My Experience Implementing Hourly Rounding in a Healthcare System
I remember vividly the day in early 2007 when the President of our health system called together a patient experience team to discuss a mission critical priority. I was being asked to co-lead the roll-out of Hourly Rounds simultaneously on 28 inpatient acute care units (including critical care) across five hospitals. Based on the results of a Studer Group study, the Executive Leadership Team was convinced that this nursing evidence based practice would fix our patient satisfaction scores before the end of the fiscal year.
My HR/Marketing co-chair and I adopted a “project-in-a-box” methodology to give the unit managers tools to customize for the unique needs of their unit. We made the unfortunate assumptions that nurse managers had project management expertise and they would include unit educators/CNSs. Things snowballed from there: Managers and bedside staff resented “the higher ups” telling them how to care for their patients, dry erase rounding boards ruined walls behind them, paper rounding logs became a “check box” exercise at shift’s end to stay off the naughty list, and ICU nurses documented every patient encounter – sometimes five times per hour. The end-users had missed the real purpose of consistent, purposeful interactions with patients to build trust, provide comfort, and to make them genuinely feel that staff cared.
Four weeks later we regrouped and started over – from bottom to top – by guiding interprofessional unit-based groups to define their service excellence goals, to wow patients and to determine what would work best for their team. The toolkit was re-evaluated, some pieces retained and rounding logs were replaced with door clocks. Leaders agreed to regularly assess and support project compliance, and educators/CNSs became non-punitive coaches providing real-time education, recognition and reinforcement.
The process stuck in a majority of areas and scores improved, but the compliance data available from the paper forms was inconsistent and not helpful. From The Two Most Important Quotes in Business , Peter Drucker said, “If you can’t measure it, you can’t improve it.” Many online tracking tools exist for nurse documentation, hourly rounding and leader rounding; but, Nobl is portable, intuitive, and supports rounding actions. Our portfolio goes beyond compliance to reward high performance, fix problems, coach staff, communicate with other stakeholders, and provide immediate service recovery! Nobl has also brought Leader Rounds on patients and employees into a single, customizable solution.
Learn from my mistakes – involve clinical staff in designing and implementing work flow improvements and also in the decision-making around technology support devices and software.
Blog written by Dr.Teresa Anderson, EdD, MSN, RN, NE-BC, Chief Nursing Officer, Nobl