presentation

NATIONAL HEALTH LEADERSHIP
CONFERENCE
University Health Network
Toronto Western Hospital
June 2, 2014
Toronto Western Hospital General Internal Medicine
Nursing Leadership Team
Mary Kay McCarthy RN, M.HS
Senior Clinical Director
Carol Banez RN, BScN, MN
Grace Ojo RN, BScN, CMSN(C), MN(c)
Clinical Nurse Specialist
Clinical Resource
Faith Daniels RN, BN, MN(c)
Janet Pilgrim RN, BScN(c), GNC(C)
Patient Care Coordinator
Interim Manager
Silvi Groe RN, BScN, MN, GNC(C)
Saverina Sanchez RN, BScN, MScN
Manager
Manager
Melissa Guiyab RN, BScN, MN, ENC(C)
Sophia Simms-Hanson RN, BScN
Clinical Nurse Specialist
Patient Care Coordinator
April Mick RN, BScN, CMSN(C)
Marta Tamburri RN, BScN, CCN(C), MN(c)
Patient Care Coordinator
Clinical Resource
Gerry Ann Nepomuceno RN, BScN, MN(c)
Adassa Wilson RN, BScN, MA, GNC(C)
Clinical Resource
Patient Care Coordinator
Creating an Exceptional Patient Experience
Through “Patient-Focused Rounding”
Creating an Exceptional
Patient Experience Through
“Patient-Focused Rounding”
Objectives

Define Patient-Focused Rounds

Describe methodology used in the
implementation of Patient-Focused
Rounds

Discuss outcomes and lessons learned
Creating an Exceptional Patient Experience
Through “Patient-Focused Rounding”
In an environment of
increased patient
complexity and
escalating fiscal
constraints, key
quality indicators
such as falls,
pressure ulcers, early
mobilization, patient
and staff satisfaction
must be addressed.
Creating an Exceptional Patient Experience
Through “Patient-Focused Rounding”
This quality
improvement process
of “Patient-Focused
Rounding” was
undertaken in an
academic, acute care
hospital in Toronto,
Canada on 3 inpatient
units within the
General Internal
Medicine Program.
Creating an Exceptional Patient Experience
Through “Patient-Focused Rounding”
 64% of our patient population is over
65 years of age, of which 20% are over
85 years of age.
 A high proportion of these patients are
non-English speaking, have multiple
co-morbidities, and a low health
literacy level.
Creating an Exceptional Patient Experience
Through “Patient-Focused Rounding”
Staff involved in this
project included
frontline nurses,
patient care
assistants, clerical
staff, and nursing
leadership.
Creating an Exceptional Patient Experience
Through “Patient-Focused Rounding”
Patient-Focused Rounding - 5 “P”s
Creating an Exceptional Patient Experience
Through “Patient-Focused Rounding”
PDSA cycle and Appreciative Inquiry (AI)
approach were the qualitative methodologies
used in this continuous process of achieving
patient and staff satisfaction.
Creating an Exceptional Patient Experience
Through “Patient-Focused Rounding”
PDSA Cycle
Series of focus sessions with staff
Patient-Focused Rounding at various intervals
What is working well, patient and staff satisfaction
Changes as appropriate, patient feedback
Creating an Exceptional Patient Experience
Through “Patient-Focused Rounding”
Appreciative Inquiry (AI) Theoretical Framework
• AI is a generative process that focuses on what is
already working well versus the traditional problemcentered approach.
• The AI model may be conceptualized as the 4D
cycle:
Discover  Appreciating and valuing the best of “What Is”
Dream  Envisioning “What Might Be”
Design  Dialoguing “What Should Be”
Delivery/Destiny  Innovating “What Will Be”
Creating an Exceptional Patient Experience
Through “Patient-Focused Rounding”
Patient and Staff Results
GIM Average Response
Likert scale 1 (poor) to 5 (excellent)
• How would you rate the care you received overall?
4.1
• Have the staff been courteous and respectful towards you?
4.6
• Do you feel well-informed about your plan of care?
4.2
• If you needed help, was someone available for you within a
reasonable amount of time?
4.4
• How well organized and co-ordinated was the care team?
4.2
• Based on your experience, how likely are you to recommend 4.6
TWH to a friend or family member?
Creating an Exceptional Patient Experience
Through “Patient-Focused Rounding”
Patient Results
•
“I felt confident that the nurses knew exactly
what to do and came back and did it without
needing to be reminded.”
•
“Impressed at how the nurses went in together
to check on my mother, helped reposition her
and asked if she was comfortable.”
Creating an Exceptional Patient Experience
Through “Patient-Focused Rounding”
Staff Results
•
“Special attention can be given to patients
needs when we are working as a team during
rounds.”
•
“Rounds has helped to decrease interruptions.”
•
“Nurses partnered with one another made the
workload lighter.”
•
“Utilizing the 5 “P”s has helped in enhancing
the patient’s journey while in the hospital.”
Creating an Exceptional Patient Experience
Through “Patient-Focused Rounding”
Conclusion
• The implementation of the Patient-Focused
Rounding model has positively impacted the
exceptional patient experience, staff
satisfaction and key quality indicators.
• Although a standardized approach of the PDSA
cycle and AI framework may be applied in
multiple units to create a successful model
change, it is important to ensure that the
delivery of the model is uniquely tailored to
each unit by the frontline staff.
Creating an Exceptional Patient Experience
Through “Patient-Focused Rounding”
Lessons Learned

Identify champions early in the process

Be prepared to make frequent changes

Gain patient and staff perspectives
Creating an Exceptional Patient Experience
Through “Patient-Focused Rounding”
Next Steps

Formal evaluation of process from
patient’s perspective

Evaluate outcomes

Involvement of interprofessional team in
patient-focused rounding
References

Burke, W., McLaughin, D., (2013). Partnering for change. American Journal of Nursing., February 119,2
47-51.

Challis, A. M. (2009). An appreciative inquiry approach to RN retention. Nursing Management, July, 9-13.

Hammond, S. A. (1998). The thin book of appreciative inquiry. Oregon : Thin Book Publishing Co.

Ludema, J. D., Whitney, D., Mohr, B. J., Griffin, T. J. (2003). The appreciative inquiry summit: A
practitioner’s guide for leading large-group change. San Francisco: Berrett-Koehler.

Mahanes, D., Quatrana, B., Dale, K. (2013). APN led nursing rounds: An emphasis on evidence-based
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
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
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
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
Watkins, J. M., Mohr, B. J. (2001). Appreciative inquiry: Change at the speed of imagination. San
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
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
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Questions

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