Leader Rounding on Patients A Must Have 1

Leader Rounding on Patients A Must Have! 1

Click to edit Evidence Based Master Leadership title style (EBL) SM ugh thro k a e r B 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 Mgr. SM (LEM) Peer interviewing Discharge Call Mgr. SM (DCM) Move Lagging performers up or out 30/90 day sessions (Principle 4) Pillar goals (Principles 1 & 2)

Click toofedit Types Rounding Masterfor title Outcomes style C Leader Rounding on Employees C Senior Leader Rounding C Physician Rounding C Leader Rounding on Internal Customers ü Leader Rounding on Patients

Inpatient Rounding for OU Medical Center 4

Click to. Rounding Leader edit Master 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. • • • 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.

Nurseto. Leader Click edit Master Rounding title. Improves style Patients’ Perception of Nursing Quality Increase in Percentile Ranking for HCAHPS Measure "Nurses Always Communicated Well" Following Implementation of Nurse Leader Rounding 1 st Qtr after Implementation 2 nd Qtr after Implementation 3 rd Qtr after Implementation 4 th Qtr after Implementation 5 th Qtr after Implementation 6 th 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 3 Q 09 -2 Q 10.

Leader ontitle Patients Click to. Rounding edit Master 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 2 Q 2010

Click toand Goals edit 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?

Click to edit 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: P Listened to when they have a complaint P Shown sensitivity by empathetic staff P Communicated with, kept informed and included in decisions P Treated with respect and dignity and emotional needs met P 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 =to. Focus 2 x 2 s edit Master title style • 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

Click. Questions 2 x 2 to edit Master title style • Key Drivers (2 x 2 s) – 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

Click. Right 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

Click to edit Master title style HCAHPS

Click. Right 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)

Click to Tool: Amb/Clinic edit Master title style

Click to edit Rounding by. Master Assignment title style • Caregiver focused which enables focused validation of staff behaviors & coaching for improved outcomes PSafety PPatient Communication Boards PPatient 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

Click to edit Master title style 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)

Click to edit Master title style 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: LRP 6: WEEKLY REPORT

Click to What Right edit. Looks 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”.

Click to What Right edit. Looks 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”

Click to What Right edit. Looks 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 Click. Principles 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 ugh thro k a e r B 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 Mgr. SM (LEM) Peer interviewing Discharge Call Mgr. SM (DCM) Move Lagging performers up or out 30/90 day sessions (Principle 4) Pillar goals (Principles 1 & 2)

® Click to edit. Flywheel Healthcare Master title style • Bottom Line Results (Transparency and Accountability) Prescriptive To Do’s Post-Visit Calls Discharge Call Manager. SM Self. Motivation Purpose, worthwhile work and making a difference ®

Click toof Annals edit Internal Master. Medicine, title style. February 2003 “Nearly 1 in 5 patients”* 400 patients surveyed 76 (19%) had adverse events after discharge Type of Adverse Events Other Fall 8% 4% Nosocomial Infection 5% Procedure Related 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 Clinical Outcomes “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…” “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 to edit Master 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 33

Click to edit Rounding on. Master 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 Master. Rounding 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 style. Report

Click to edit Master title style What questions do you have?