Purposeful Rounding Presented by April Fairey Why? We rely on all of our team members to be mission critical in creating patient centered excellence… But… how do we validate that they meet patient and internal customer expectations on their terms? Four Types of Rounding Hourly Rounding for Patient Centered Excellence Patient Centered Communication Leaders Rounding on Patients HCAHPS Key Drivers Willingness to Recommend Communication With Nurses Pain Management Responsiveness of Hospital Staff Communication about Medicines Communication with Doctors Cleanliness of Hospital Environment Quietness of Hospital Environment Discharge Information .73 .60 .52 .49 .47 .44 .39 .30 .30 This analysis comes from the 2011 HealthStream Database, which consists of discharges from 10/01/07 – 10/31/10. Hourly Rounding Evidence Based Practice that Can: Reduce call lights Reduce patient falls Reduce skin breakdown Improve patient perception of care Improve patient satisfaction and HCAHPS scores • Increase time spent with patients • • • • • Outcomes of Hourly Rounding The 5 P’s of Hourly Rounding Hourly Rounding Pain Potty Positioning Personal Items Privacy Effective Hourly Rounding Words and actions that help us partner with our patients and families for the best outcomes and care. Patient Communication Board Pain Leaders Rounding on Patients Leaders Rounding on Patients Traditional • • • • • Admissions/Discharges Physician Rounding Complaint Visit Interdepartmental Rounding Problem Patient BLG Focused VS. • Staff Driven • Uses staff action plans • Validate staff actions and behaviors • Set patient’s expectations • Service recovery • Staff recognition Rounding Steps On admission advise what hourly rounding is and managing pain is a priority for this unit Whiteboard has names and last pain score Example alignments to HCAHPS and Patient Centered Excellence: • Script commitment to being the best possible hospital, quiet at night • Validate if staff have been responsive to call lights • Ensure patient communication board is updated with nurse, doctor, plan of care and pain goals Sample Leader Interaction with Patient I’m _____, the Director of ______. Our goal is that you receive Very Good care while you are a patient here. Do you feel well enough to answer a few questions for me? Discovery and Service Recovery • In the last 24 hours have you needed to use your call light? If so what for? Were we timely in our response? • Describe your experience • Tell me more • Is there anyone I can recognize for providing you with “excellent ” care? What exactly did they do? • I apologize for the delay in answering your call light. Tell me how I can make this better for you? Focus on Positives • Manage up staff and organization • Identify and recognize by name staff who consistently follow the action plan; send thank you notes to their home • Involve employees in the decision making process Action Plan • • • • • • • Educate all staff on actions; share rounding date Share agreed actions in common area for high visibility Document agreed actions on Patient Rounding Log Select patient population for rounding Begin rounding with focused questions Document outcomes on rounding log Share findings with staff and senior leaders Outcomes of Leaders Rounding on Patients • • • • • • Build Relationships Reward and Recognize Patient Safety Deliver High Quality Services Identify OFI’s Create a “WOW” experience Outcomes of Leaders Rounding on Patients • Patients rounded on by Nurse Leaders reported satisfaction levels on average 59 percentile points higher than patients not rounded on by nurse leaders • Decrease patient complaints by 66% • Reduce Emergency Department LWOT from 4.5% to 2% Rounding Queen Interdepartmental Rounding Interdepartmental Rounding Traditional BLG Focused • Problem Focused • Reactive • As Needed VS. • Scheduled • Customer Knows the Question being asked • Focus is what is working well and staff recognition • Mutual OFI identified and plans agreed to • Information Harvested documented and shared with staff and senior leaders Example Alignments to Patient Centered Excellence: • Pharmacy: Who can I recognize that has helped you communicate medication side effects? • Environmental Services: What can our team do to help you keep rooms “always” clean? Ancillary Departments: Environmental Assessment Meet patient needs and reduce call lights: • • • Manage up experience; share your role Use key words and phrases Conduct an environmental assessment; are important items in reach? It’s Not Just About “Nursing” or “IP” • Everyone is an owner of HCAHPS success • 60% of inpatients start their experience in the ED • HCAHPS survey is expanding across the house Annual Goal Results 290 Bed Hospital Location: Waterbury, CT Month Nov 2011 Sep 2011 Jul 2011 May 2011 Mar 2011 Jan 2011 Nov 2010 Sep 2010 Jul 2010 May 2010 Mar 2010 Jan 2010 Nov 2009 Sep 2009 Jul 2009 May 2009 Mar 2009 Jan 2009 Nov 2008 Sep 2008 Jul 2008 May 2008 Mar 2008 Jan 2008 Nov 2007 Sep 2007 Jul 2007 May 2007 Mar 2007 Jan 2007 Number of Infections Number of Hospital Acquired Infections by Month 40 35 30 25 20 FY Monthly Average FY 2010 Goal 15 FY 2011 Goal 10 5 FY 2012 Goal 0 290 Bed Hospital Location: Waterbury, CT Likely Barriers to Effective Rounding 1. Not prioritized as part of daily schedule 2. Distractions and called to fight “fires” 3. Accountability Gaps 4. Overall lack of belief in patient focused rounding as a critical management tool 5. Failure to act on the information © Baptist Leadership Group, MMX. All rights reserved.