Transcript Leader Rounding on Patients

Leader Rounding on Patients
A Must Have!
1
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Evidence
Based
Master
Leadership
title style
(EBL) SM
Foundation
STUDER GROUP:
Leader
Development
Leader
Evaluation
Aligned Goals
Implement an
organization-wide
leadership
evaluation syst.
to hardwire
objective
accountability
PILLAR GOALS
LEM
(Principle 7)
Rev 11.07
Create process
to assist leaders
in developing
skills and
leadership
competencies
necessary to
attain desired
results
LDI
(Principles 4 & 8)
Must
Haves®
Performance
Gap
Aligned Behavior
Rounding
Thank You Notes
Employee
Selection
Pre and Post
Phone Calls
Key Words at
Key Times
AIDET &
Managing Up
(Principles 3, 5,
6, & 9)
Standardization
Accelerators
Aligned Process
Re-recruit
Excelling
and
Achieving
performers
Agendas
by pillar
Leader Eval
MgrSM (LEM)
Peer
interviewing
Move
Lagging
performers
up or out
30/90 day
sessions
Discharge
Call MgrSM
(DCM)
(Principle 4)
Pillar goals
(Principles 1 & 2)
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Types
Rounding
Masterfor
title
Outcomes
style
 Leader Rounding on Employees
 Senior Leader Rounding
 Physician Rounding
 Leader Rounding on Internal Customers
Leader Rounding on Patients
Inpatient Rounding
Rounding for OU Medical Center
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Leader
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ontitle
Patients
style
What is it?
Why is it
important?
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.
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How will it
be used?
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.
NursetoLeader
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Rounding
titleImproves
style
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.
Leader
ontitle
Patients
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style
“Did a Nurse Manager Visit You During Your
Stay?”
n= 561
n= 604
n= 601
n= 608
Tactic and Tool Implemented:
• Leader Rounding on Patient
n= 106
n= 104
n= 105
n= 96
Source: Arizona Hospital, Total beds = 355, Employees = 4,000, Admissions = 10,188; updated 2Q2010
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Goals
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Questions
Master title style
Communicate to Patients
1. 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 Accountability
1. Round by assignment
2. Coaching for performance conversations
At conclusion, ask:
1. What have I learned about the quality of care of that patient?
2. What must I do with that information?
3. Are there gaps in performance? Actions to address?
4. What recognition do I need to provide for consistent performance?
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Reward
the Behaviors
Master title
that
style
Patients Need
Patients assume quality clinical care
It 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
Perspectives on American Healthcare 2007. A report from studying 2.3 million patients at 1700 hospitals. Press, Ganey
Click =toFocus
2x2s
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• 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
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2x2
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• 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
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The
to edit
Questions
Master title
(Inpatient
style Nursing)
• Ask targeted questions to obtain
actionable information
• Two areas of focus from patient
perception
• One area of focus from quality
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HCAHPS
ClickRight
The
to edit
Questions
Master title
(Other
style
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)
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Tool:
Amb/Clinic
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Rounding
byMaster
Assignment
title style
• Caregiver focused which
enables focused validation of
staff behaviors & coaching for
improved outcomes
 Safety
 Patient Communication
Boards
 Patient education
• Captures patient concerns &
can be connected to
Communication with Nurses
• Can eliminate re-work
Click to
Who
and
edit
How
Master
Oftentitle style
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
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Guidelines
• 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)
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Compliance/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
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What
Right
editLooks
Master
Like
title style
• 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”.
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What
Right
editLooks
Master
Like
title style
• 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”
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What
Right
editLooks
Master
Like
title style
• 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 style
Tools
Click to
Tools
– Plan
edit Master
and Roles
title
Defined
style
Discharge Call Manager
Results in Patient Safety and Satisfaction
25
Nine
ClickPrinciples
to edit Master
for Service
title style
and Operational Excellence
1.
2.
3.
4.
5.
6.
7.
8.
9.
Commit to Excellence
Measure the Important Things
Build a Culture Around Service
Create and Develop Great Leaders
Focus on Employee Satisfaction
Build Individual Accountability
Align Behaviors with Goals and Values
Communicate at All Levels
Recognize and Reward Success
Click to edit
Evidence
Based
Master
Leadership
title style
(EBL) SM
Foundation
STUDER GROUP:
Leader
Development
Leader
Evaluation
Aligned Goals
Implement an
organization-wide
leadership
evaluation syst.
to hardwire
objective
accountability
PILLAR GOALS
LEM
(Principle 7)
Rev 11.07
Create process
to assist leaders
in developing
skills and
leadership
competencies
necessary to
attain desired
results
LDI
(Principles 4 & 8)
Must
Haves®
Performance
Gap
Aligned Behavior
Rounding
Thank You Notes
Employee
Selection
Pre and Post
Phone Calls
Key Words at
Key Times
AIDET &
Managing Up
(Principles 3, 5,
6, & 9)
Standardization
Accelerators
Aligned Process
Re-recruit
Excelling
and
Achieving
performers
Agendas
by pillar
Leader Eval
MgrSM (LEM)
Peer
interviewing
Move
Lagging
performers
up or out
30/90 day
sessions
Discharge
Call MgrSM
(DCM)
(Principle 4)
Pillar goals
(Principles 1 & 2)
®
Click to editFlywheel
Healthcare
Master title
style
• Bottom Line Results
(Transparency and Accountability)
Prescriptive
To Do’s
Post-Visit Calls
Discharge Call
ManagerSM
SelfMotivation
Purpose,
worthwhile work
and making
a difference
®
Click toof
Annals
edit
Internal
MasterMedicine,
title styleFebruary 2003
Type of Adverse Events
“Nearly 1 in 5
patients”*
Other
400 patients surveyed
76 (19%) had adverse
events after discharge
Fall
Nosocomial
Infection
Procedure
Related
8%
4%
5%
17%
66%
Adverse
Drug
Event
* 81 events occurred in 76 patients
* “Adverse Events After Discharge from Hospital”, Annals of Internal Medicine,
February 2003
Click to edit
Post-Visit
Call
Master
- Benefits
title style
•
•
•
•
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
Post-Visit
Discharge
Master title
Phone
style
Call Sample
Empathy and Concern
“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…”
Clinical Outcomes
“Mrs. Smith, did you get all your medications filled? . . .”
“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? . . .”
Reward and Recognition
“Mrs. Smith, we like to recognize our employees. Who did an excellent
job for you while you were in the hospital? . . .”
“Can you tell me why Sue was excellent?. . .”
Service
“We want to make sure you were very satisfied with your care. How
were we, Mrs. Smith?. . .”
Process Improvement
“We’re always looking to get better. Do you have any suggestions for
what we could do to be even better? . . .”
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? . . .”
Best
to Implement
Click Practices
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title style
Discharge Call Manager
SM
• 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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Rounding
onMaster
Patients
title
andstyle
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 and
Patient
edit Family
MasterRounding
title style
1.
2.
3.
4.
Use AIDET
Manage up
Think of it as quality improvement
Think of it as safety checks
Click to Rounding
Patient
edit Master
fortitle
Outcomes
style
Click to Rounding
Patient
edit Master
Frequency
title styleReport
Click to edit Master title style
What questions do you have?