Staff Accountability and Feedback

1. Staff Accountability and Feedback • Patient Focused Rounding

2. Do we really know what our patients want?

3. Patient’s perceptions are influenced by… • Environmental Factors • (Service Environment) • Human Factors • (Service Delivery) • Process Factors • (Service Processes)

4. Human Factors (Service Delivery) All of these are communicated by you • What We Do • Service standards • How We Do It • Body language • What We Say • Scripting • How We Say It • Para-language • How We Look • Appearance

5. The Voice of Our Customer • Why does this matter?

6. I gave you “very good” on your survey. I am six times morelikely to go to your competitorin the future.

7. I gave you “excellent” on your survey. I am six times lesslikely to go to your competitorin the future.

8. What’s in the gap between the “usually” and the “always”? • The “very goods” to the “excellent”

9. Nurse Leader Rounding on Patients • Organization-wide applicability and accountability • A way of hard-wiring a consistent message for the organization.

10. Nurse Leader Rounding on Patients • Builds relationships • Take notes • Accept feedback • Validate staff performance • Follow up on compliments and concerns

11. Focused • Traditional vs. • Nurse Leader Rounding on Patients • Defined population daily • All new or All DC • Clinical Assessment • IP visit • Complaint Visit • Part of Interdepartmental Rounding • Problem disposition • Problem patient • Population is staff driven • Focus is derived from action plans your staff has committed to • Goal is listen and confirm that actions are consistent in all staff • Goal is setting expectation “our goal is excellent care…” • Goal is fix problem and seek recognition for staff

12. Benefits of Nurse Leader Rounding on Patients • Build relationships • Reward and recognize • Ensue patient safety • Ensure high quality & consistency of services provided • Identify opportunities for improvement • Remove barriers to a “WOW” experience

13. Begin the process by… • Understanding what your patient/family is telling you regarding their past experience through HCAHPS, and survey data, comments, letters and rounding..

14. Action Plan • Educate all staff to actions and advise effective date • Display agreed actions in common area on unit for visibility • Leaders document agreed actions on Pt. Rounding Log • Select patient population for rounding (consider staff assignment) • Begin rounding with focused questions • Document outcomes on rounding log • Share findings with staff and senior leaders

15. Preparing to Round • Patient satisfaction and or HCAHPs surveys, comments, reports, census and knowledge of services provided • Staff assignments • Business cards…Rounding Logs • Dry erase markers and/or pad and pencil • Ancillary department numbers and resource information • Items for “On the Spot” reward and recognition

16. Getting Started • What is the goal? The “Always experience” • What is the action plan decided on by the staff to address the priority items in the survey? • What questions might be asked that will validate consistency in following the action plan? • How frequently will rounding occur for patient/family?

18. Conduct Rounding and Document

19. Rounding Steps

20. Step 1: Build the Relationship • Provide an introduction • Maintain eye contact/smile • Put the person at ease • Good morning Mrs. ____. My name is Kathleen, and I am the head nurse of 4W, how are you this morning? Is this your first time in Unity Point?

21. Step 2: Set Expectations • Explain reason for rounding • Encourage open and honest communication It is very nice to meet you. As I said, I am the Head Nurse, and I have been with Unity Point for ten years. One of the things I like to do as HN is take time to meet my patients and ask them a few questions about the care they have received while in our hospital. Is this a good time?

22. Step 3: Focus the Inquiry • Listen, learn and help connect the dots • Use specific language • Focus on fact-finding, not fault-finding • Ask probing questions-high gain, open ended In Unity Point we want to make sure that every patient receives excellent care, now on my unit part of excellent care is making sure we have good communication with our patients, and making sure they understand the plan of care so can I ask you……

23. Step 4: Close the Encounter • Offer to provide additional assistance/help • Tell them what you will do with the information and by when • Say “thank you” and leave your contact information I want to thank you so much for this information, it is so important for us to hear from our patients and I also want to thank you for choosing Unity Point, it is our privilege to care for you, I will be sharing this feedback with our staff

24. Step 5: Act On the Information • Take notes and follow-up on actions • Act on opportunities for improvement • Under promise and over deliver • Reward, recognize, and celebrate! • Trend issues/opportunities for improvement. Share findings with the senior leaders, peers, and employees

25. Our Coaching To Engage Leaders and Front Lines • Connect to purpose • Identify departmental situations • Involve staff in developing examples • Role play, practice, and observe • Monitor and Measure patient reactions and results • Reinforce the behaviors and accountabilities

26. Discovery and Apology Scripts • In the last 24 hours have you needed to use your call light? If so, what for? Were we timely in our response? • Describe your experience. • Tell me more. • Is there anyone I can recognize for providing you with “excellent” care? What exactly did they do? • I apologize for the delay in answering your call light. Tell me how I can make this better for you?

27. Focus on the Positives • Manage up • Send “Thank You” notes to the employee’s home • During rounds, identify employees within your department, as well as employees from other departments, who should be recognized for consistently following the action plan • Recognize those employees mentioned by name • Involve employees in the decision making process

28. Entry Script to Interact with Patient’s Family • “I’m _______, the Director of _________. Our goal is that you receive Very Good care while you are a patient here. • Do you have time to answer a few questions for me?

29. Likely Barriers to Effective Nurse Leader Rounding on Patients • Not prioritized as part of daily schedule • Distractions and called to fight “fires” • Accountability Gaps • Overall lack of belief in patient focused rounding as a critical management tool • Failure to act on the information

30. Does Nurse Leader Rounding on Patients • Really make a difference?

31. 90 82 81 76 80 71 66 70 60 50 40 30 30 21 20 13 11 6 10 0 Aug Apr May Jun Jul Aug Apr May Jun Jul All Hospitals Inpatient - 2009 • Percentile Ranking Nurse Leader Rounded Yes No

32. Journey from the 24th to 99th percentile in 24 months Implemented Monthly Patient Satisfaction Tracking and Reporting System: turning data into actionable knowledge and transparency, accountability, Rounding, Words that Work

33. Impact of Nurse Leader Rounding on Patients

34. Outcomes of Nurse Leader Rounding on Patients • Patients rounded on by Nurse Leaders reported satisfaction levels on average 59 percentile points higher than patients not rounded on by nurse leaders • Decrease patient complaints by 66% • Reduce Emergency Department LWOT from 4.5% to 2%

35. Questions?

36. Thank You for Making a Difference • Anne Mendoza RN,MS