1. Leader Rounding on Patients
A Must Have!

2. 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
© Studer Group

3. 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

4. Rounding for OU Medical Center
Inpatient Rounding
Rounding for OU Medical Center

5. 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?

6. 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.

7. 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
© Studer Group®

8. 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?
© 2010 Studer Group

9. 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 A report from studying 2.3 million patients at 1700 hospitals. Press, Ganey
© Studer Group

10. 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

11. 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

12. 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.
© Studer Group 12

13. HCAHPS

14. 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.
© Studer Group 14

15. Tool: Amb/Clinic

16. 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

17. 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

18. 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

19. 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

20. 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”.

21. 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”

22. 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

23. Tools

24. Tools – Plan and Roles Defined

25. Discharge Call Manager
Results in Patient Safety and Satisfaction

26. 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

27. 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
© Studer Group

28. 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

29. 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

30. 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

31. 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? . . .”

32. 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

33. Patient Rounding (Clinic Environment)
Rounding for OUP Clinics

34. 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

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

36. Patient Rounding for Outcomes

37. 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

38. What questions do you have?