Leader Rounding on Patients A Must Have!

Evidence Based Leadership (EBL) SM Meeting Title Here (on Notes Master) Evidence Based Leadership (EBL) SM Breakthrough Foundation STUDER GROUP: Leader Evaluation Leader Development Must Haves® Performance Gap Standardization Accelerators Aligned Goals Aligned Behavior Aligned Process Implement an organization-wide leadership evaluation syst. to hardwire objective accountability PILLAR GOALS LEM (Principle 7) Create process to assist leaders in developing skills and leadership competencies necessary to attain desired results LDI (Principles 4 & 8) Rounding Thank You Notes Employee Selection Pre and Post Phone Calls Key Words at Key Times AIDET & Managing Up (Principles 3, 5, 6, & 9) Re-recruit Excelling and Achieving performers Move Lagging performers up or out (Principle 4) Agendas by pillar Peer interviewing 30/90 day sessions Pillar goals (Principles 1 & 2) Leader Eval MgrSM (LEM) Discharge Call MgrSM (DCM) Rev 11.07 www.studergroup.com © 2008 Studer Group

Types of Rounding for Outcomes Leader Rounding on Employees Senior Leader Rounding Physician Rounding Leader Rounding on Internal Customers Leader Rounding on Patients Senior Leader Rounding – Scouting Report

Rounding for OU Medical Center Inpatient Rounding Rounding for OU Medical Center

Leader Rounding on Patients 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. What is it? 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 Why is it important? 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. How will it be used?

Nurse Leader Rounding Improves Patients’ Perception of Nursing Quality 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.

Meeting Title Here (on Notes Master) Leader Rounding on Patients “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= 104 n= 105 n= 106 n= 96 Source: Arizona Hospital, Total beds = 355, Employees = 4,000, Admissions = 10,188; updated 2Q2010 www.studergroup.com © 2009 Studer Group®

Meeting Title Here (on Notes Master) Goals and Questions Communicate to Patients I am the leader and responsible for the quality of care delivered. I care about you (Empathy and Expectations) I appreciate you sharing that. (Reward and Recognition) I am proud of the care we provide. (Manage Up, Quality) I am sorry. (Service Recovery if needed) Hardwire Staff Behaviors and Increase Accountability Round by assignment Coaching for performance conversations At conclusion, ask: What have I learned about the quality of care of that patient? What must I do with that information? Are there gaps in performance? Actions to address? What recognition do I need to provide for consistent performance? www.studergroup.com © 2010 Studer Group

Reward the Behaviors that Patients Need Meeting Title Here (on Notes Master) Reward the Behaviors that 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 www.studergroup.com © 2007 Studer Group

Determined from analysis of patient satisfaction results 2x2s = Focus 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

Highest Priority Quality Issues Ask Questions in the Right Way 2x2 Questions 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

The Right Questions (Inpatient Nursing) Meeting Title Here (on Notes Master) The Right Questions (Inpatient Nursing) Ask targeted questions to obtain actionable information Two areas of focus from patient perception One area of focus from quality There are proven leadership behaviors that create better organizational performance and Rounding for outcomes is one of them. www.studergroup.com © 2007 Studer Group 12

HCAHPS

The Right Questions (Other Areas) Meeting Title Here (on Notes Master) The Right Questions (Other 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) There are proven leadership behaviors that create better organizational performance and Rounding for outcomes is one of them. www.studergroup.com © 2007 Studer Group 14

Tool: Amb/Clinic

Rounding by Assignment 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

Who and How Often 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

Summarize findings and trends Document (logs are mandatory) 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) Best practice – round on patients day after transfer from ICU unit or admission from ED

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

What Right Looks Like 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”.

What Right Looks Like 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”

What Right Looks Like 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

Tools

Tools – Plan and Roles Defined

Discharge Call Manager Results in Patient Safety and Satisfaction

Nine Principles for Service and Operational Excellence 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

Evidence Based Leadership (EBL) SM Meeting Title Here (on Notes Master) Evidence Based Leadership (EBL) SM Breakthrough Foundation STUDER GROUP: Leader Evaluation Leader Development Must Haves® Performance Gap Standardization Accelerators Aligned Goals Aligned Behavior Aligned Process Implement an organization-wide leadership evaluation syst. to hardwire objective accountability PILLAR GOALS LEM (Principle 7) Create process to assist leaders in developing skills and leadership competencies necessary to attain desired results LDI (Principles 4 & 8) Rounding Thank You Notes Employee Selection Pre and Post Phone Calls Key Words at Key Times AIDET & Managing Up (Principles 3, 5, 6, & 9) Re-recruit Excelling and Achieving performers Move Lagging performers up or out (Principle 4) Agendas by pillar Peer interviewing 30/90 day sessions Pillar goals (Principles 1 & 2) Leader Eval MgrSM (LEM) Discharge Call MgrSM (DCM) Rev 11.07 www.studergroup.com © 2008 Studer Group

Purpose, worthwhile work and making a difference Healthcare Flywheel® Bottom Line Results (Transparency and Accountability) Prescriptive To Do’s Post-Visit Calls Discharge Call ManagerSM Purpose, worthwhile work and making a difference ® Self-Motivation

Annals of Internal Medicine, February 2003 “Nearly 1 in 5 patients”* Type of Adverse Events Other 400 patients surveyed Fall 8% 76 (19%) had adverse events after discharge 4% Nosocomial Infection 5% Adverse Drug Event Procedure Related 17% 66% * 81 events occurred in 76 patients * “Adverse Events After Discharge from Hospital”, Annals of Internal Medicine, February 2003

Post-Visit Call - Benefits Reconfirms discharge instructions Reduces patient anxiety Reduces complaints and claims Reinforces patient perception that excellent care has been provided Confirms hardwiring of processes

Post-Visit Discharge Phone 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? . . .” “Mrs. Smith, we like to recognize our employees. Who did an excellent job for you while you were in the hospital? . . .” Reward and Recognition “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 Practices to Implement Discharge Call ManagerSM 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

Rounding on Patients and 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

Patient and Family Rounding Use AIDET Manage up Think of it as quality improvement Think of it as safety checks

Patient Rounding for Outcomes

Patient Rounding Frequency Report Record daily rounding, frequency, and outcomes. Report weekly at huddles and send weekly to Claudette Greenway, Shella Southern, Margaret Wilson, or Heather Gaultney If Metrics are not moving in a positive direction you must bring an Action Plan

What questions do you have?