Considerations for Oncology Leader Rounding
No one wants to hear a diagnosis of “cancer” but with medical research and new treatment breakthroughs, more and more survivors are winning the battle for long and healthy lives. But until the prognosis and outcome are known, patients and families have many questions and need strong support from the healthcare community. Patient “transitions” are a key component of cancer care as patients are referred from their primary care provider and navigate through a team of specialists who assure that body systems are protected while aggressive treatments are aimed at the disease. Even when cancer goes into remission or is cured, many of these patients face a future of long-term episodic care. These patients and their families present with “unique but consistent” needs. Care that is unique to them, based on their cancer and treatment, but once established, consistent and ongoing.
Why are you rounding?
Seeking real clarity about why you are rounding is critical with this population. As patients progress through treatment, their needs will vacillate between a safety focus and an experience focus. These patients need to understand and protect themselves from infections, falls, skin breakdown and nutrition deficits. During this phase, rounding might focus on safety questions and observations. Avoiding infections might lead to patient isolation and feelings of loneliness. These feelings can negatively impact patient experience perceptions. In small centers, where all patients are seen consecutively, leaders can utilize general rounding question sets to visit with all patients. In large academic centers, approaching patient safety and experience by diagnostic group can help to streamline the process and drill down on relevant issues. Environmental rounds (audits) to assess safety risks and service gaps can be extremely helpful.
Who is the most appropriate leader to round on cancer center patients?
Unfortunately, assigning leaders or team members to round on patients in ambulatory cancer care settings is not a “one-size-fits-all” decision. It might depend upon workflow, diagnoses, individual patient needs or preferences, and the realities of leader workload. The substance of a round with “genuine caring and concern” are much more important than the title of the person who rounds. While the listening ear of a leader can be very effective if service recovery is needed, any caring individual who is empowered to list and act on patient needs can be helpful. In some settings, engaging a team of individuals to share rounding responsibilities is a better fit. Facilities utilizing the Nobl Leader rounding platform can add or delete any number of rounders and any number of customized question sets at the clinic or division level. By managing permissions, access to the real time data by individuals conducting the rounds, those in their chain of command or other facility leaders, such as the patient experience team, is easily accomplished. Rounders have all the results and comments from the previous round on the patient at their fingertips, no matter who conducted the round. Leaders can also enter information from their desk or smart device, within or outside of a formal round.
What time is appropriate to round?
Rounding on patients during episodic care is challenging. Set or staggered times of day to round in the reception or waiting areas can be helpful but might still result in missed rounds. Incorporating an appointment with the nurse leader (or designee) into the initial visit to the center can provide a greeting and direct conduit for the patient to reach out when support or service recovery is needed. This can be a time to establish the expectations of both the providers and the patients. Follow up with scheduled rounds at specific visit intervals (after the third, sixth or tenth visits) can help the leader to remain engaged with the patient throughout their care. Using a leader business card with patient-appropriate contact information can also be a valuable tool.
With recent advances, oncology care has become primarily an ambulatory practice and inpatient admissions have been greatly reduced. But there are exceptions when patients may still require inpatient stays. Whether inpatient stays are overnight or extended, finding ways for ambulatory leaders to connect with patients during these stays is important. Letting them know that their clinic team is thinking of them and staying up to date on what is happening can greatly enhance their perception of courtesy, respect, listening, and feeling that their individual needs are being met.
How do you set realistic rounding goals for this population?
Leader rounding on cancer patients is as variable as the diagnoses involved. Creating rounding goals might require an element of trial and error at first, but it is well worth the effort to identify targets for success. By evaluating the needs and schedules of the staff and patients, realistic and attainable goals can be reached. For organizations that have had a strong manual process, the conversion to digital is straightforward. After allowing for a brief device related learning curve compliance can quickly reach much higher levels, thanks digital recording and reporting time savings. Nobl platforms support customized goals that account for multiple rounders in the same area, limited hours when rounds are possible, and counting rounding attempts as a successful round when environmental or safety assessments are accomplished. Questions can be alternated to reduce repetition from day-to-day or to drill down on specific quality and patient experience targets by clinic or unit.
How can rounding be linked to service recovery and employee recognition?
Nobl recognizes that sometimes things are missed, or patients need a little more assistance. Sometimes healthcare teams need to go above and beyond to restore patient trust. Using our “concerns” feature and Service Recovery module to communicate, resolve, and trend issues, facilities can move beyond isolated tracking to a more comprehensive and data-based approach. Similarities across clinic settings may identify larger systemic service issues that require a more global approach to achieve lasting change. Nobl RealTime™ allows a leader to review previous engagement and rounding responses for a specific patient prior to conducting a round, so that service recovery can be assessed and prior issues can be made a priority of the conversation.
Our “praise” feature makes it easy to pass along patient recognition to team members in real time, forward praises to direct supervisors, or celebrate the positive comments and compliments received by the whole cancer center.
Is it realistic to round on patients finishing therapy?
If leader rounding is challenging, make it a priority to round as the patient is beginning and ending therapy. The final visit is also a great time to evaluate the overall care experience, initiate service recovery as needed, and explain expected surveys or phone calls that the patient and family might receive. Another strategy might be sending personal cards/emails at intervals to remind the patient that he was valued beyond just his physical needs. Nobl products can audit any persistent process.
Everyone can share a story of a family member or friend who has been impacted by cancer. The expertise, empathy, and caring provided by oncology healthcare professionals saves lives and provides hope. These teams need supportive technology that enhances their ability to do this critical work, saves time spent on documentation, and provides follow-up data to make patient experiences better. The Nobl team delivers customized technology, responsive service, and ongoing analysis to meet those goals.
Written by Teresa Anderson, EdD,MSN, NE-BC, Nobl CNO