5 min read
One of the realities of life is that we are constantly giving and receiving feedback. Sometimes feedback is formal, such as annual performance reviews or meetings with supervisors or faculty. Other times it is as casual as a reassuring smile from a colleague or mentor when mastering a new task or comforting another. How we process and apply feedback is influenced by many things. Comments or feedback might take the mind to a similar stressful experience in the past or to a pleasant memory surrounding a success. Either way, it triggers thought processes and emotions and informs the way we respond. For some people, feedback is viewed as a welcome, growth-inspiring gift to aid in improvement or success. But to others, feedback can trigger defensiveness and even fear, if their past experiences have been unpleasant or nonconstructive.
If we, as trained healthcare professionals, feel uncomfortable or need coaching related to feedback, how must our patients and their families feel when they are asked to provide feedback either on a survey or face-to-face during leader rounding? Giving feedback that may not be perceived as positive is never easy. Combine that with the vulnerability of being hospitalized or entering an environment where one has little previous experience or knowledge, and it becomes easy to understand why patient responses to leader rounding don’t always match the scores or comments on patient satisfaction surveys.
As leaders, it is important to help your patients feel at ease and part of the team. Only when they feel safe, will they risk providing the truth when things are not going well.
Not every patient concern, complaint or grievance starts from a position of vulnerability. Many concerns or issues may have started long before the patient or family reached your doors. Previous healthcare experiences may have been filled with fear, disappointment, or tension causing some patients to begin their current visit on the offensive so that they can maintain control and feel safe this time. Your job, as the leader is to provide the space for them to express their needs, ideas, or fears. Let’s explore two different types of leader rounds and consider how each might be perceived by our customers and how each might be part of patient satisfaction strategies.
Scenario 1
Mary is a leader who embodies the mission to ‘put safety first’ in all the care provided. She wants to make sure that her staff are meeting standards and that all are following through on expectations. She has adopted a list of questions for patients that help her to validate team skills and behaviors. She can then use their responses to provide real-time feedback and/or coaching to her staff that will lead to safer care and improved outcomes. Her goal is to round on 100% of patients every day, especially those under the care of a specific nurse or nurse/nursing assistant dyad.
Scenario 2
John is a leader who believes that while safety is important, his goal is to build relationships with patients and families. He tries to see patients who are new to the unit or heading for home to provide the best welcome and farewell that he can. He spends a lot of time with each patient and might deviate from the standard healthcare communication methods that are the basis for the question sets and rounding form.
How might each of these leaders be perceived by the patient and what tools can help both to achieve their goals, while always putting the patient in the center?
Mary’s Rounding
Mary might aim her safety related questions toward a single skill or outcome each week or month, thus focusing patients to watch or listen for something specific while they are hospitalized. This will help them to be empowered, or invited, to be part of that evaluation rather than feeling like they are offering bad news about someone who is responsible for their needs. These two or three focused questions about staff skills and behaviors might be best if placed near the end of the round, after patients have had a chance to bring up what is important to them. If questioning quickly draws patients to consider things they have seen or heard from staff, they might forget to bring up something that is really bothering them, remembering only after the leader has left their room. This is a missed opportunity to address their true patient experience needs. In facilities with a goal of rounding on 100% of patients, Mary could still be successful if she focuses the round to one or two key questions that convey the desire of the team to provide excellent care and her availability if there are any unmet needs. Making eye contact, sitting down, and smiling can make even a shortened round into a meaningful one.
Here are a few rounding questions that might work well for Mary to add to her routine.
- Thank you for choosing our facility. The team and I want to provide excellent care. I’m here as the nursing leader on this unit, so you know someone who can assist you if for any reason you have concerns, suggestions or even compliments for our staff. How are things going so far?
- I know that being in the hospital can be stressful and there is so much information to absorb. Do you have any questions or other needs right now?
- Every month we focus our attention on a different safety need. We are currently working on preventing patient falls. While you are here, please help us by making sure that you have been provided with information about falls in the hospital and that safety measures like bed and chair alarms, yellow gripper socks and assistance out of bed are provided for you, if you are at risk of falling. When I stop in tomorrow, let me know if we have met those goals and any suggestions you have about that plan.
- [The next day] Hello again, I see you have your yellow socks on today. Have staff been helping you out of bed promptly?
- Did they explain the bed/chair alarm and are they activating it to help remind you not to arise without help?
- Any other suggestions to keep you safe from falling?
With these questions, she starts her rounds with a question that she hopes will put the patient and family at ease, provides them with a chance to share first, and then sets up expectations that their observations and suggestions for fall safety will be welcome when next she sees them.
John’s Rounding
John obviously has a kind heart and wants to cultivate a strong trusting relationship with patients and families. But he also might benefit from adjusting his routine to round on more patients, while still maintaining the caring and concern that mean so much to him as a person and a leader. Facility expectations for compliance with round completion goals could become a real dilemma for him. His new routine might add in 3-4 binary or multiple response questions that conserve his time and are important for the facility to reach global patient experience goals, while retaining 2-3 of his preferred open-ended, patient-focused listening questions.
John might even achieve his goal with the same key questions that Mary was asking by adjusting the order, which gives him the ‘extra’ time he wants for each patient.
- Thank you for choosing our facility. I’m the nursing leader on this unit. The team and I want to provide excellent care. Every month we focus our attention on a different safety need. We are currently working on preventing patient falls. While you are here, please help us by making sure that you have been provided with information about falls in the hospital and that safety measures like bed and chair alarms, yellow gripper socks and assistance out of bed are provided for you, if you are at risk of falling. When I stop in tomorrow, let me know if we have met those goals and any suggestions you have about that plan.
- [The next day] Hello again, I see you have your yellow socks on today. Have staff been helping you out of bed promptly?
- Did they explain the bed/chair alarm and are they activating it to help remind you not to arise without help?
- Any other suggestions to keep you safe from falling?
- As the nursing leader on this unit, I want to assist you if for any reason you have concerns, suggestions or even compliments for our staff. How are things going so far?
- I know that being in the hospital can be stressful and there is so much information to absorb. Do you have any questions or other needs right now?
Although it is important to make eye contact, sit down when possible, and to be fully present with the patient, John might not want to get too comfortable, because his time might slip away, if he forgets that he has other patients to see.
Leader rounding is an art and a science, where ‘style points’ matter. Even when there are standardized rounding question sets or compliance goals, each leader can adjust the order of the questions to fit what works for them, put the patient at ease, and still meet facility expectations. Communication in health care is not just a nicety, it is a necessity. Patients will not be able to trust anyone who cannot genuinely engage with the rounding process. Leaders who are comfortable with their own style, will be worthy of trust and should increase patient and family willingness to provide truthful feedback when asked.
Written by Teresa L Anderson, EdD, MSN, NE-BC, Nobl Chief Nursing Officer
