
Lippincott Williams & Wilkins.
Nelson et al. (2002). Microsystems in healthcare: Part 1.
learning from high performing frontline clinical units.
Joint Commission Journal on Quality Improvement,
28 (9). 472-493. Retrieved from
https://d2l.arizona.edu/d2l/le/content/434224/viewCo
ntent/3597299/View
13
Questions?
14

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12/6/2015

Reference: (Marquis & Huston, 2015, p. 271)

o Decision making at the top/ I and you status

o The gap that sometimes exists between a position of

authority and subordinate response. Right to

Reference: (Marquis & Huston, 2015, p. 288-292)

Reference: (W. Larson, October 21, 2015)

Reference: (Marquis & Huston, 2015, p. 274)

Interdisciplinary Care Approach in the ED:

o All are working towards providing patient

centered care and are making progress

According to staff nurse (personal communication,

Microsystem Model: Matrix

Purpose: Everyone gets the right information at the

management is introducing the

It is critical to be able to quickly and correctly triage

are various standards to measure

Burns Best Practice

Most nurses expressed lack of confidence while caring

Process Improvement - better prepared and more

Marquis, B.L. & Huston, C.J. (2015). Leadership roles and

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