Hourly Rounding

April 15, 2008

When we begin working with new organizations, one of the most important things we do is help them appropriately sequence how, when, and why they rollout the tactics proven to get results. Just like courses in school, there are some foundational pieces that need to be in place before more advanced techniques are attempted. One of the best examples of this is when organizations jump to advanced rounding techniques, such as hourly rounding on patients, before hardwiring the foundational rounding technique of rounding on employees.

In this blog I’d like to give some tips for sequencing tactics, as well as a perspective on why hourly rounding is such a powerful tool and worth waiting for.

An important early step toward hardwiring clinical, service, and operational excellence is all about engaging employees. Get your workforce on board and everything else falls into place. The most powerful tool at this stage is for the leaders of the organization to round on employees. That’s why when we coach organizations we ensure this step is happening with consistency before moving on. To learn more about how to round effectively, you can read more on our website. When done right, you will uncover mountains of knowledge currently lying hidden in the minds of your employees. However, the real benefit comes not from uncovering new information but from the wins you get with employees when you fix the issues that they have shared.

Once leaders are effectively rounding on employees, some organizations decide to adjust the focus of the rounding conversations to address specific pressing issues. For example, in their efforts to hardwire a culture of safety, hospitals across the country are incorporating some of the following questions into their rounding:

  • Were you able to care for your patients this week as safely as possible? If not, why not?
  • Can you describe how communication between caregivers either enhances or inhibits safe care on your unit?
  • Do you know how to report an adverse incident?
  • Can you describe the unit’s ability to work as a team?
  • Have there been any “near misses” that almost caused patient harm but didn’t?

Fast forward. A few months of effective rounding conversations between leaders and employees have resulted in a culture of accountability, trust and open dialogue. Now is the time to rollout the powerful tactics like hourly rounding that have been proven to get the incredible results we’ll discuss in a moment. Why is this the right time? Any earlier and the employee rounds on patients would fade away over time. The discipline, the trust, and the accountability that are generated by leader rounding and objective accountability systems are critical for rounding to happen with every patient, every hour . . . and that’s the only way the results improve to the extent research has shown is attainable.

So what’s the big deal about hourly rounding? Why all of the effort? Because of the powerful impact this single tactic can have across your organization; and more importantly, its impact on the lives of thousands of patients and their families. For example:

  • Inpatient Setting
    • Our study published in the September 2006 American Journal of Nursing proved that hourly rounding cuts patient falls in half, reduces pressure ulcers 14%, increases patient satisfaction 12 points and decreases call light usage 38%. In summary, results across the board . . . better outcomes for patients, employees, and budgets.
  • Emergency Department Setting
    • We are delighted to announce that our recent research on the effectiveness of rounding in the ED setting has been accepted for publication by the Journal of Emergency Medicine. The results were very similar to the inpatient results. With just slight adaptation, rounding works everywhere. To share these adjustments we have produced a video-based tool that shows how to effectively round in the ED.
  • National Acclaim
    • During the Institute for Healthcare Improvement’s December 2007 Annual Forum, hourly rounding was described as one of the most powerful ways to redesign patient care, in addition to helping “restore sanity and joy to our workforce.”
    • Let’s put that 50% reduction in patient falls in perspective. At a time when numerous proposals are floating around aimed at saving money or improving quality in US healthcare, if every hospital in the United States implemented hourly rounding it would prevent a quarter million falls, 75,000 injuries, and more than $2 billion. At the same time, patients perceive their care as better and safer and nurses work more efficiently. I don’t see the same side benefits from most of the legislative proposals for reforming healthcare.

To learn more about how to implement leader rounding on staff or the many different forms of hourly rounding I’ve discussed, consider attending our annual conference, What’s Right in Health CareSM June 18-20 in Atlanta. You’ll hear more than 30 best practice sessions specifically designed to help you implement these and other evidence-based tactics. Here are just a few sessions related to rounding:

  • Learn how one organization used hourly rounding in both inpatient units and their ED to generate more than $1 million in additional revenue and cost savings.
  • Learn how another organization used both leader rounding and hourly rounding to raise its Emergency Department from the 4th percentile in patient satisfaction to the 92nd percentile in less than one year.
  • Learn how another organization implemented hourly rounding on nursing units to improve their patient’s perception of care from the 32nd percentile to the 96th percentile while decreasing patient falls with injury by 43%.
  • Learn how a hospice care provider implemented leader rounds on staff to obtain consistency in practice, approach, and clinical results.
  • Learn how to implement leader rounding in physician practices.
  • Learn how to combine leader rounding on employees with pulse surveys to improve employee engagement and lower turnover.

I hope to see you in Atlanta.


One Response to “Hourly Rounding”

  1. Ken Garner Says:


    I work in the Healthcare Industry and support the IT side of the business. In your discussion on hourly rounding, do you have examples of questions that would relate to that area of the business?

    Even though we do not touch the patient directly, our job is to support the systems and clinicians that do. I feel that IT staff does not always see this in their day-to-day work and rounding could lend an opportunity to develop this connection. The questions we ask as leaders can go a long way in this development.

    Appreciate any insight you may offer.

    Ken Garner
    Manager, Information Security
    Oakwood Healthcare System

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