Using Nurse Leader Rounding to Improve Patient Experience

January 02, 2019 - As healthcare professionals continue to weigh hospital amenities and a luxurious hospital and patient experience, nurse leaders from Lucile Packard Children’s Hospital Stanford, a part of Stanford Children’s Health, have demonstrated that patient-provider relationships and interpersonal skills are more valuable than any other part of the care counter.

A positive patient experience has always been an important part of Stanford Children’s Health’s mission, the provider’s chief nursing officer Kelly Johnson, PhD, RN, NEA-BC, said in an interview with PatientEngagementHIT.com.

“There's a national perspective on the patients’ care experience across the continuum of care that they receive by any organization,” explained Johnson, who is also Stanford’s vice president for patient care services. “Like other organizations, we're putting a lot of effort and energy into ensuring that the patients do have a great care experience for a variety of reasons.”

The rationale for this has many layers, Johnson continued. Foremost, she and her colleagues believe there is a moral obligation to deliver the best quality of care and the best care experience possible.

But outside of those moral obligations, hospitals and health systems across the country are facing new payment models that focus on the experience of care for the patient. Additionally, consumer expectations are pushing more industry groups to focus on patient satisfaction.

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“Consumers have high expectations of their experience,” Johnson said. “They're responsible for more of the payment of their care, so they're becoming more knowledgeable and coming with having done more research on the internet and other places. For all of these reasons, every care team member, physicians, nurses, our patient experience partners, we're all involved in ensuring that we deliver the best care.”

So when Johnson and her team noticed patient satisfaction scores dipping, they knew it was time for an overhaul.

Lucile Packard Children’s Hospital serves not only pediatrics but also obstetrics care. But as the hospital has seen incredible growth, they are no longer able to provide every mother a private room.

“That clearly can impact a patient's experience, especially in this day and age when people are more used to private rooms, and in some maternity hospitals, more of a spa-like experience,” Johnson said.

On the whole, the hospital’s less desirable patient experience scores were less about care quality and more about facilities. But improving facilities is a costly project and one that cannot improve patient experience overnight. It requires time for renovations that Johnson and her team did not have.

Like so many organizations across the country, they have had to toe the line between creating a luxury hospital experience and using patient interactions to improve care experience.

Ultimately, Johnson and her team decided instead to deliver customer service that is above and beyond by employing nurse leader rounding.

The initiative started with what Johnson called Rounding 1.0. Armed with iPads for documentation, nursing leaders visited every patient at least once each day to check in on patient concerns and report any issues with rooms and treatment.

Although this approach certainly improved some aspects of the patient experience, it was far from perfect, Johnson explained.

“On the nurse leaders' side, they were frustrated that they couldn't always get to every patient every day because of a variety of issues – the family's not in the room, the patient has had a procedure, they're not accessible, or there were emergencies the nurse needed to manage,” Johnson reported.

Additionally, technology served as a considerable burden for nurse leaders. Technology has the ability to streamline patient care and add efficiency to quality reporting. But when a nurse’s goal is to improve the patient experience and nurse-patient interaction, putting a piece of technology between herself and the patient is not ideal.

“The issue with the technology, it was taking in an iPad into the room, and it didn't matter what generation they were or how long they had been a nurse, they wanted that personal connection with the patient and not to be paying attention to the iPad,” Johnson stated.

To cope with the technology burden, nurses began leaving the iPad out of the room, which added a documentation burden down the line. This increased nurse workflows or, if they didn’t end up documenting, disqualified them for receiving rounding credit.

There were also issues on the patient side of Rounding 1.0, Johnson explained.

“Some moms didn't want to be rounded on every day,” she pointed out. “They're only here for two or three days and one check-in was adequate. The technology felt cumbersome and in the way for patients, as well.”

So Johnson and her team went back to the drawing board and designed Rounding 2.0. This new approach removed the technology and provided more flexibility for nurses to round to patient preferences.

The nurse leadership team effectively removed the iPad tracking system by creating a tiered huddle structure. These huddles, which are a part of the hospital’s daily management system, include key performance measure reporting that can reach up to the executive level where necessary.

“One of the key performance indicators that we look at in our nursing operations huddle is unit by unit, how many leader rounds were complete,” Johnson explained. “Nurse leaders have an opportunity to report out with their peers and it also is an easy way for us to document successful completion of those rounds without it having to be a paper or a documentation process.”

Johnson and her team also restructured the frequency of patient rounding. For example, if a mother is only going to be in the hospital for two days for a child birth, the nurse leader will round on them right after delivery to ensure any needs are met.

The nurse leadership team has found that leadership rounding is a key patient experience driver, even when the hospital cannot offer expectant mothers private rooms.

“Obviously the highest scores are moms in private rooms who were rounded on by a nurse leader,” Johnson said. “But the second highest is moms in shared rooms who were rounded on by a leader. It's been a 10-point increase in satisfaction for a sustained period of time.”

Rounding from a nurse leader specifically may have been key, Johnson added. Although relationships between patients and all nurses are essential, adding the leader to the equation has made the difference in driving personalized care.

“Patients don't always know how to get help for some of these things that the nurse leaders can take care of immediately and triage to the right place to get things fixed,” Johnson stated. “It gives them, the patients, permission to note things that aren't exactly like they'd like them and makes them feel better if they can get things the way that they want them delivered.”

There is also something important about getting the attention of a hospital leader, Johnson added. It makes patients feel listened to and valued in the hospital.

“The visibility of how important patient care and patient experience is to leaders in the organization and the opportunity also to recognize the nursing and other care providers that are delivering the care is really important and it models our behavioral expectations in our organization,” Johnson concluded. “I think patients are savvy and pick up on that.”