Strides in service: Leader rounding connects with patients

Angie Douglas, assistant nurse manager on Med 100 at Cox Branson, rounds on patients each morning.

Patient experience efforts are streamlining work for staff and improving patient perceptions.

Every morning at 8:30, leaders in the Med 100 Unit at Cox Medical Center Branson know where they will be: face-to-face with their patients.

The unit has committed to leadership rounding, visiting each patient and making it a priority to see how their care has been and if their needs are being met. On a recent morning, a patient who was recovering from an infection had a simple goal on his communication board: feel better and go home.

Assistant Nurse Manager Angie Douglas asked about his pain. It had been a rough night, he admitted. Even with medication, his pain was still significant. He just wanted to feel better. She talked with him about his care and about the next steps before he could go home. Then she asked if there were any staff members who stood out to him.

His face brightened. “They all stand out, every one of them,” he said.

That sentiment is one reflected in Med 100’s patient satisfaction scores, which have been on the rise since the unit implemented daily leadership rounding.

Med 100 is just one of many areas at CoxHealth emphasizing fundamental customer service behaviors with the goal of improving patient perceptions of care. Across the system, units are working with support from CoxHealth’s Office of Patient Experience. OPE recently deployed consultants in several units to work with leaders and staff as we strive to create a uniformly excellent patient experience.

“Whether it’s in a clinic, a hospital or in the ED, for patients it is all one CoxHealth experience,” says Kaylyn Lambert, system director of patient experience.

OPE recently restructured to reach more of the system – supporting areas with consultants and offering in-depth customer service training.

“We have a high expectation of service and we are working to provide the resources to do that,” Lambert says. “We don’t want leaders to have to train the employees on the floor. Our goal is that, on the first day, we are able to give staff the tools to do great service.”

Leaders on Med 100 knew they had a service challenge to overcome. The unit is frequently a patient’s last stop before discharge. Patients can be dealing with a variety of recovery challenges. In the past, it had been difficult to earn top satisfaction scores.

Director of Nursing Adene Smith had heard stories about teams at other hospitals who were focused on positivity and consistency and who were able to overcome barriers to patient satisfaction. She and her leaders began discussing a focused approach with a 90-day turnaround project for the unit.

Kelsey Bagwill, an OPE consultant who is embedded in Med 100, worked with leaders to implement changes, beginning with an idea Smith had: intentional rounding on a set schedule.

In the past, rounding was done as time allowed. The only problem: On a busy nursing floor, time rarely allows.

Committing to a fixed time each day makes sure rounding happens. Now, the team divides the unit’s 21 beds and makes sure everyone is seen.

“This focus means a lot to me,” says Douglas. “It’s a privilege to do it and I know it’s important to Adene, because she spends time doing it.”

Leaders and staff on the unit say the morning check-in sets the tone for the day, allowing plenty of time to correct any issues and address any patterns leaders see in their rounds.

The rounds are intentional, with leaders having a conversation with each patient. In that discussion, they are able to assess how well patients and nurses are communicating, and how well the patient understands his or her care.

Leaders track patient responses on an iPad as Bagwill takes notes and offers feedback on the rounding process.

They also ask about how quickly call lights were responded to and if nurses did their shift report at the bedside.

Patients who are receiving any new medications should have received a standardized “hit the highlights” form, which explains the medication, what it does and any side effects.

Patients are asked if they understand their discharge plans and what follow-up they will need after they go home.

If there is an issue to be solved, staff members can immediately perform service recovery. If there are general opportunities for improvement, or recognition for a job well done, staffers receive that feedback as well.

Bagwill says just a visit from a unit leader goes a long way toward making patients feel cared for. “For a lot of patients, it’s a pleasant surprise. Just seeing a leader take the time to check in helps, and the leaders enjoy it as well,” she says.

“We get to know patients and know what is important to them,” Smith says.

Making rounding a top priority has been a major key to improving patients’ perceptions of their care. Before the project, the unit’s national comparison rank was in the single digits. Those scores are now improving as rounding and other behaviors are reinforced.

“We’re committed to moving forward,” Smith says.

Leaders close their rounding visit by asking patients if there are staff members who should be recognized for a job well done.

The patient who had “feel better” as his goal simply asked Douglas to “thank them all for me.” She says she will, telling him: “You don’t know how much that means to them.”

“You don’t know how much they mean to me,” he responds. “You have been taking care of me and I appreciate it. You have great people here.”