Transcript Rounding and Coaching

Rounding and Coaching
Applying Clinical Expertise Through Leadership
Georgia Hospital Association
June 5, 2014
Slide 1
COPYRIGHT © STUDER GROUP
Please do not quote or disseminate without Studer Group authorization
Session Objectives
1. Describe the Why, What, How of Rounding – A quick
review of definitions and expectations (30 min)
2. Learn six coaching tips for successful execution
including removing barriers (40 min)
3. Ask questions to take rounding to higher level of
reliability (20 min)
Slide 2
COPYRIGHT © STUDER GROUP
Please do not quote or disseminate without Studer Group authorization
ENGAGEMENT
QUALITY
SAFETY
FINANCIAL PERFORMANCE & PATIENT EXPERIENCE
Slide 3
COPYRIGHT © STUDER GROUP
Please do not quote or disseminate without Studer Group authorization
Georgia Hospitals Rank 47th of 50 States
in Improvement in Pain Management
Are you asking targeted questions in rounding?
Slide 4
COPYRIGHT © STUDER GROUP
Please do not quote or disseminate without Studer Group authorization
Georgia Hospitals Rank 32 of 50 States
in Improvement in Nurse Communication
Slide 5
COPYRIGHT © STUDER GROUP
Please do not quote or disseminate without Studer Group authorization
2015 Patient Experience of Care Domain
(HCAHPS)
Green = increased threshold from 2014
Red = decreased threshold from 2014
2015
Floor
2014
2015
2014
2015
National National
National
National
Threshold Threshold Benchmark Benchmark
Communication with Nurses
47.77%
75.79%
76.56%
84.99%
85.70
Communication with Doctors
55.62%
79.57%
79.88%
88.45%
88.79
Responsiveness of Hospital Staff
35.10%
62.21%
63.17%
78.08%
79.06
Pain Management
43.58%
68.99%
69.46%
77.92%
78.17
Communication about Medicines
35.48%
59.85%
60.89%
71.54%
71.85
Hospital Cleanliness & Quietness
41.94%
63.54%
64.07%
78.10%
78.90
Discharge Information
57.67%
82.72%
83.54%
89.24%
89.72
Overall Rating of Hospital
32.82%
67.33%
67.96%
82.55%
83.44
Slide 6
COPYRIGHT © STUDER GROUP
Please do not quote or disseminate without Studer Group authorization
Georgia Hospitals
Nurse Communication Drives Hospital Overall Patient Experience of Care Rating
Average Percentile Ranking for "Patients Rate Hospital a 9 or 10" by Hospital
Ranking in Nurse Communication
70%
60%
60%
57%
51%
Percentile Rank
50%
40%
30%
26%
20%
10%
0%
0-24th Percentile
25-49th Percentile
50-74th Percentile
75-99th Percentile
Hospital Ranking in Nurse Communication
Slide 7
COPYRIGHT © STUDER GROUP
Please do not quote or disseminate without Studer Group authorization
Georgia Hospitals
Nurse Communication Drives Patient Falls
Falls and trauma (per 1,000 medical and surgical discharges) by Hospital Ranking
in Nurse Communication
0.700
0.644
0.600
0.630
0.585
Falls per 1000
0.500
0.386
0.400
0.300
0.200
0.100
0.000
0-24th Percentile
25-49th Percentile
50-74th Percentile
75-99th Percentile
Hospital Ranking in Nurse Communication
Slide 8
COPYRIGHT © STUDER GROUP
Please do not quote or disseminate without Studer Group authorization
In FY2015 Value Based Purchasing (VBP) Adds a New
Efficiency Domain Measured by
Medicare Spending Per Beneficiary (MSPB)
Measure
reflects higher
quality at a
lower cost
Slide 9
COPYRIGHT © STUDER GROUP
Please do not quote or disseminate without Studer Group authorization
Georgia Hospitals
Nurse Communication Drives MSPB After Discharge
MSPB - 1 through 30 days After Discharge from Hospital
by Hospital Rating in Nurse Communication
$15,000
$14,829
$14,500
$14,052
$14,000
$13,711
MSPB
$13,500
$13,000
$12,563
$12,500
$12,000
$11,500
$11,000
0-24th Percentile
25-49th Percentile
50-74th Percentile
75-99th Percentile
Hospital Ranking in Nurse Communication
Slide 10
COPYRIGHT © STUDER GROUP
Please do not quote or disseminate without Studer Group authorization
Georgia Hospitals
Nurse Communication Drives Total MSPB
MSBP Complete Episode of Care
by Hospital Rating in Nurse Communication
$35,000
$34,412
$34,000
$33,475
$32,634
$33,000
MSPB
$32,000
$31,000
$30,480
$30,000
$29,000
$28,000
0-24th Percentile
25-49th Percentile
50-74th Percentile
75-99th Percentile
Hospital Ranking in Nurse Communication
Slide 11
COPYRIGHT © STUDER GROUP
Please do not quote or disseminate without Studer Group authorization
Nurse Communication Drives VBP Results
Both Clinical Process of Care and Patient Experience of Care VBP Scores Are
Influenced by Quality of Nurse Communication
Average VBP Clinical Process of Care
Domain Score
by Hospital Ranking in Nurse
Communication
80
64.2
65.0
64.0
63.0
62.0
60.6
61.0
60.0
59.0
61.2
59.0
58.0
73
70
Patient Experience Domain Score
Clinical Process of Care Domain Score
Average VBP Patient Experience of Care
Domain Score by Hospital Ranking in
Nurse Communication
60
50
50
40
40
30
26
20
10
57.0
56.0
0
0-24th
25-49th 50-74th 75-99th
Percentile Percentile Percentile Percentile
0-24th
25-49th 50-74th 75-99th
Percentile Percentile Percentile Percentile
Hospital Ranking in Nurse Communication
Hospital Ranking in Nurse Communication
Slide 12
COPYRIGHT © STUDER GROUP
Please do not quote or disseminate without Studer Group authorization
Nurse Leader Rounding Improves
Patients’ Perception of Nursing Quality
Increase in Percentile Ranking for HCAHPS Measure "Nurses Always
Communicated Well" Following Implementation of Nurse Leader Rounding
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%
0%
Avg Percentile Rank Improvement Among Partners Implementing Nurse Leader
Rounding
4%
0%
9%
5%
11%
5%
16%
5%
25%
10%
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.
Slide 13
COPYRIGHT © STUDER GROUP
Please do not quote or disseminate without Studer Group authorization
The What
for Evidence-Based Decision-Making
Slide 14
COPYRIGHT © STUDER GROUP
Please do not quote or disseminate without Studer Group authorization
The What Rounding for Outcomes
PROACTIVE plan to engage, listen to, communicate with, build
relationships with and support important people
Employees Physicians Patients and Families Departments Served
Structured mechanism to ensure we create a quality, safe and
compassionate environment by obtaining ACTIONABLE
information from those closest to the situation
Method to coach/reward and recognize staff in real-time fashion
Link to a person of “authority” but not a “hero” to solve issues
A thoughtful plan to differentiate your facility from others by
providing distinctive communication around specific questions to
create a great place for employees and physicians to work and
patients to receive care
Slide 15
COPYRIGHT © STUDER GROUP
Please do not quote or disseminate without Studer Group authorization
Types of Rounding
What Rounding IS NOT:
Senior Leader Rounding
Rounding on Staff
New Hires 30-90 Days
Rounding on Patients
Hourly Rounding
Rounding on Internal
Customers
Slide 16
An “open door” policy
Management by
wandering around
Reactive
Focused on “what’s
wrong”
Being “out there”
Happenstance
Asking what’s working
well during meetings
COPYRIGHT © STUDER GROUP
Please do not quote or disseminate without Studer Group authorization
Rounding on Staff Must Be Hardwired FIRST
Rounding questions
Are focused on developing a relationship
And staff engagement
1.
2.
3.
4.
5.
6.
7.
8.
9.
Personal Connection
What is working well?
Anyone I can recognize? Why?
What systems/processes are not working well/safety issues?
What can we do to improve them?
Do you have the tools you need to do your job?
What’s one way we can improve ….
Is there anything you need from me to be a better leader for you?
Thank you for making a difference!
Slide 17
COPYRIGHT © STUDER GROUP
Please do not quote or disseminate without Studer Group authorization
Rounding on Staff Aligns With
Creating Joy, Meaning and Workforce Safety
1. Am I treated with dignity and
respect by everyone, every day, in
each encounter?
2. Do I have what I need: education,
training, tools, financial support,
encouragement, so I can make a
contribution to this organization
that gives meaning to my life?
3. Am I recognized and thanked for
what I do?
Download at Lucian Leape Foundation
www.npsf.org/lli
Slide 18
COPYRIGHT © STUDER GROUP
Please do not quote or disseminate without Studer Group authorization
Business case for “employee” engagement
Median differences between top-quartile and
bottom-quartile units in employee engagement
were:
-12% in customer ratings
-18% in productivity
-49% in safety incidents
-37% in absenteeism
-41% in patient safety incidents
Source: Q12® Meta-Analysis: The Relationship Between Engagement at Work and Organizational Outcomes, Gallup 8
Slide 19
COPYRIGHT © STUDER GROUP
Please do not quote or disseminate without Studer Group authorization
Hospital Staff Responses to the 2012 Hospital
Survey on Patient Safety Culture
Agency for Healthcare Research and Quality (AHRQ)
 Staff feel free to question the decisions of those with more authority - 47%
 Staff feel like their mistakes are held against them - 50%
 Important patient care information is often lost during shift changes - 51%
 We have enough staff to handle the workload - 56%
 It is often unpleasant to work with staff from other hospital units - 59%
 Staff are afraid to ask questions when something does not seem right 63%
 My supervisor/manager overlooks patient safety problems that happen
over and over - 76%
Slide 20
COPYRIGHT © STUDER GROUP
Please do not quote or disseminate without Studer Group authorization
Most trusted but are we engaged?
Engagement
Inspired by his/her hospital
Willing to invest discretionary effort
Likely to recommend the employer
Planning to stay for the foreseeable
future
Nurse DISENGAGEMENT ranges from 9%
to 24% based on literature from Gallup,
Advisory Board and the Nurse Executive
Council (NEC)
Nurse Engagement
Survey
22%
9%
26%
43%
Engaged
Ambivalent
Content
Disengaged
Source: JONA. Vol. 41. No. 6. June 2011
Slide 21
COPYRIGHT © STUDER GROUP
Please do not quote or disseminate without Studer Group authorization
The Why
for Evidence-Based Decision-Making
Slide 22
COPYRIGHT © STUDER GROUP
Please do not quote or disseminate without Studer Group authorization
The Why Four Goals EVERY Day
Round on staff to communicate
1. I care about the quality of care we provide
2. I appreciate the quality of care you deliver (or not)
4 Goals with each interaction
1. Create an empathetic connection with patients; manage
their expectations
2. Proactively assess quality of care using focused, probing
questions to determine gaps and obtain actionable
information
3. Harvest compliments and manage up
4. Service recovery (if needed)
Slide 23
COPYRIGHT © STUDER GROUP
Please do not quote or disseminate without Studer Group authorization
The How Two Key Questions
1. What have you learned about the care being delivered to
the patients you have rounded on?
2. What MUST you do with that information?
• Recognition
• Coach/development of staff
• Process improvement
• Environmental safety
Slide 24
COPYRIGHT © STUDER GROUP
Please do not quote or disseminate without Studer Group authorization
Leader Rounding on Patients is the Validation
for the Patient Excellence Care Model
Hourly
Rounding
Bedside Shift
Report
Nursing and
Patient Care
Excellence
Individualized
Patient Care
Slide 25
Discharge
Phone Calls
COPYRIGHT © STUDER GROUP
Please do not quote or disseminate without Studer Group authorization
The Why Evidence-Based Leadership
Foundational, best practice tactic that ensures your ability
to deliver quality care on your unit by evaluating and
monitoring processes and behaviors
Reconnects leaders to patient care on a personal level
Provides best opportunity for “line of sight” leadership to
see the highlights and gaps leading to elevated performance
Builds leadership assessment skills, just like you built nursing
assessment skills
Reduces patient/family anxiety
Proactively manages concerns
Slide 26
COPYRIGHT © STUDER GROUP
Please do not quote or disseminate without Studer Group authorization
The How
A Consistent Focus on Quality to Drive
Consistently High Quality Results
Slide 27
COPYRIGHT © STUDER GROUP
Please do not quote or disseminate without Studer Group authorization
The How Prepare the Right Questions
Highest Priority Quality Issues in need of improvement
Key Drivers of Patient Satisfaction/HCAHPS
Ask Questions in the Right Way
• Open-ended vs. Closed-ended
Ensure staff know the questions you will be asking
before you round
Slide 28
COPYRIGHT © STUDER GROUP
Please do not quote or disseminate without Studer Group authorization
Sample Nurse Leader Questions
What is Joyce doing to manage your pain today?
• Patient should be able to reference medications or activity to manage pain
Were you able to sleep through the night last night?
• (If No) What things woke you up?
Have you had to push your call light in the last 24 hours?
• NO- “Good, that tells me (name) is doing a good job of anticipating your needs.”
• YES- “Good, I’m glad you’re calling when you need us. What did you have to push
the call light for? How long was it before someone came in and took care of that
for you?”
Assess the environment. NLs don’t have to ask patients about
cleanliness, they should simply look at the environment.
• Check for nurse clutter, food trays, soiled linen, clean sink area and clean
bathroom (including flushed toilet).
Slide 29
COPYRIGHT © STUDER GROUP
Please do not quote or disseminate without Studer Group authorization
Fine or Excellent
 What are you going to say about your experience
when you leave here?
 Fine is not exceptional quality care to me. Is
there something specific that we could have done
differently to make you say your experience was
better than “fine.”
Slide 30
COPYRIGHT © STUDER GROUP
Please do not quote or disseminate without Studer Group authorization
Novice 2 Expert – Nurse Leader Rounding
Novice
Completed
training on
Rounding
on Patients
Focus on
details of
the process
No
Advanced
Beginner
Begins
rounding on
patients
Wants script
Uses script
Doesn’t vary
from script
Will stay
discretionary overtime to hit
judgment
compliance
numbers –
Very “task”
wants to be
oriented
compliant
Competent
Proficient
Comfortable
with rounding
Rounding is
second nature
Can prioritize
conversation
and questions
Asks clarifying
questions to
fully understand
patient
perception
Links action to
outcome and
has moved
from
compliance to
quality
Feels mastery
but lacks
speed and
flexibility
Slide 31
Recognizes
nuances and
can make
priority
decisions with
great follow-up
Has RESULTS
Expert
Rounding is
intuitive, fluid and
flexible and does
not need rules,
compliance grids
or scripting to
demonstrate
extreme
competency and
consistency
Driven by the
“why”
Has OUTCOMES
~Patricia Benner 1984
COPYRIGHT © STUDER GROUP
Please do not quote or disseminate without Studer Group authorization
Novice 2 Expert – Nurse Leader Rounding
Novice
Coach on
focused
areas – no
more than
2.
Advanced
Beginner
Competent
Coach on
practicing to
become more
comfortable
Coach on
linking
outcomes and
results
“Tell me
“Coach me to be
what to do more efficient”
“I got this”
and I will
do it”
Reward and
recognition is
KEY
Proficient
Expert
Coach on
raising the bar
and linking
action to
outcomes – see
the whole
Coach on
teaching and
influencing others
– they Don’t see
themselves as
experts
“I can do it
better”
Help them see
that
“I can teach this”
~Patricia Benner 1984
Slide 32
COPYRIGHT © STUDER GROUP
Please do not quote or disseminate without Studer Group authorization
Lessons Learned: Nurse Leader Rounding
Six tips from the experts
Slide 33
COPYRIGHT © STUDER GROUP
Please do not quote or disseminate without Studer Group authorization
Tip #1 Connect The Dots to Meaningful Work
“Rounding on patients allows us to truly connect with our
patients and our families and gather feedback every day
on our efforts to deliver exceptional quality care. But
more important, it allows us to build relationships with
and recognize each of our primary nurses for the
meaningful work they do everyday.”
Pennie Peralta, Chief Nursing Officer
Bon Secours, Roper St. Francis, Charleston, SC
Named one of Becker’s Hospital Review Top 100Top 100
Slide 34
COPYRIGHT © STUDER GROUP
Please do not quote or disseminate without Studer Group authorization
http://go.globoforce.com/rs/globoforce/images/Mood_Tracker_Spring2012-final_2.pdf
Slide 35
COPYRIGHT © STUDER GROUP
Please do not quote or disseminate without Studer Group authorization
Tip #2 Senior Leadership Sets Expectations
“Leader
rounding is not optional. It has
to be looked at as seriously as giving
correct medications.”
Quint Studer, Chief Learning Officer
Studer Group
Slide 36
COPYRIGHT © STUDER GROUP
Please do not quote or disseminate without Studer Group authorization
Set Expectations: Who and How Often?
Manager must conduct a minimum of 50%
• May delegate up to 50% to charge nurse,
educator, assistant manager
• Only nurse leaders can coach/develop staff in a
way that brings results
Inpatient: 100% patients daily, 7 days / week
Outpatient and ED: 25% / day
Ambulatory Surgery: Minimum 50% / day
Slide 37
COPYRIGHT © STUDER GROUP
Please do not quote or disseminate without Studer Group authorization
Track Compliance
• Every unit must report
rounding compliance daily
• CNO must be able to see
weekly and monthly
performance by unit
• Results must be public
Slide 38
COPYRIGHT © STUDER GROUP
Please do not quote or disseminate without Studer Group authorization
Track Results
Slide 39
COPYRIGHT © STUDER GROUP
Please do not quote or disseminate without Studer Group authorization
Tip #3 Standardize the WORK, Not Just the Process
“ If five front line process users can describe the process you
have a good chance to achieve 95% performance and to
sustain the performance over time.”
“Standardization in health care commonly means everyone
uses the same protocol but really must include standard
work including who, what, where, when, why.”
Roger Resar, MD
Moving to 95% Reliability
Slide 40
COPYRIGHT © STUDER GROUP
Please do not quote or disseminate without Studer Group authorization
Standardize Logs
Not Optional
1. Sets a common expectation for all nurse leaders to follow,
creating a highly reliable process
2. Provides focus and helpful prompts for nurse leaders while
rounding
3. Creates a record of important follow-up actions to be
completed
4. Establishes a method to track and trend rounding outcomes
5. Validates the behavior is being executed consistently
Slide 41
COPYRIGHT © STUDER GROUP
Please do not quote or disseminate without Studer Group authorization
Standardized Tools
 Welcome letter using
key words sets
expectations for leader
rounding
 Should be the same
from one unit to the
other
Slide 42
COPYRIGHT © STUDER GROUP
Please do not quote or disseminate without Studer Group authorization
Tip #4 Validate Nurse Leader Rounding Competency
“Consistency is the key to success of a highly reliable
organization. It is more than just “rolling out” the training
and assuming it is being done. Everyone can have their own
style but there needs to be consistency in the evidencebased delivery of rounding on patients from one unit to
another. It is my job to make sure they have the training
and coaching to be successful.”
Rhonda Scott, Chief Nursing Officer
Grady Medical Center
Slide 43
COPYRIGHT © STUDER GROUP
Please do not quote or disseminate without Studer Group authorization
Nurse Leader
Competency
Assessment
• Skills labs with
various scenarios
• Shadow rounding
by designated coach
for consistency
• Novice to expert
model – goal is
competency
Slide 44
COPYRIGHT © STUDER GROUP
Please do not quote or disseminate without Studer Group authorization
Rounding on Patients Is a Learned Skill
Ask your staff for input.. How’m I Doin’ Rounding on OUR
patients every day
What should I keep doing?
What should I do more of?
What should I do less of?
What should I stop doing?
Slide 45
COPYRIGHT © STUDER GROUP
Please do not quote or disseminate without Studer Group authorization
Tip #5 Help Leaders Manage Time Effectively
“Rounding is an investment of time. You will get it back
with less complaints, less performance issues and more
engaged staff. Some leaders may need help with efficiency,
some may be on too many committees, some may not have
capable delegates… Leadership can role model
prioritization and can help them FIND the time to complete
their rounds.
Sheila Bennett, VP Patient Care Services and CNO
Floyd Medical Center, Rome, GA
Named one of Becker’s Hospital Review Top 100
Slide 46
COPYRIGHT © STUDER GROUP
Please do not quote or disseminate without Studer Group authorization
Coaching Tips for Efficiency
1.
Block time on calendar and commit to NOT changing
2.
Round on nurses first to set priority of patients to be rounded on
3.
Set time expectation with patients/families at the start of rounds (avg
3-4 min)
4.
Use “change of plane” to signal the interaction is ending
5.
Be fully “present” with each patient/family to help focus conversation
letting the two questions carefully segue into other dialogue
6.
Gather all tools needed before starting rounds (census sheet, marker,
business cards, etc)
7.
Shadow another leader that seems to be more efficient
8.
Empower and train others to help
9.
Evaluate interruptions
10. Say “no” to all but the most essential of activities if you don’t have time
to round
Slide 47
COPYRIGHT © STUDER GROUP
Please do not quote or disseminate without Studer Group authorization
Tip #6 Set Measurable Goals
“When patient was rounded on by nurse leader, all but two
HCAHPS questions were favorable to national top decile.
The largest increase noted was with Overall Hospital Rating
and Nurse Listens which both had an increase of 95%tile
rankings when the leader rounded. This is evidence-based
proof that effective nurse leader rounding WORKS.”
Carol Martin, Chief Nursing Officer
Roper, St. Francis Hospital, Charleston, SC
Named #2 on Becker’s Hospital Review Top 100
Slide 48
COPYRIGHT © STUDER GROUP
Please do not quote or disseminate without Studer Group authorization
Tactic and Tool Implemented:
• Leader Rounding on Patient
Source: Professional Research Consultants - HCAHPS Data 2013 – Roper Hospital
Slide 49
COPYRIGHT © STUDER GROUP
Please do not quote or disseminate without Studer Group authorization
Tactic and Tool Implemented:
• Discharge Phone Calls
Source: Professional Research Consultants - HCAHPS Data 2013 – Roper Hospital
Slide 50
COPYRIGHT © STUDER GROUP
Please do not quote or disseminate without Studer Group authorization
Roper St. Francis Healthcare Patient Experience Trends
GREEN = VBP 2016
Achievement Target
(National Average)
ORANGE = National 75th
%tile Ranking
BLUE = VBP 2016
Benchmark Target
(National Top Decile)
RED = below VBP 2016
Achievement Target
(National Average)
200
7
200
8
200
9
201
0
201
1
Slide 51
201
2
201
3
ytd- 2014
COPYRIGHT © STUDER GROUP
Please do not quote or disseminate without Studer Group authorization
More Potential Measures
University of Maryland Study on effectiveness of rounding
Slide 52
COPYRIGHT © STUDER GROUP
Please do not quote or disseminate without Studer Group authorization
Summary of Tips
1. Connect the dots with staff that they are providing
excellent care and doing meaningful work
2. Set clear, concise expectations about rounding
and communication of themes/trends
3. Standardize the work to ensure consistency
4. Validate nurse leader competency in rounding
5. Help leaders manage time effectively
6. Set measurable goals and targets
Slide 53
COPYRIGHT © STUDER GROUP
Please do not quote or disseminate without Studer Group authorization
Dialogue: Your Questions
Share Your Lessons Learned and Barriers
Slide 54
COPYRIGHT © STUDER GROUP
Please do not quote or disseminate without Studer Group authorization