As a former nurse leader, I am passionate about rounding. I saw firsthand the benefit of capturing information, providing coaching in real time, rewarding behaviors and so on. However, I also remember how long it took to go through a stack of paper rounding logs. Aside from the volume, trying to decipher the handwriting of my charge nurses to examine for trends and recognition was at times challenging (and sometimes, it just didn’t get done). The good news is, advancements in technology allow us to streamline our rounding process.
Rounding remains foundational to the work we do at Studer Group. In fact, we’d be hard pressed to find a healthcare organization that doesn’t round. Truly elevating the outcome of this behavior now comes down to how well we synthesize, centralize and coach to the feedback we hear from our patients. How does the day change for the nurse leader based on what the patients say? The time we spend coaching our staff in follow up to the round is as important as the encounter with the patient.
Hardwiring (ensuring a tactic or process has become second nature) the Must Haves® is a key step in Studer Group’s Evidence-Based LeadershipSM framework, an execution framework that aligns goals, processes and behaviors across the entire organization.
Execution Framework: Evidence-Based Leadership℠
Rounding has proven to be the best way to collect vital information. When a strong nurse leader gains direct feedback from patients and communicates that feedback back to staff, we collect the win on many levels. We can then reward and recognize staff, build stronger relationships, and even validate key behaviors for safety. Rounding also builds engagement across the organization. Ensuring leaders develop and refine their skill in rounding on both patients and staff is a crucial first step. Skill development should include:
- Asking the right questions by using strong key words to gather the data we are trying to capture. It’s important to ask open-ended questions that tie directly to patient outcomes and require more than a “yes or no” answer. For example: “What is your nurse doing to manage your pain?”
- Hardwiring how to trend this data and information to understand the behavior of staff (we can validate behaviors are consistent when staff conduct the right behaviors, even when no one is looking).
- Learning how to coach staff in the moment so immediate actions can be taken to correct the behavior. This skill of a nurse leader is what drives the best outcome for our patients and the true commitment to engaging our staff in their development.
By creating standard questions with specific key words, we reduce variance, ensure consistency and get closer to hardwiring. Just standardizing the explanation of the process can bring tremendous value as patients more regularly understand WHY we’re rounding on them in the first place. Remember, one of the key reasons we round is to ensure patient safety and quality. An added benefit is the predictive information we gain, and can even come to expect our results based on our rounding on patients.
The Financial Benefits of Rounding
While we’ve always coached on the importance of rounding, we have taken this foundational tactic one step further. With MyRounding®, a software-based accelerator, leaders utilize flexible technology that offers customizable rounding templates, instant reports, and the ability to escalate issues identified during rounds. As compared to paper-based rounding, MyRounding creates efficiencies for leaders. When rounding is done, documentation is done, which also saves leaders valuable time. This time savings turns into direct productivity savings. The below Return on Investment (ROI) calculation is just one example.
Earlier I mentioned the challenges I found with paper rounding logs. MyRounding removes those barriers, and at the push of a button we can:
- Capture and send immediate reward and recognition through the Recognition button, or trend the behaviors of our high performers. We always coach to elevate the skill of the nurse leader to manage these up during huddles and take every opportunity to drive engagement through commitment to patient care.
- Drill down by question and over time, see the trend in how departments or facilities are improving in a certain domain, or individual question.
- Combine Nurse Leader Rounding with other audits we need to do, i.e. safety/falls audits, call light audits, isolation precautions, Joint Commission audits…anything that a leader is currently documenting on paper can be documented in MyRounding. We have organizations also automating HR tracked processes like 30- and 90-day meetings for new hires – managing retention practices are becoming more and more significant for healthcare organizations today.
The Patient Experience and Rounding Connection
Further, we have found a direct correlation between utilization of the MyRounding technology and increased HCAHPS outcomes. One organization coached by Studer Group realized a 108 percent increase in their Communication with Nurses domain, and an average improvement of 30 percent across all HCAHPS domains. We’ve also seen a direct correlation in the Care Transitions domain and how the behaviors that positively affect that domain also impact the Responsiveness and Pain domains.
At a partner location, we coached the Nurse Leader Rounding on Patients process from sometimes to always alongside the MyRounding software. We piloted it first to focus on improving the Pain Management domain and to track compliance of Hourly Rounding®. In only five weeks, the organization increased the response rate for “How often are you seeing staff rounding on you?” from 89 percent at every hour to 94.8 percent at every hour.
We also saw a reduction in call lights during the pilot. By asking “how quickly did staff respond,” if patients did have to use a call light, we began seeing predictive HCAHPS results on the Responsiveness domain. As the percentage of patients who rated the question “quickly” or “very quickly” increased, the percentage of patients rating the Responsiveness domain as “always” also improved.
Both sets of outcomes moved quickly because nurse leaders coached staff and validated based on the immediate pull they were able to achieve. The reality of sifting through paper vs. immediately pulling a snapshot showed a marked difference in fast improvement.
Simple Implementation. Rapid Results.
If rounding is not hardwired in your organization, we recommend starting now. Leaders can use paper logs at first to become familiar with the process and the questions they should ask patients. The same questions can then be entered into the templates when MyRounding is implemented.
MyRounding is what I like to call a “plug and play” system, meaning we can start rounding almost immediately after the software is installed. Some organizations implement with an ADT interface, which simplifies the rounding process even more for nurse leaders, while others move forward without the ADT component. My top tips for implementation and effectively using the software include:
- The rounding template and questions need to be simple. Don’t over think the questions!
- Take a deep dive into current patient experience results and focus on just a few questions in one domain first.
- Training should be designed around the leaders. There are many training options, from virtual sessions to onsite coaching, to help remove barriers and accelerate the rounding process.
- Set a regular cadence with teams to run and review reports. Then, be sure to take action on the information!
Take time as leaders to validate that staff are rounding correctly, and with the right frequency. The benefits of rounding are plentiful and can impact the entire organization. But we only see true transformation when leaders use the data and take action on what is captured.
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About the Author:
Erin Shipley, RN, MSN, is a coach and rounding expert with Studer Group. She is passionate and dedicated to developing and coordinating new ways to improve overall patient experience, employee engagement and physician alignment. To learn how to take rounding to the next level at your organization, contact us at partnerships@studergroup.com.