Purposeful Rounding: Pitfalls and Promises

The dreaded call light. Patients have a need, press the call button, and expect an immediate response. Understandably, nurses and care staff feel the pressure to oblige. After all, patient satisfaction scores are tied to reimbursements, and customers will share their dissatisfaction very publicly on social media and consumer rating sites. Unfortunately, the call light interruptions to workflow ultimately often lead to even worse satisfaction for both patients and caregivers.

Are there better alternatives? Many health care organizations are adopting purposeful, hourly rounding so caregivers have the opportunity to tackle patient requests before they arise.

The migration from traditional rounds – usually centered on physician needs versus patient or system needs – to purposeful rounding is not likely to be easy and certainly requires change management. The “hardwiring” of purposeful rounding requires caregiver buy in, thoughtful training and leadership support.

Your health care system’s brand is dependent upon customer and community perception of your organization’s promise of quality, safety and service. Many health care organizations are now aligning marketing’s brand promise with the clinical and operational delivery of care. This represents a true partnership between marketing and operations.

Patient Safety and Satisfaction

Studies show purposeful rounding can result in higher patient safety and better patient and staff satisfaction.

According to a study in 2016 at Walden University, hourly nurse rounding has “an almost immediate positive impact on patient satisfaction.”

Sacred Heart Hospital in Pensacola Florida hardwired hourly rounding into their care culture. After five months, they found patient falls were reduced by one-third and hospital-acquired pressure ulcers were reduced by 56%. Call light usage in their short five-month study was reduced by half, and patient satisfaction increased by 71%.

It’s not just patients who are more satisfied at Sacred Heart. Staff indicated feeling less chaotic and having more control over their day and an “uncanny feeling of calmness” during a time of increased census. Nurse satisfaction when from 31% to 98%

Successful Implementation – and Possible Pitfalls

With so much evidence supporting the implementation of hourly rounding for its positive effects on patient safety and satisfaction, everyone should be doing it, right? Well…yes and no.

An Advisory Board study “Enhancing the Patient Experience – Staff-Driven Hourly Rounding” (please note this link requires membership) addresses the problem of caregiver compliance and lack of buy-in that are often associated with hourly rounding. Their key solutions include: making sure front line staff understands the benefits of hourly rounding, increasing staff investment/input in the process, and consistently and effectively auditing compliance.

The Studer Group Sacred Heart study focuses heavily on hardwiring hourly rounding into their culture as a means to truly embrace it. Their astounding positive results in patient satisfaction were a direct result of the tools they used to hardwire hourly rounding including (but not limited to):

  • hourly rounding dashboard report
  • competency checklist
  • hourly rounding patient materials (for patients)
  • weekly hourly rounding leadership meeting including CNO
  • consistently connecting to purpose (sharing positive patient and staff feedback).

This idea of hardwiring can also be found in an “Analysis of How Newly Hired Nurses are Educated to Provide Customer Service” from Walden University. In this article, Patricia McAfee suggests that improving customer service skills for nurses may directly impact health outcomes for patients. She proposes that organizations should thoughtfully consider the ways in which it trains and teaches customer service – and its expectations of nursing staff around customer service and patient satisfaction.

One final potential pitfall is a lack of leadership participation. In “Nurse Leader Patient Rounds” Methodist Children’s Hospital’s CNO Ann Winn suggests that when nurse leaders round, there is a perception of quality as well as accountability. She advises nursing leaders to keep rounding logs to show accountability and trends – and comparing those rounding logs against HCAHPS scores. Ultimately nurse leaders should share this information with staff at a weekly huddle that is driven by rounding logs data. The bottom line: nurse leaders should join the rounding process.

In Conclusion

Consider your brand and your brand promise to your customers.

The promise of hourly rounding is clear: increased patient safety, reduced call light usage and improved patient satisfaction. The pitfalls can be many: without an engaged staff who understands your brand promise, the importance and benefits of hourly rounding and a supportive leadership team who willingly participates, purposeful rounding can quickly become a task-oriented, checklist-based practice without meaning – one in which the patient isn’t seen as a person, but rather a checkmark on a list.

As the need for improved patient satisfaction scores rises and customer rating sites grow in receptivity, your organization may have to develop new policies as they relate to customer service and patient satisfaction; likewise, new practices may need to be implemented – practices like hourly rounding. Take the time to partner with your nursing operations group and review your current processes for patient satisfaction against evidence-based, best-practice strategies and consider whether hourly or purposeful rounding might be right for your organization, and your patients.