Date of Graduation

Summer 8-7-2018

Document Access

Project/Capstone - Global access

Degree Name

Master of Science in Nursing (MSN)


School of Nursing and Health Professions

First Advisor

Nancy Taquino, DNP, RN, CNL


Problem: Data analysis based on two surveys revealed team communication, interdependence, technology interfaces, and integration as the quality gaps in the Virtual Surveillance Team. When compared with traditional in-person teams, a virtual working team faces different types of communication challenges.

Context: The virtual surveillance team in the regional quality department at Oakland monitors both Advance Alert Monitor (AAM), a statistical model developed by the Kaiser Permanente (KP) Division of Research (DOR) that is used to predict an individual’s likelihood of deterioration, and eHospital care gaps for Kaiser Foundation Hospitals in Northern California (KFH, NCAL). The latest evaluation from DOR of the AAM intervention in the pilot site from August 2016-February 2017 showed mean 35.5 hour reduction in hospital length of stay (LOS), and mean 19.1 hour reduction in Intensive Care Unit (ICU) LOS (Kaiser Permanente, 2017). As a result of the AAM implementation, the KP NCAL region planned to implement AAM intervention in all 21 facilities of KFH. To achieve this goal, the virtual surveillance team which includes the Clinical Nurse Leader (CNL) student has expanded rapidly. Communication failures have been frequently attributed to harmful events in healthcare for nearly two decades (Clarke, 2016). For this reason, better communication strategies, knowledge sharing among the team members, and collaborative technologies are critical for the CNL student’s team, where patient safety is the primary goal.

Interventions: The quality improvement project aims at two interventions with the purpose of streamlining the workflow, and improving communication among the team. One intervention is to create a SharePoint team communication platform. A second is to develop an online training module of the SharePoint site for the team.

Measures: The outcome measures are to improve the percentage of interdependence responses, and the percentage of integration of technology used to support the work of the virtual team. The outcome measures are analyzed through pre, intermediate, and post implementation surveys.

Results: Trust and collaboration among team members increased from 58% to 72%. Integration of information and technology used to support the work of the team increased from 47% to 60%. With the implementation of SharePoint communication platform an increase in staff productivity is expected, due to decrease in time spent at the start of the shift to 15 mins per team member. The cost avoidance accrued through increase in staff productivity is estimated to be $21,040. The long term cost savings attributable to this project through enhanced communication and with AAM implementation is an estimated 4.5 hour mean reduction in hospital length of stay and a 0.9 mean hour reduction in ICU length of stay. This would generate an annual cost savings of $14,160 per facility in 2018 with an estimated annual savings of $142,000 for the healthcare organization. The team effectiveness, and the ease of use of technology is expected to improve once the SharePoint site has been implemented.

Conclusions: The implications for practice are pending based on feedback from team members after using the site. Enhanced team communication with this project implementation is predicted to improve quality outcomes and increase cost savings.