Nobl Insights

My Experience Implementing Hourly Rounding in a Healthcare System

I remember vividly the day in early 2007 when the President of our health system called together a patient experience team to discuss a mission critical priority. I was being asked to co-lead the roll-out of hourly rounding simultaneously on 28 inpatient acute care units (including critical care) across five hospitals. Based on the results of a Studer Group study, the Executive Leadership Team was convinced that this nursing evidence based practice would fix our patient satisfaction scores before the end of the fiscal year.

My HR/Marketing co-chair and I adopted a “project-in-a-box” methodology to give the unit managers tools to customize for the unique needs of their unit. We made the unfortunate assumptions that nurse managers had project management expertise and they would include unit educators/CNSs. Things snowballed from there: Managers and bedside staff resented “the higher ups” telling them how to care for their patients, dry erase rounding boards ruined walls behind them, paper rounding logs became a “check box” exercise at shift’s end to stay off the naughty list, and ICU nurses documented every patient encounter – sometimes five times per hour. The end-users had missed the real purpose of consistent, purposeful interactions with patients to build trust, provide comfort, and to make them genuinely feel that staff cared.

Four weeks later we regrouped and started over – from bottom to top – by guiding interprofessional unit-based groups to define their service excellence goals, to wow patients and to determine what would work best for their team. The toolkit was re-evaluated, some pieces retained and rounding logs were replaced with door clocks. Leaders agreed to regularly assess and support project compliance, and educators/CNSs became non-punitive coaches providing real-time education, recognition and reinforcement.
The process stuck in a majority of areas and scores improved, but the compliance data available from the paper forms was inconsistent and not helpful. From The Two Most Important Quotes in Business , Peter Drucker said, “If you can’t measure it, you can’t improve it.” Many online tracking tools exist for nurse documentation, hourly rounding and leader rounding; but, Nobl is portable, intuitive, and supports rounding actions. Our portfolio goes beyond compliance to reward high performance, fix problems, coach staff, communicate with other stakeholders, and provide immediate service recovery! Nobl has also brought leader rounding on patients and employees into a single, customizable solution.

Learn from my mistakes – involve clinical staff in designing and implementing work flow improvements and also in the decision-making around technology support devices and software.

Blog written by Dr.Teresa Anderson, EdD, MSN, RN, NE-BC, Chief Nursing Officer, Nobl

Learn how Vigilance™, Nobl’s purposeful rounding tool, enables frontline staff to proactively anticipate and meet patient needs.

Bringing Purpose to Patient Interactions through Sacred Encounters

Nobl combines evidence-based practices with intuitive technology to help hospitals document and ultimately hardwire their rounding processes. But, no software, even with great prompts and customizable screens, will make a difference if we are doing the wrong things, or we are doing the right “things” with the wrong intent.

Through my Magnet consulting I have been in over 130 hospitals; a mix of academic medical centers, community-based and critical access settings, as well as not-for-profit, profit, and faith-based institutions. A long-term client system, the St Joseph Health System has enculturated a value-based practice known as “sacred encounters.”

A sacred encounter is when a task as commonplace as a patient assessment, bath or hourly round takes on new meaning. The practice of sacred encounters is a model that encourages the caregiver to pause and be mindful of the significance of the moment for the patient. This model promotes empathy and a genuine caring presence to the client and family. Within the faith-based context, the moment welcomes the presence and grace of the Holy Spirit to be with the caregiver and the cared for. Some non-faith based facilities embrace Kristen Swanson’s caring model components – knowing, being with, doing for, enabling, and maintaining belief.

To be emotionally present and sustaining faith are a critical component of patient care that we cannot forget. Regardless of whether a faith-based or non-faith based context applies – the key is to be in the moment and ensure that actions really are centered on the patient.

Blog written by Dr.Teresa Anderson, EdD, MSN, RN, NE-BC, Chief Nursing Officer, Nobl

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