“But we’re already doing it!”: Why Validation Is the Key to Effective Hourly Rounds

February 9, 2009

No doubt about it: Hourly rounding is hot. And no wonder. In 2006 Studer Group’s Alliance for Health Care Research initiated a call light study—whose findings were published in the American Journal of Nursing—which proves how well it works. In addition, 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.”

Since then, the tactic has been implemented in hundreds of organizations across the country. So it’s no surprise that at conferences I attend, discussion invariably turns to this subject. When leaders are asked whether they are doing hourly rounds, many of them will reply that, yes, they are. And when you ask staff if they are doing hourly rounds, they will also tell you, “We’re doing it.”

So why don’t all organizations experience fantastic results from hourly rounding? First of all, some organizations have been known to deviate from the original formula we set forth. It is critical to follow the eight behaviors of hourly rounding, which you will find explained in detail in the Hourly Rounding DVD and implementation guide available on the Studer Group website at www.studergroup.com.

The eight behaviors of hourly rounding are:

  1. Use opening Key Words.
  2. Accomplish scheduled tasks.
  3. Address the “Three Ps”pain, potty, position.
  4. Address additional comfort needs.
  5. Conduct environmental assessment.
  6. Ask, “Is there anything else I can do for you? I have time.”
  7. Tell each patient when you will be back.
  8. Document the round.

In our experience, the main difference between those that are successful and those that are struggling to achieve results is validation—or, said another way, lack of validation. If you want to drive the results described above, you have to Validate, Validate, Validate.

The most often heard excuse from staff regarding hourly rounds is, “We are already in the room that much anyway,” or “I am already doing those things.” Certainly this is the perception that many staff have; however, it is often not the reality. If it were, we would not hear so many patient complaints like, “I don’t see my nurse enough,” or “The staff seems so busy.”

Done right and properly validated, hourly rounding will improve your patient care and satisfaction. Here are just a few principles to keep in mind:

Face time is not enough. Staff must understand that hourly rounding is not about getting in the room every hour. It is about doing the eight behaviors every hour—which just happen to require us to be in the room to do them.

Nurse leaders, it’s your job to validate. It’s the nurse leader’s task to validate that the eight behaviors of hourly rounding are being implemented with enough consistency to achieve results. The key? Rounding logs. I have yet to see an organization be successful in getting the level of results we mentioned above without using them. I also advocate for the use of an annual competency that will add credibility to this skill and make it as important as all the other skills we validate annually. But even annual validation is not enough in the early phases of implementation, which can last sixth months or more. Nurse leaders need to continue frequent validation long enough to ensure that the staff’s initials on the log truly represents that all eight behaviors were accomplished.

Yes, validation takes time—but it’s worth it. If the validation is so critical—why do we have such a hard time doing it? The most obvious answer is time. Validating skills directly by observation is certainly an investment in time, but those organizations that bite the bullet and get it done will tell you the results they get far outweigh the time spent.

Trust, but verify. Many nurse leaders will tell me, “When I verify rounding, the staff feels like I don’t trust them. They think I am checking up on them.” Well…that’s because you are—but it’s the right thing to do. At Studer Group we call it trust but verify. After all, we trust that a physician will do a history and physical on every patient, but we still verify that he has done it. And we trust that a pilot will do his pre-flight checklist, but, again, we verify. As a leader on your unit, you have the ultimate responsibility for the competency of your staff. For critical skills a “trust but verify” approach is necessary—and hourly rounding does qualify.

“Soft” validation doesn’t work. I sometimes see nurse leaders invest the time in doing the validation but use too soft of an approach to get the real value. For instance: “Sara, I appreciate being able to shadow you and validate your hourly rounding skills. I think you did a great job. The only thing I didn’t hear was you using the closing key words. I’ll go ahead and check you off but please be sure to do them next time.” In this case, we have left open the door for Sara to continue to forget to use one of the eight behaviors of hourly rounds—Use closing key words.

Take the ACLS approach. I recommend you use an approach most clinicians are very accustomed to if they have ever tested for ACLS or similar certifications. That is, you need to be 100 percent correct to pass certification. You would never be ACLS certified and have them say, “You were pretty close on that dose of medication; just be sure to check closer next time.” If you are validating skills, take an ACLS approach and give specific and immediate feedback on each of the eight behaviors. This way the staff will know what they are doing well and what they need to do differently.

With diligence in validating skills, a tighter discipline to get all eight behaviors done well, and verification that they are actually occurring with every patient…the results will come.

For more information on tools that are available to help you implement hourly rounding in your organization please click here, or feel free to contact George Scarborough with questions.

Yours in service,

Lyn Ketelsen, RN, MBA

Studer Group Coach Leader

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