Knowledge of the Healthcare Environment Project The purpose of this project is to integrate knowledge of quality improvement, motivation, collaboration, team building, communication, leadership, managing outcomes, problem-solving, and business planning into a plan to address the problem. The student learning outcomes of the communication and relationship building project include: Implement an appropriate decision-making model Develop a plan to address barriers to planning, as well as actions the leader-manager can take to reduce or eliminate these barriers Assess concepts of line and staff relationships, span of control, span of influence, and unity of command to create an effective plan to resolve the problem Use an evidence-based approach in determining problem solutions Consider internal and external climates, upward and downward, horizontal and diagonal, and grapevine communication strategies Integrate concepts of quality control  and quality improvement in the analysis of the problem and the development of solutions to the problem Scenario You are the manager of a 36-bed orthopedic unit. The average age on your nursing unit is 76.  A high percentage of patients on the unit are postoperative total hip replacement related to hip fracture secondary to fall.  The average length of stay is 6.5 days before transfer to a rehabilitation level of service. Since 2003, the average length of stay has decreased by 49%.  Since 2010, the postoperative complication of urinary tract infection has declined by 28%. Since 2009, the use of catheters greater than 48 hours post-op has decreased by 45%. However, circumstances have changed in the past five months.  There is a significant increase in postoperative nosocomial urinary tract infections which are defined as the presence of >105 organisms/mL or symptomatic infection with 103 organisms/mL  Recent data on postoperative hip replacement patients reflects: Month Baseline 1 2 3 4 5 Admitted From Nursing Facility 6.1% 7.9% 3.3% 3.0% 4.5% 3.7% Mean Length of Stay 6.5 days 7.0 days 7.0 days 10.25 days 10.5 days 11.5 days Percentage Nosocomial Post Op UTI 3% 6.8% 15.8 19.6 20.5 23.1 Percentage Post-Operative Catheters Indwelling for > 48 Hours. 3.6% 10% 22% 32% 46% 45.1% Mean Nosocomial UTI Cost excess per patient $3652.17 $3652.17 $9,130,43 $9739.13 $12,173 The patient population has been stable in terms of co-existing disease, reasons for admission, and types of surgery. The orthopedic medical staff have remained constant. The reasons justifying urinary catheterization by percentages during the four-month period were: Documented Reason  Percentage out of 100% Urinary retention 17% Bladder outlet obstruction 3% History of paralysis or stroke 12% Neurogenic bladder 3% Multiple sclerosis 1% Prostate disease 23% Obesity 4% Unknown, not documented 37% The unit is staffed with 80% full time, 10% part-time, and 10% hospital float pool in order ...

1. Knowledge of the Healthcare Environment Project
The purpose of this project is to integrate knowledge of quality
improvement, motivation, collaboration, team building,
communication, leadership, managing outcomes, problem-
solving, and business planning into a plan to address the
problem.
The student learning outcomes of the communication and
relationship building project include:
Implement an appropriate decision-making model
Develop a plan to address barriers to planning, as well as
actions the leader-manager can take to reduce or eliminate these
barriers
Assess concepts of line and staff relationships, span of control,
span of influence, and unity of command to create an effective
plan to resolve the problem
Use an evidence-based approach in determining problem
solutions
Consider internal and external climates, upward and downward,
horizontal and diagonal, and grapevine communication
strategies
Integrate concepts of quality control and quality improvement
in the analysis of the problem and the development of solutions
to the problem
Scenario

2. You are the manager of a 36-bed orthopedic unit. The average
age on your nursing unit is 76. A high percentage of patients on
the unit are postoperative total hip replacement related to hip
fracture secondary to fall. The average length of stay is 6.5
days before transfer to a rehabilitation level of service. Since
2003, the average length of stay has decreased by 49%. Since
2010, the postoperative complication of urinary tract infection
has declined by 28%. Since 2009, the use of catheters greater
than 48 hours post-op has decreased by 45%. However,
circumstances have changed in the past five months. There is a
significant increase in postoperative nosocomial urinary tract
infections which are defined as the presence of >105
organisms/mL or symptomatic infection with 103
organisms/mL Recent data on postoperative hip replacement
patients reflects:
Month
Baseline
1
2
3
4
5
Admitted From Nursing Facility
6.1%
7.9%

3. 3.3%
3.0%
4.5%
3.7%
Mean Length of Stay
6.5 days
7.0 days
7.0 days
10.25 days
10.5 days
11.5 days
Percentage Nosocomial Post Op UTI
3%
6.8%
15.8
19.6
20.5
23.1

4. Percentage Post-Operative Catheters Indwelling for > 48 Hours.
3.6%
10%
22%
32%
46%
45.1%
Mean Nosocomial UTI Cost excess per patient
$3652.17
$3652.17
$9,130,43
$9739.13
$12,173
The patient population has been stable in terms of co-existing
disease, reasons for admission, and types of surgery. The
orthopedic medical staff have remained constant.
The reasons justifying urinary catheterization by percentages
during the four-month period were:
Documented Reason

5. Percentage out of 100%
Urinary retention
17%
Bladder outlet obstruction
3%
History of paralysis or stroke
12%
Neurogenic bladder
3%
Multiple sclerosis
1%
Prostate disease
23%
Obesity
4%
Unknown, not documented
37%
The unit is staffed with 80% full time, 10% part-time, and 10%
hospital float pool in order to keep overtime within benchmark

6. levels. Over the five months, the monthly mean hours per
patient day by all nursing staff was between 15.86 hours and
17.39, and the monthly mean RN hours per patient day is 14.89
and 16.39 hours. A typical 7 am to 7 pm shift is staffed with 5
to 6.5 RNs and 2 nursing assistants. A typical 7 pm to 7 am
shift 4 to 5 RNs and 2 nursing assistants. There are two newly
graduated nurses that have completed a three-month orientation
as part of the full-time staff.
On any given weekday, there are between 6-8 associate degree,
baccalaureate degree, and nursing assistant students. The
registered nurse students are supervised by an instructor and are
assigned to direct patient care in tandem with the registered
nurse. The nursing assistant students are assigned to work with
an employed nursing assistant.
Assignment
Prepare a 1200-2000 word plan to present to the Infection
Control Committee. The Infection Control Committee is
comprised of the Medical Director, the four infectious disease
specialists, the hospital’s Infection Control nurse, the various
Directors of Nursing, and the two hospital’s pathologists. The
order of the paper should be a title page, the plan, and
references. The plan should be evidence-based. The textbook
should be one reference. Include a
minimum
of three additional references from the literature. Use APA
format. Refer to the BSN Handbook and to the course syllabus
to identify the acceptable sources for references. The rubric can
be viewed in Introduction to Written Assignments.
Include in the plan the following components:
Identification of the problem

7. Explanation of the problem
Impact of the problem on the interpersonal roles and decisional
roles of management
Solution
alternatives, including the pros, cons, and potential
consequences/outcomes
Selected approaches and the implementation plan
Quality control and quality improvement activities
Integrate into the body of the paper the following elements:
Rationales for problem resolution strategies
Leadership role/s and a leadership style appropriate to the
situation and the rationale

8. Effective strategies to facilitate team building as an outcome of
effective collaboration
When you are ready to submit your assignment, you will attach
your assignment as one single document including the reference
page by submitting your assignment below under Submit.
You are encouraged to use Smart Thinking as a resource for
review of your paper. All scholarly papers will be run through
Canvas to Turnitin and a Similarity report will be produced.
Please review your Similarity report after the first submission.
If you wish, you will be able to make corrections and resubmit
no more than two additional times up until the due date and
time.