What Hourly Rounding is NOT and Why It Often Fails

This blog post continues our series of patient experience best practices. It demonstrates our expansive understanding of the challenges faced by healthcare organizations and offers solutions for improving the patient experience, as well as patient and business outcomes.

We are currently focusing on hourly rounding as a component of improving the patient experience. Hourly rounding is a structured means of promoting patient-centered communication in a healthcare setting between staff, patients, and their loved ones to ensure the best outcomes.

What Hourly Rounding is NOT

• Solely for patient satisfaction - There’s much more at stake here than just making patients and their families happy.
• A magic bullet for service and quality - To see true improvements, care organizations need to be in it for the long haul. Successful hourly rounding is hard work, and organizations that do it successfully and see results often take a long time to do so.
• Robotic - There’s definitely more to hourly rounding than just checking a box or making a rote visit at certain intervals. Connection is part of this communication, and caregivers have to act from their emotional motivation for why they are engaged in this career in the first place.
• Only nursing’s responsibility - Anyone who communicates with patients and families is responsible for the success of hourly rounding. That includes physicians, technicians, therapists, non-clinical staff, AND nurses.
• Just a log that gets tucked away - One reason for rounding is to gather data, another is to ensure understanding. Communicating the why, when, and how of care can go a long way towards ensuring that the outcomes of care are more successful.
• A skill that is easily learned and a behavior that is easy to hardwire - It takes work, patience and coaching. Hourly rounding is intense, and doing it well requires motivation and commitment. Everybody involved needs to be engaged in making it a success.

Hourly Rounding Compared to Traditional Practice

Traditionally, interactions with patients can be characterized as:

• Reactive
• Driven by call bell or patient care delivery
• Inconsistent use of Rounding Log
• Observation only no “active interaction with patient about “why” rounding

Purposeful rounding is different. It is:

• Part of “Exceptional care” introduced on admission to patient
• Prescriptive, with times based on day/night
• Responsibility between nursing and nursing support are outlined
• Ancillary and Support Staff are trained
• No Pass Zones are established
• Validated through Leader Rounding
• Included in Annual competency measures
• Visible Rounding Log is maintained and checked

Why Hourly Rounding Fails? 

We have already mentioned that establishing a successful hourly rounding program is not easy. There are lots of reasons that, as we have mentioned earlier, “Despite significant efforts being made in terms of staff time, training, and re-training, most organizations are failing to see improved outcomes, and therefore are experiencing significant frustration due to the perception that their efforts are not producing results. Here are some reasons we have seen hourly rounding efforts falter: 

1. Staff ownership and motivation

Oftentimes, hourly rounding can be perceived as optional. Staff would never “skip” quality requirements of Core Measures, checking vital signs, medication administration; however, we have encountered perceptions that Hourly Rounding is a luxury for when staff has time and is not short-staffed or in peak volumes. This has to change. Leaders need to engage staff to be a part of owning hourly rounding as non-negotiable; as well as contributing and giving feedback in the process.

Motivation is also critical. Leaders need to celebrate those staff members that excel with hourly rounding. Additionally, improvements in quality (e.g., Falls, Pressure Ulcers), decreases in call lights, and improvements in HCAHPS and patient experience results should also be recognized. Failure to celebrate wins (even small gains) can have a negative impact on staff engagement. 

2. Staff skills

It is often thought that hourly rounding can be rolled out in a classroom setting with DVDs, articles and worksheets, and then staff would know how to round. However, conceptually hearing about the practice of hourly rounding and actually changing behaviors and developing the communication to be effective is a very different skill set. HEI spends significant time coaching, skill developing, and certifying to support adoption among our clients. 

3. Leader accountability

Leaders must first hold up the mirror to themselves. It is unfair for leaders to expect
staff to round on every patient, every time, if they themselves are not:

• Conducting leader rounding on patients to validate hourly rounding
• Rewarding and recognizing
• Coaching for Performance
• Reviewing rounding logs

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