Leader Rounding on Patients

A Must Have!

1

Click to edit Master title styleEvidence Based Leadership (EBL) SM

Standardization AcceleratorsMust Haves®

Performance Gap

Leader Evaluation

Leader Development

Foundation Breakthrough

STUDER GROUP:

Rev 11.07

RoundingThank You NotesEmployee SelectionPre and Post Phone CallsKey Words at Key TimesAIDET &

Managing Up

(Principles 3, 5, 6, & 9)

Re-recruit Excelling and Achieving performers

Move Lagging performers up or out

(Principle 4)

Agendas by pillar

Peer interviewing

30/90 day sessions

Pillar goals

(Principles 1 & 2)

Leader Eval MgrSM (LEM)

Discharge Call MgrSM (DCM)

Aligned Goals Aligned Behavior Aligned Process

Create process to assist leaders in developing skills and leadership competencies necessary to attain desired results

LDI

(Principles 4 & 8)

Implement an organization-wide leadership evaluation syst.to hardwire objective accountability

PILLAR GOALS LEM

(Principle 7)

Click to edit Master title styleTypes of Rounding for Outcomes

Leader Rounding on Employees Senior Leader Rounding Physician Rounding Leader Rounding on Internal CustomersLeader Rounding on Patients

Inpatient Rounding

Rounding for OU Medical Center

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Click to edit Master title styleLeader Rounding on Patients

What is it?

Why is it important?

How will it be used?

Structured process to ensure we create a quality, safe and compassionate environment and resolve issues by obtaining “just in time” feedback from patients and families.

• Furthers mission to deliver patient-centered care• Builds relationships and provides emotional support• Improves clinical outcomes and quality of care• Promotes patient safety and a culture of safety• Ensures patient needs are anticipated and expectations exceeded

which increases efficiency and reduces “waste”• Raises patient engagement and perception of quality • Proactively addresses service recovery opportunities • Establishes a relationship with the leader and demonstrates our

commitment to quality care through supervision and oversight• Provides a system of accountability to validate behaviors and raise

the performance bar of all staff• Allows opportunity for reward and recognition• Builds leader skills

Leaders round on patients to obtain feedback on quality, care and validation of staff expected behaviors. Staff then coached/recognized and actions taken to address improvement opportunities.

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1st Qtr after Implementation

2nd Qtr after Implementation

3rd Qtr after Implementation

4th Qtr after Implementation

5th Qtr after Implementation

6th Otr after Implementation

4%

4%

9%

11%

16%

25%

0%

0%

5%

5%

5%

10%

Increase in Percentile Ranking for HCAHPS Measure "Nurses Always Communicated Well" Following Implementation of Nurse Leader Rounding

National Average Percentile Rank Improvement

Avg Percentile Rank Improvement Among Partners Implementing Nurse Leader Rounding

Source: The graph above shows a comparison of average percentile rank improvement using the Studer Group partner database compared to CMS data based on 3Q09-2Q10.

Nurse Leader Rounding Improves Patients’ Perception of Nursing Quality

Click to edit Master title styleLeader Rounding on Patients“Did a Nurse Manager Visit You During Your Stay?”

Source: Arizona Hospital, Total beds = 355, Employees = 4,000, Admissions = 10,188; updated 2Q2010

n= 608

n= 106

n= 604n= 561

n= 601

n= 104

n= 96

n= 105

Tactic and Tool Implemented:• Leader Rounding on Patient

Click to edit Master title styleGoals and Questions

Communicate to Patients1. I am the leader and responsible for the quality of care delivered. I

care about you (Empathy and Expectations)2. I appreciate you sharing that. (Reward and Recognition)3. I am proud of the care we provide. (Manage Up, Quality)4. I am sorry. (Service Recovery if needed)

Hardwire Staff Behaviors and Increase Accountability5. Round by assignment6. Coaching for performance conversations

At conclusion, ask:7. What have I learned about the quality of care of that patient?8. What must I do with that information?9. Are there gaps in performance? Actions to address?10.What recognition do I need to provide for consistent performance?

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Patients assume quality clinical careIt is caring service that differentiates us and creates loyal patients and customers Specifically, patients want to be: Listened to when they have a complaint Shown sensitivity by empathetic staff Communicated with, kept informed and

included in decisions Treated with respect and dignity and

emotional needs met Taken care of in a timely manner

Reward the Behaviors that Patients Need

Perspectives on American Healthcare 2007. A report from studying 2.3 million patients at 1700 hospitals. Press, Ganey

Click to edit Master title style2x2s = Focus

• Determined from analysis of patient satisfaction results

• Aligns with the patient perception of care action plan • Tests if what we have asked the staff to do is actually

happening from the patients perspective and if it is having the impact we expected

• No more than two specific questions because no more than two improvement initiatives at a time

Click to edit Master title style2x2 Questions

• Key Drivers (2x2s)– Focus on 2 questions for 2 quarters to

improve and sustain before changing– No chasing the red boxes

• Highest Priority Quality Issues• Ask Questions in the Right Way

– Open Ended versus Yes/No

Click to edit Master title styleThe Right Questions (Inpatient Nursing)

• Ask targeted questions to obtain actionable information

• Two areas of focus from patient perception

• One area of focus from quality

Click to edit Master title styleHCAHPS

Click to edit Master title styleThe Right Questions (Other Areas)

• Ask targeted questions to obtain actionable information– How well are we explaining….tests, treatment, procedures,

etc.?– Are your caregivers washing their hands every time before

touching you? – Is there anyone I can recognize for taking great care of

you/making you feel safe? – Are my staff introducing themselves and their role in your

care?– How well are we doing at answering your questions?– What can you tell me about your care related to ….?– Can you tell me about your medication? Purpose and/or side

effects? (Respiratory)

Click to edit Master title styleTool: Amb/Clinic

Click to edit Master title styleRounding by Assignment

• Caregiver focused which enables focused validation of staff behaviors & coaching for improved outcomes

SafetyPatient Communication

BoardsPatient education

• Captures patient concerns & can be connected to Communication with Nurses

• Can eliminate re-work

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Parameters for Patient Rounding

Inpatient• Director/Manager must conduct majority of rounding• Ultimate Goal is every patient every day

ED • Nursing Leadership – Director, Managers, & Supervisors• 25% of treat and release patients • 100% of patients holding for an inpatient bed

Outpatient, Ambulatory, and Clinic Settings • Leaders - Director, Managers, & Supervisors• Sampling of patients – Greater of 10% or 20 per month• 100% of patients in a recurring setting

Who and How Often

Click to edit Master title styleGuidelines

• Round by assignment• Round on all patients

cared for by staff you have any concerns about (prioritize)

• Summarize findings and trends

• Document (logs are mandatory)

Click to edit Master title styleCompliance/Transparency

• Every area must report compliance weekly until hardwired, then monthly

• Senior Leaders must be able to see weekly and monthly performance by area

• Results must be posted publicly

Note: LRP6: WEEKLY REPORT

Click to edit Master title styleWhat Right Looks Like

• Know the patient• Limit the areas of focus for follow up rounding (address

key driver of patient satisfaction, validate staff’s use for key behaviors, etc.) to no more than two items

• Sit to help the patient feel you are listening • Set the time expectation up front • Provide the patient with specific information when

managing up the staff, “Today, Stephanie will be taking care of you, she is an excellent nurse. I have worked with her for ten years and would want her to be my nurse if I was having this procedure”.

Click to edit Master title styleWhat Right Looks Like

• Do not quiz the patient regarding their experience or the staff who are caring for them-asking questions such as “do you know your nurses name, do you know what you are waiting for, or do you have any concerns.” These questions may create anxiety for the patient if they are not able to answer. It is more effective to engage the patient in a conversation which connects the dots for them in terms of the behaviors that are expected and

• Focus the patient on the positive (asking “how well are we doing” initiates a different conversation then asking the patient if something was done)

• Dig deeper into specific issues-use phrases such as “please tell me more about that” or “I am pleased to hear you think your nurse is great. What is she doing to make you feel that way”

Click to edit Master title styleWhat Right Looks Like

• Use closing statements-when a leader says, “Is there anything I can do for you before I leave?” it tells the patient you care and their input is important

• Communicate outcomes with staff following any interaction with patients

• Information that is documented should include a patient identifier, feedback on areas of focus, staff and physicians to recognize, and items for follow-up

Click to edit Master title styleTools

Click to edit Master title styleTools – Plan and Roles Defined

Discharge Call Manager

Results in Patient Safety and Satisfaction

25

Click to edit Master title styleNine Principles for Service and Operational Excellence

1. Commit to Excellence2. Measure the Important Things3. Build a Culture Around Service4. Create and Develop Great Leaders5. Focus on Employee Satisfaction6. Build Individual Accountability7. Align Behaviors with Goals and Values8. Communicate at All Levels9. Recognize and Reward Success

Click to edit Master title styleEvidence Based Leadership (EBL) SM

Standardization AcceleratorsMust Haves®

Performance Gap

Leader Evaluation

Leader Development

Foundation Breakthrough

STUDER GROUP:

Rev 11.07

RoundingThank You NotesEmployee SelectionPre and Post Phone CallsKey Words at Key TimesAIDET &

Managing Up

(Principles 3, 5, 6, & 9)

Re-recruit Excelling and Achieving performers

Move Lagging performers up or out

(Principle 4)

Agendas by pillar

Peer interviewing

30/90 day sessions

Pillar goals

(Principles 1 & 2)

Leader Eval MgrSM (LEM)

Discharge Call MgrSM (DCM)

Aligned Goals Aligned Behavior Aligned Process

Create process to assist leaders in developing skills and leadership competencies necessary to attain desired results

LDI

(Principles 4 & 8)

Implement an organization-wide leadership evaluation syst.to hardwire objective accountability

PILLAR GOALS LEM

(Principle 7)

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Purpose, worthwhile work

and makinga difference

®

Healthcare Flywheel®

• Bottom Line Results(Transparency and Accountability)

Self-Motivation

Prescriptive To Do’s

Post-Visit Calls

Discharge Call ManagerSM

Click to edit Master title styleAnnals of Internal Medicine, February 2003

Type of Adverse Events

66%17%

5%

8%

4%

Adverse Drug Event

Procedure Related

Nosocomial Infection

Fall

Other

* 81 events occurred in 76 patients

“Nearly 1 in 5 patients”*

400 patients surveyed

76 (19%) had adverse events after discharge

* “Adverse Events After Discharge from Hospital”, Annals of Internal Medicine, February 2003

Click to edit Master title stylePost-Visit Call - Benefits

• Reconfirms discharge instructions• Reduces patient anxiety• Reduces complaints and claims• Reinforces patient perception that

excellent care has been provided• Confirms hardwiring of processes

Click to edit Master title stylePost-Visit Discharge Phone Call Sample

Empathy and Concern

Clinical Outcomes

Reward and Recognition

Service

Process Improvement

“Mrs. Smith? Hello. This is <name>. You were discharged from my unit yesterday. I just wanted to call and see how you’re doing today…”

“Mrs. Smith, did you get all your medications filled? . . .”

“Mrs. Smith, we like to recognize our employees. Who did an excellent job for you while you were in the hospital? . . .”

“We want to make sure you were very satisfied with your care. How were we, Mrs. Smith?. . .”

“We’re always looking to get better. Do you have any suggestions for what we could do to be even better? . . .”

“Can you tell me why Sue was excellent?. . .”

“Do you have your follow-up appointment?. . .”

“Is your pain better or worse than yesterday? . . .”

“Mrs. Smith, we want to make sure we do excellent clinical follow-up to ensure your best possible recovery. Do you understand your discharge instructions? . . .”

Appreciation “We appreciate you taking the time this afternoon to speak with us about your follow up care. Is there anything else I can do for you? . . .”

Click to edit Master title styleBest Practices to Implement Discharge Call ManagerSM

• Set expectations and ensure they are clear– Set a number to be done every shift

• Post results by employee in the unit• Don’t accept excuses• Appoint a discharge call champion to

monitor, audit and report out on success/challenges

• Utilize rounding to eliminate barriers

Patient Rounding (Clinic Environment)

Rounding for OUP Clinics

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Click to edit Master title styleRounding on Patients and Family

• Opportunity to connects the dots in real-time• It’s a proactive approach• Gathers information for

– reward and recognition– process improvement– coaching

• Presents an opportunity for service recovery

Click to edit Master title stylePatient and Family Rounding

1. Use AIDET 2. Manage up 3. Think of it as quality improvement4. Think of it as safety checks

Click to edit Master title stylePatient Rounding for Outcomes

Click to edit Master title stylePatient Rounding Frequency Report

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What questions do you have?