NATIONAL HEALTH LEADERSHIP

CONFERENCE

University Health Network

Toronto Western Hospital

June 2, 2014

Toronto Western Hospital General Internal Medicine

Nursing Leadership Team

Carol Banez RN, BScN, MN

Clinical Nurse Specialist

Faith Daniels RN, BN, MN(c)

Patient Care Coordinator

Silvi Groe RN, BScN, MN, GNC(C)

Manager

Melissa Guiyab RN, BScN, MN, ENC(C)

Clinical Nurse Specialist

April Mick RN, BScN, CMSN(C)

Patient Care Coordinator

Gerry Ann Nepomuceno RN, BScN, MN(c)

Clinical Resource

Grace Ojo RN, BScN, CMSN(C), MN(c)

Clinical Resource

Janet Pilgrim RN, BScN(c), GNC(C)

Interim Manager

Saverina Sanchez RN, BScN, MScN

Manager

Sophia Simms-Hanson RN, BScN

Patient Care Coordinator

Marta Tamburri RN, BScN, CCN(C), MN(c)

Clinical Resource

Adassa Wilson RN, BScN, MA, GNC(C)

Patient Care Coordinator

Mary Kay McCarthy RN, M.HS

Senior Clinical Director

Creating an Exceptional

Patient Experience Through

“Patient-Focused Rounding”

Creating an Exceptional Patient Experience

Through “Patient-Focused Rounding”

Objectives

Define Patient-Focused Rounds

Describe methodology used in the

implementation of Patient-Focused

Rounds

Discuss outcomes and lessons learned

Creating an Exceptional Patient Experience

Through “Patient-Focused Rounding”

In an environment of

increased patient

complexity and

escalating fiscal

constraints, key

quality indicators

such as falls,

pressure ulcers, early

mobilization, patient

and staff satisfaction

must be addressed.

This quality

improvement process

of “Patient-Focused

Rounding” was

undertaken in an

academic, acute care

hospital in Toronto,

Canada on 3 inpatient

units within the

General Internal

Medicine Program.

Creating an Exceptional Patient Experience

Through “Patient-Focused Rounding”

64% of our patient population is over

65 years of age, of which 20% are over

85 years of age.

A high proportion of these patients are

non-English speaking, have multiple

co-morbidities, and a low health

literacy level.

Creating an Exceptional Patient Experience

Through “Patient-Focused Rounding”

Staff involved in this

project included

frontline nurses,

patient care

assistants, clerical

staff, and nursing

leadership.

Creating an Exceptional Patient Experience

Through “Patient-Focused Rounding”

Creating an Exceptional Patient Experience

Through “Patient-Focused Rounding”

Patient-Focused Rounding - 5 “P”s

Creating an Exceptional Patient Experience

Through “Patient-Focused Rounding”

PDSA cycle and Appreciative Inquiry (AI)

approach were the qualitative methodologies

used in this continuous process of achieving

patient and staff satisfaction.

Creating an Exceptional Patient Experience

Through “Patient-Focused Rounding”

Series of focus sessions with staff

Patient-Focused Rounding at various intervals

What is working well, patient and staff satisfaction

Changes as appropriate, patient feedback

PDSA Cycle

• AI is a generative process that focuses on what is

already working well versus the traditional problem-

centered approach.

• The AI model may be conceptualized as the 4D

cycle:

Discover Appreciating and valuing the best of “What Is”

Dream Envisioning “What Might Be”

Design Dialoguing “What Should Be”

Delivery/Destiny Innovating “What Will Be”

Creating an Exceptional Patient Experience

Through “Patient-Focused Rounding”

Appreciative Inquiry (AI) Theoretical Framework

Creating an Exceptional Patient Experience

Through “Patient-Focused Rounding”

Patient and Staff Results GIM Average Response

Likert scale 1 (poor) to 5 (excellent)

• How would you rate the care you received overall? 4.1

• Have the staff been courteous and respectful towards you? 4.6

• Do you feel well-informed about your plan of care? 4.2

• If you needed help, was someone available for you within a 4.4

reasonable amount of time?

• How well organized and co-ordinated was the care team? 4.2

• Based on your experience, how likely are you to recommend 4.6

TWH to a friend or family member?

Creating an Exceptional Patient Experience

Through “Patient-Focused Rounding”

• “I felt confident that the nurses knew exactly

what to do and came back and did it without

needing to be reminded.”

• “Impressed at how the nurses went in together

to check on my mother, helped reposition her

and asked if she was comfortable.”

Patient Results

Creating an Exceptional Patient Experience

Through “Patient-Focused Rounding”

• “Special attention can be given to patients

needs when we are working as a team during

rounds.”

• “Rounds has helped to decrease interruptions.”

• “Nurses partnered with one another made the

workload lighter.”

• “Utilizing the 5 “P”s has helped in enhancing

the patient’s journey while in the hospital.”

Staff Results

Creating an Exceptional Patient Experience

Through “Patient-Focused Rounding”

• The implementation of the Patient-Focused

Rounding model has positively impacted the

exceptional patient experience, staff

satisfaction and key quality indicators.

• Although a standardized approach of the PDSA

cycle and AI framework may be applied in

multiple units to create a successful model

change, it is important to ensure that the

delivery of the model is uniquely tailored to

each unit by the frontline staff.

Conclusion

Lessons Learned

Identify champions early in the process

Be prepared to make frequent changes

Gain patient and staff perspectives

Creating an Exceptional Patient Experience

Through “Patient-Focused Rounding”

Next Steps

Formal evaluation of process from patient’s perspective

Evaluate outcomes

Involvement of interprofessional team in patient-focused rounding

Creating an Exceptional Patient Experience

Through “Patient-Focused Rounding”

References Burke, W., McLaughin, D., (2013). Partnering for change. American Journal of Nursing., February 119,2

47-51.

Challis, A. M. (2009). An appreciative inquiry approach to RN retention. Nursing Management, July, 9-13.

Hammond, S. A. (1998). The thin book of appreciative inquiry. Oregon : Thin Book Publishing Co.

Ludema, J. D., Whitney, D., Mohr, B. J., Griffin, T. J. (2003). The appreciative inquiry summit: A

practitioner’s guide for leading large-group change. San Francisco: Berrett-Koehler.

Mahanes, D., Quatrana, B., Dale, K. (2013). APN led nursing rounds: An emphasis on evidence-based

nursing care. Intensive & Critical Care Nursing, October, 29-5, 256-60

Registered Nurses’ Association of Ontario (2008). Workplace, health and safety of the nurse. Toronto,

Canada: Registered Nurses’ Association of Ontario.

Richer, M., Ritchie, J., & Marchionni, C. (2009). ‘If we can’t do more, let’s do it differently!’: using

appreciative inquiry to promote innovative ideas for better health care work environments. Journal of

Nursing Management, 17, 947-955.

Shendell-Falik, N., Feinson, M., & Mohr, B. (2007). Enhancing patient safety: improving the patient

handoff process through appreciative inquiry. The Journal of Nursing Administration 37(2), 95 – 104.

Watkins, J. M., Mohr, B. J. (2001). Appreciative inquiry: Change at the speed of imagination. San

Francisco: A Wiley Company.

Weisgram, B., Raymond, S. (2008). Using evidence-based nursing rounds to improve patient outcomes.

Medsurg Nursing, December, 17-6, 429-430.

Wood, S. (2004). Creating a positive future for nursing using appreciative inquiry. AI Practitioner,

February, 13-18.

Questions