Improving Interdependence of the

Healthcare Team
Alyssa Brooks, Lauren Grant, Madeline Gunnell,
Kayla Killigrew, Isabel Mosier
December 2nd, 2020
 Overview of Patient Care Delivery System
Saint Joseph’s Hospital – Tucson
● Orthopedic Medical-Surgical/Trauma Unit, a 42-bed unit
○ Tempo
■ Unit RN, charge RN, PT, OT, Case Management, Social
Services, and the Chaplain
● Focus
○ Impaired interdependence of the healthcare team related to impaired
interdisciplinary rounding due to poor communication, impaired
teamwork, and lack of patient involvement.

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 Microsystem Model: Leadership
● Charge nurse role
○ Highly respected by staff
○ Daily stand-up meetings
● Charge nurse uses laissez-faire leadership
○ Indirect leadership
○ Characterized by hands-off approach, little direction, and motivating by
support
● Unit Management
○ Unit Nurse Manager leads through democratic leadership
○ All nurse managers meet weekly to discuss patient safety and improving
outcomes
● Unit Manager and Charge nurses meet as needed to evaluate unit performance
(Marquis & Huston, 2020)
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 Microsystem Model: Organizational Culture
and Support
● “Tempo” held at 1000 and 2200 to discuss patient plan of care
● Clear chain of command to support the nurses
● Nurses allowed to utilize judgement and request other interdisciplinary teams
be involved in the patient care
○ Nurses able to utilize nursing judgement to contact IV team if unable to
start IV successfully or feel a midline may be more appropriate due to the
type of medication the patient is receiving
○ Nurses supported by physicians if requesting verbal orders for PT/OT
eval, wound care consults, etc.

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 Microsystem Model: Patient/Staff Focus of
Healthcare Delivery
● Care is patient-centered
● Ratio 1:5
○ Utilize acuity tools
● Annual corporate compliance
● EKG Strip test (annual)
● ACLS every 2 years

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 Microsystem Model: Interdependence of Care
Team
● Nurses work closely with PCTs, PT/OT, and case management
○ Lack of interdisciplinary support from physicians and
surgeons
● Lack of rounding with providers
● Entitled nurses on unit
● Collaboration between physicians/surgeons and nurses is
dependent on personal relationship

(Johnson, 2001)
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 Microsystem Model: Use of Information and
Healthcare Technology
● Cerner EMR
○ Paper charts for certain orders and discharge paperwork
● Computers in every patient room as well as nurses station
○ 3 workstations on wheels (WOWs)
● Pyxis stations (3)
● Wireless enabled vitals machine
● Voiceras
● Smartpage

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 Microsystem Model: Process for Healthcare
Delivery Improvement Activities
● Aspects regarding patient care are audited (scanning of
medications, patient wristband, line infections, etc.)
○ Audited through patient charts and incident reports
● Requirement of continuing education for all floor nurses
(Annual Corporate Compliance Courses, ACLS every 2 years,
EKG Strip Test)
● If there is at least one patient on telemetry on the unit, a nurse
who is certified in Telemetry must be present on the floor

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 Microsystem Model: Staff Performance
Patterns
● Benchmarks and quality improvements of certain areas (ex.
Falls with injury, CAUTIs, CLABSIs, etc.) are posted on the
whiteboard in the charge office
○ States how long it has been since each event has occurred in
days
● Yearly staff evals from unit nurse manager to unit RNs
● Huddle is held at 1000 and 2200 before each tempo to discuss
areas of needed improvement on the floor and acknowledge
areas of strength on the unit

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 Specific Aspect Targeted for Improvement
Targeted Aspect for Improvement: Interdependence of the Healthcare Team
Proposal: Implementing interdisciplinary rounding at the patient bedside
● Includes entire care team
● Allows patients to feel more comfortable asking physicians and surgeons
questions regarding their plan of care and allows the nurse to be present to
help to advocate for the patient
● Increase unit perspective of teamwork

Supported by evidence-based article “Improving nurse–physician teamwork

through interprofessional bedside rounding”
(Henkin, Chon, Christopherson, Halvorsen, Worden
& Ratelle, 2016) 10
 Integrative Nursing Principle

Integrative Nursing Principle #4

• “Integrative nursing is person-centered and
relationship-based”
• Includes developing staffing and scheduling patterns
that lead to continuity of nurse/patient relationships and
care

(Kreitzer, 2015)
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 Project Timeline
1-2 weeks
Educating interdisciplinary team on importance and evidence of interdisciplinary rounding

Next 4-6 weeks

Workshop simulation, each modality needs to come to at least 2 workshops

Next 1-2 weeks

Unit manager facilitates and oversees effective interdisciplinary rounding

After 6 months
Follow-up survey/check-in for each discipline. Meeting to discuss feedback and adaptation of
intervention for long term success
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 References
Henkin, S., Chon, T. Y., Christopherson, M. L., Halvorsen, A. J., Worden, L. M., Ratelle, J. T.
(2016). Improving nurse-physician teamwork through interprofessional bedside rounding.
Journal of Multidisciplinary Healthcare, 9(201-205). doi: 10.2147/JMDH.S106644

Johnson, J. K. (2001). Clinical Microsystem Assessment Tool. Retrieved from

https://clinicalmicrosystem.org/uploads/documents/microsystem_assessment.pdf

Kreitzer, M. J. (2015). Integrative nursing: Application of principles across clinical settings.

Rambam Maimonides Medical Journal, 6(2). doi: 10.5041/RMMJ.10200

Marquis, B.L. & Huston, C.J. (2020).  Leadership Roles and Management Functions
(10th Edition).  Lippincott Williams and Wilkins.

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