1. AMGA
2010 Annual Conference
Leadership Rounding:
How to Hardwire Excellence,
Share Accountability,
and Improve the Patient Experience
Thursday, March 18th
, 2010
Presented by:
Brad Kruger, Administrator , Aurora Health Care
Dan Bent, Improvement Manager, Press Ganey Associates
Aurora Health Care is a not-for-profit health care provider and a national leader in the
efforts to improve the quality of health care.
2. Aurora health Care is a not-for-profit health care provider and a national leader in the efforts to improve the quality of health care.
Learning objectives:
• Define leadership rounding
• Identify why leadership rounding is an
important tool for the practice
• Identify roles and expectations for clinical
leaders in Implementing care rounds
• Be able to coach clinical leaders on key
components of rounding and rounding for
outcomes
• Participants will take away sample tools for
implementation
3. Aurora health Care is a not-for-profit health care provider and a national leader in the efforts to improve the quality of health care.
Leadership Rounding
• Evolution of an idea
• Why does it matter?
• What have we seen?
• What have we learned?
• How have patients responded?
4. Aurora health Care is a not-for-profit health care provider and a national leader in the efforts to improve the quality of health care.
5. Aurora health Care is a not-for-profit health care provider and a national leader in the efforts to improve the quality of health care.
Our vision
There is a better way to provide health care:
• Better access
• Better care and service
• Better results
Working together, the people of Aurora
will find a better way
Aurora health Care is a not-for-profit health care provider and a national leader in the efforts to improve the quality of health care.
6. Aurora health Care is a not-for-profit health care provider and a national leader in the efforts to improve the quality of health care.
Our values
Our CEO, Dr. Nick Turkal, opens many
meetings and presentations with our
values. Values guide our behaviors.
• We believe every patient deserves
the best care
• We believe in responsibly managing
resources
• We believe in accountability,
teamwork, and respect
7. Our promise to our patients
The best patient experience … Our #1 Priority
Our patients deserve the best care.
When we achieve top performance in
our clinical quality, patient
satisfaction and caregiver
engagement measures, patients
receive a better care experience than
they can get anywhere else.
Aurora health Care is a not-for-profit health care provider and a national leader in the efforts to improve the quality of health care.
8. Aurora health Care is a not-for-profit health care provider and a national leader in the efforts to improve the quality of health care.
Getting to know Aurora,
Integrated Health System Bringing health care to communities
throughout WI as one Aurora
9. Aurora health Care is a not-for-profit health care provider and a national leader in the efforts to improve the quality of health care.
Aurora Medical Group and Aurora UW Medical
Group consists of:
• ~1150 employed physicians
• 145 sites that span the eastern
one-third of Wisconsin
• 2.6 million patient visits in 2008
10. Aurora health Care is a not-for-profit health care provider and a national leader in the efforts to improve the quality of health care.Aurora health Care is a not-for-profit health care provider and a national leader in the efforts to improve the quality of health care.
11. Aurora health Care is a not-for-profit health care provider and a national leader in the efforts to improve the quality of health care.Aurora health Care is a not-for-profit health care provider and a national leader in the efforts to improve the quality of health care.
12. Our promise to our patients
We measure the patient experience through
patient feedback:
• Real-time feedback
• Call backs
• Surveys
• Focus groups
Aurora health Care is a not-for-profit health care provider and a national leader in the efforts to improve the quality of health care.
13. Aurora health Care is a not-for-profit health care provider and a national leader in the efforts to improve the quality of health care.
2009 to 2011 Strategic Plan
Key Action 2009 Target 2010 Target 2011 Target
Adopt and embrace • Achieve 40% of patient loyalty • Achieve 70% of patient loyalty • Achieve 90% of patient loyalty
the Planetree scores by survey type in the scores by survey type in the scores by survey type in the
philosophy of top quartile. top quartile. top quartile.
patient-centered care. • Increase system-wide • Increase system-wide • Achieve top quartile
employee engagement index employee engagement index system-wide employee
to 68% agree. to 70% agree. engagement index
(70% agree).
14. Aurora health Care is a not-for-profit health care provider and a national leader in the efforts to improve the quality of health care.
Care Rounds
•Administrative Rounds on patients and caregivers
• Manager/Supervisor Rounds on patients and
caregivers
15. Aurora health Care is a not-for-profit health care provider and a national leader in the efforts to improve the quality of health care.
Nine key elements for successful
rounding on caregivers
1. Communication with caregivers
2. Knowledge of the area
3. Relationship building
4. Remembering issues/updates
5. Five questions with key words
6. Communication of plan
7. Recording issues
8. Recognize and Reward
9. Consistency
16. Aurora health Care is a not-for-profit health care provider and a national leader in the efforts to improve the quality of health care.
Nine key elements
Communication with caregiver
- Caregivers should know that rounding is
occurring and why it is being done
Knowledge of the area
- Leaders should talk to other leaders about
potential issues
Relationship building
- Learn something about each caregiver
17. Aurora health Care is a not-for-profit health care provider and a national leader in the efforts to improve the quality of health care.
Nine key elements
Remembering issues/updates
- Caregivers should have updates on progress
with successes and issues
Five questions with key words
- Consistent questions can be focused on site-
specific issues and shape perspectives
Communication of plan
- Assure caregivers that issues are being
investigated and addressed.
18. Aurora health Care is a not-for-profit health care provider and a national leader in the efforts to improve the quality of health care.
Recording issues
- Maintain a log for follow-up and submission to other
leaders
Recognize and reward
- Find as many stories and positive behaviors as possible
to recognize and reinforce
Consistency
- Regular rounding will reinforce behavior, trust, and
communication
• Rounding regularly with a focus, for 30-60 minutes at
a time
• Administrators-Once per quarter at each site
• Managers-Three areas/sites/pods per week
• Supervisors-Four areas/sites/pods per week
Nine key elements
19. Aurora health Care is a not-for-profit health care provider and a national leader in the efforts to improve the quality of health care.
Sample Leader Rounding Logs
20. Aurora health Care is a not-for-profit health care provider and a national leader in the efforts to improve the quality of health care.
The Five Questions using Key Words
• What would you strongly agree is working well today?
• Are there any caregivers, including physicians, that
should be recognized?
• Do you have the tools and equipment you need to serve
our patients and your colleagues?
• Is there anything that we could do better?
• Is there anything else that you would like me to know?
21. Aurora health Care is a not-for-profit health care provider and a national leader in the efforts to improve the quality of health care.
22. Aurora health Care is a not-for-profit health care provider and a national leader in the efforts to improve the quality of health care.
Using Key Words in Key Ways *
• Using key words in key ways is a powerful tool that
can be used by all caregivers. It is the use of
specific behaviors, phrases, and body language to
help us succeed in providing an exceptional patient
care experience.
• The caregiver will shape the message as opposed
to robotically delivering a script
* Scripting can include any act or behavior that communicates (Baptist Health Care Leadership Institute, 2003).
23. Aurora health Care is a not-for-profit health care provider and a national leader in the efforts to improve the quality of health care.
Caregiver Engagement:
- Clear understanding of why decisions are
made
- Make me feel as though I’ve been heard
24. Aurora health Care is a not-for-profit health care provider and a national leader in the efforts to improve the quality of health care.
Caregiver Engagement
Employee and Nurse Check-up Report,
http://www.pressganey.com/galleries/default-file/Employee_Nurse_Check-Up_10-08-08.pdf, Press Ganey, 2008
25. Aurora health Care is a not-for-profit health care provider and a national leader in the efforts to improve the quality of health care.
Caregiver Engagement
Employee and Nurse Check-up Report,
http://www.pressganey.com/galleries/default-file/Employee_Nurse_Check-Up_10-08-08.pdf, Press Ganey, 2008
26. Aurora health Care is a not-for-profit health care provider and a national leader in the efforts to improve the quality of health care.
Leadership Care Rounds How to Get Started
• Talk with your leadership team
• Outline how the 9 elements will be
incorporated in your area
• Develop a regular schedule that is blocked
for rounding
• Have all of your tools/report data ready
before rounding
• Identify issues that are likely to come up
• Round in a wide-array of areas
27. Aurora health Care is a not-for-profit health care provider and a national leader in the efforts to improve the quality of health care.
Things to Start Doing Now
• Build care rounding into daily routine – have a
definite purpose
• Look through the patient and/or caregiver lens
• Own the experience you see
• Use the 9 steps for successful rounding
28. Aurora health Care is a not-for-profit health care provider and a national leader in the efforts to improve the quality of health care.
Leadership Care Rounds:Your Responsibilities
• Rounding regularly with a focus, for 30-60 minutes
at a time
• Administrators-Once per quarter at each site
• Managers-Three areas/sites/pods per week
• Supervisors-Four areas/sites/pods per week
• Using the rounding log
• Supervisors and managers to discuss regularly
• Leaders to present to their “one-up” for review
and action planning
29. Aurora health Care is a not-for-profit health care provider and a national leader in the efforts to improve the quality of health care.
Leadership Care Rounds:Your Responsibilities
• Problem solving using responsible freedom
• Caregivers closest to the patients implementing
solutions with support from their leaders and
each other
• Developing and implementing a recognition plan
• Hard-wiring behaviors that support the
exceptional patient care experience
• Recognition needs to occur in real time to be
effective
30. Aurora health Care is a not-for-profit health care provider and a national leader in the efforts to improve the quality of health care.
31. Aurora health Care is a not-for-profit health care provider and a national leader in the efforts to improve the quality of health care.
32. Aurora health Care is a not-for-profit health care provider and a national leader in the efforts to improve the quality of health care.
QUESTIONS?
Editor's Notes
(Introductions made): Hello everyone and welcome to our presentation! Today we would like to share our journey with you on our path towards top quartile patient loyalty. We will share with you: Our Vision Where We Started Where We Are Now/ Our Goal Tools We Used to Get Where We Are Although we also have process in place for Caregiver Rounding on Patients, today our focus will be on Leader Rounding.
Here are the main areas that we will cover today. Upon completion of this session, participants should be able to: [Read from slide] Leadership Care Rounding provides a time not only to build relationships, but also to connect the team to purposeful work and create a culture of accountability. We will discuss how Aurora Medical Group (AMG) and Aurora University of Wisconsin Medical Group (AUWMG) structured our program, how our leadership prepared the physicians and caregivers, and how our practices overcame barriers and achieved excellent service, both common and unique.
During the fall of 2008, Aurora Health Care, in partnership with Press Ganey, set out to dramatically and quickly improve the patient experience. Clinical Leadership Rounding was a key ‘must have’ initiative that kicked-off our journey of improving patient satisfaction scores to top-quartile performance levels. This presentation tells our story: the good, the bad, and the unbelievably compassionate acts of service that we were able to discover and share as a result of implementing an effective leadership rounding program.
First, some background on Aurora Health Care. This is important to provide a cultural context for Leader Rounding, define the scope of the roll-out, and allow for a better understanding of how leadership rounding integrates into – and supports – Aurora’s vision and values. Our vision is this… We will be satisfied only when Aurora gives people better access, better service, and better results than they can get anywhere else. Better access means an Aurora facility within 15 – 20 minutes from where our patients live or work; better hours for services to accommodate the schedules of our patients Better care and service means utilizing the best of science, technology and medical practices delivering health care. Better service means having dedicated caregivers that will do whatever is possible to provide care in ways based on the patient’s preferences. Better results means using national benchmarks to make sure our results meet and or surpass national standards. Our vision guides our work across all sites and disciplines.
[Read from slide] What does this mean ? We believe every patient deserves the best care: Provide the right care for patients at the right time and in the right place. We Believe in Responsibly managing resources: Support our caregivers to provide effective and efficient care, utilizing our financial resources wisely. All of us share this responsibility. We don’t want unnecessary expenses passed on to our patients We Believe in Accountability , teamwork, and respect: Respecting the diversity, skills and talents of all of our caregivers and utilizing them to provide the best care to our patients and their families. These are the values that we live every day in everything that we do!
[Read from slide] How do we measure whether we do this? We monitor our clinical quality We monitor our employee’s engagement, and We monitor our patient’s satisfaction
This is how Aurora Looks today. Within Aurora’s primary service area, eastern Wisconsin into northern to Marinette, we provide care to millions of patients every year. People want to receive their care locally. By studying the way they access their health care, we identified 11 markets where people tend to focus their care. Within those 11 markets, we serve our patients through: (Click for photo of ) Hospitals : Aurora has two tertiary care hospitals, Aurora St. Luke’s Medical Center in Milwaukee and Aurora Bay Care Medical Center in Green Bay, where we provide advanced levels of care, and 11 community hospitals, all providing leading edge care and advancements such as Aurora eICU Care, computerized patient records and all digital diagnostics. Two additional specialty hospitals are located in the Milwaukee area, Milwaukee Psychiatric Hospital and the Aurora Women’s Pavilion (which is affiliated with Aurora West Allis Medical Center). Many Aurora hospitals have earned national recognition and honors for quality and innovation, and the Milwaukee area hospitals have twice received Magnet* certification, the highest honor for nursing care awarded by the American Nursing Credentialing Center. There are two more hospitals under construction and they will open in 2010. (Click to show photo of) Clinics : More than 100 Aurora clinics serve communities throughout eastern Wisconsin with by providing primary care, urgent care, diagnostic services (testing such as lab work and x-rays), behavioral health services, rehab and therapy. Some of our clinics are freestanding buildings and others such as the Vince Lombardi Cancer Clinics, or the Aurora Sports Medicine Institute, are located within our hospitals. (Click to show photo of) Pharmacies : Almost 110 Aurora pharmacies are located in grocery stores, as free standing community retail stores, and in hospitals. All provide home delivery. (Click to show photo of) Aurora Quick Cares : 10 Quick Care sites located in Aurora Pharmacy or other convenient community centers such as grocery stores or malls where people can get quick results and treatment for common conditions such as strep throat or ear infection. (Click to show photo of) Home Care : The Aurora Visiting Nurse Association touches more lives in one year than all of our hospitals combined. They not only provide nursing care in patient’s homes, but also mobile meals, durable medical equipment, social work, physical therapy, hospice, and chaplaincy. (Click to show photo of) Laboratories : clinical laboratory services through 60 ACL laboratories in WI and IL If you want to find a clinic near you, or locate a doctor within out network. In addition, Aurora Vision Centers offer eyewear and eye care services. Diversified Care, Inc. (or “DCI” for short) is an element of Aurora Ventures that provides temporary staffing and employment solutions. This insures that our temporary helpers share the same vision and values as all caregivers of Aurora Health Care. * Magnet – creating the environment for nursing staff to provide the highest quality of nursing care compared to national standards
Patient-centered care is our core patient care philosophy. Look at this visual – the puzzle pieces could be the different components of Aurora Health Care I just described. Every employee of Aurora is a caregiver and has a daily responsibility to do whatever we can to make the experience of our patients exceptional regardless of where they are seen . Simply stated, we are here to provide the best experience for all of our patients. I now want to share with you the promise we make to our patients and our role in creating the optimum patient experience.
5 Areas of Focus
Read/paraphrase from slide (regarding Call Backs, can mention that in Aurora Quick Care they call patients within 48 hours after their visit) We survey our patients to learn about their experience. We look at patient satisfaction, also known as patient loyalty We are looking for the percent of our patients who rate their likelihood of recommending Aurora to their family and friends as ‘very good’ We measure ourselves against other health care providers and national benchmarks.
This is a portion from our 2009 through 2011 Strategic Plan. Notice how the Targets increase over the next few years for achieving top quartile performance in our measures of how patients rate their experience. Care rounding when done correctly has been proven to be one of the most effective tools that can be used to achieve these vital strategic goals
Let’s talk now more specifically about Leader Care Rounds. There are two types of Leader Care Rounds: Administrative Rounds and Manager/Supervisor Rounds are performed by leaders on either patients and/or caregivers Let’s pause for a moment…. While you have been sitting here in this presentation so far… think about what is going on in the practices back home…. How many patients have been seen today? How are those patients and families being greeted…being treated? How many touch points are occurring where there is an opportunity to impact the experiences of those patients and families in your practice right now? Leadership rounding will open your eyes to those opportunities…
There are 9 elements to successful rounding which we will explore individually These elements are included in your handouts as a document for your reference. We want to emphasize that we are rounding for a purpose – to get favorable insights/feedback that will ultimately improve the patient experience. Including all these elements which are part of best practices in Care Rounding, can improve patient experience outcomes. Let’s look briefly at each of the elements.
When preparing to perform Leadership Care Rounds it is important to: Let the caregivers know that rounds will be occurring. There are many ways to do this including - posting it, sending email, announcing Care Rounds at staff meetings, etc. Prior to rounding, talk to managers, supervisors, and leads about caregivers that have recently done something well that you can recognize, to identify sensitive issues, such as supply problems or relationship issues that are likely to be brought up by caregivers, and about recent patient satisfaction measures that could be acknowledged. For example you might say: “I need your help to see what is working well, who should be recognized, where the issues are, and in what areas do our patient satisfaction results show we are doing well or can do better.” Think about opportunities during rounding to build relationships. Demonstrate that you care about our caregivers. Reaching out, recognizing a positive, supporting a concern, and learning something about a colleague are all actions that can build trust and enhance engagement.
Be prepared to provide regular updates regarding successes and issues. Doing this will create confidence that issues are being addressed and successes are being recognized. This can include follow-up from previous care rounds. Look at the document that was provided in your handouts: “Five questions with key words”. By utilizing these questions as the core of your interaction with caregivers or patients will help you to stay positive, form and deliver a specific message, and have a focused approach to gathering information. We will talk more about the five questions in a few minutes. When someone brings up a problem, assure them that you will do the best you can to get it resolved. Whenever possible, let their immediate supervisor be ‘the hero’ to encourage appropriate ongoing feedback through their ‘one-up’ leader.
Use of Logs are one of the critical parts of performing Care Rounds. Logs will help you to track successes and opportunities, and will serve as a tool to share best practices. They can be used to jog the memory before subsequent rounding. They should be reviewed with one-ups to identify needs for and as a basis for action planning. Please look at the variety of sample log documents that were included in your handouts. Notice that the five key questions using key words are incorporated into each log as a reference for your use in performing care rounds. Utilizing the logs will assist you in demonstrating accountability in performing care rounds. Recognition plans should be in place, with materials readily available at all times to reward the behaviors that support our strategies. A verbal thank you followed up with a written note; or a small token of appreciation from a stash of readily available items will go a long way to reinforce repetition of positive behaviors. Rounding must occur regularly to be effective. Over time, rounding will save time by reducing the number of “fires” that need to be put out. It will also increase efficiencies and serve as a powerful tool to reach the operational goals that cascade from the long-term strategy. Note the recommended frequency for rounding based on your position. This frequency was developed by a team of leaders and has the support of our top leadership. (Optional: Let’s pause here to illustrate what rounds look like when performed by Senior Leaders, Administrators, and Managers) Brad, do we want to insert the rounding logs here?
Sample Rounding Log
Let’s look again at the document “The Five Questions Using Key Words”. As a reminder, the rounding logs all include the Five Questions using Key Words for your reference. These questions can be used as is when doing leadership rounding on care givers. To focus your rounds to increase the impact on patient satisfaction outcomes, the question “Is there anything that you would like me to know?” can be replaced by a focused question stating a goal and asking for feedback. For example, it could read “It is our goal to be very good at demonstrating a cheerful environment. How are we doing in meeting that goal today?” The question(s) can be varied at the discretion of the leader in order to elicit focused feedback on site-specific areas of performance or behaviors that lead to success (behaviors to reinforce) or show opportunity for improvement. Notice that we use actual words, key words from the survey they will see. We want our patients to identify later on with our desire and efforts to be “very good”. Very good is the highest rating level a patient could choose to recognize their experience. With each interim patient satisfaction report, the questions can be customized to address current areas of opportunity and success. (Optional: Let’s pause to illustrate the Manager or Supervisor performing Care Rounds on both caregivers and patients).
Here is what the document “The Five Questions Using Key Words” looks like. This document is part of your handouts.
If you want to you can close your eyes. (Slowly state): I’d like you to imagine every caregiver in your organization using gestures and words that are in perfect harmony with your organization’s mission, vision, and values. Hopefully that conjures up a picture in your mind of behaviors and activities that effectively enhance each patient’s experience. That is the essence of using key words in key ways. “It guides our caregivers to say certain things and act certain ways in given situations-both with patients and with each other so we get the maximum possible benefit from actions we already take…” Scripting is not a robotic, verbatim delivery of a message, but a personal delivery of a message that utilizes much more than words. Scripting includes body language, eye contact, tone of voice, conversational phrasing, and facial expressions. It (Scripting) can include any act or behavior that communicates (Baptist Health Care Leadership Institute, 2003).”
Our Employee Satisfaction (Pulse) research has shown that two ways to focus caregivers on purposeful work while at the same time improving caregiver engagement are to: provide a clear understanding of why decisions are made and to provide communications that make caregivers feel as though they have been heard . Effective rounding on caregivers can lead to these outcomes. Engaged caregiver behaviors are more cheerful, sensitive, and personal. These are all elements of an exceptional patient care experience.
Look at the document in your handouts entitled: Leader Rounding Action Plan. This is a tool that can help you get started in planning and performing focused leader care rounds.
If you are not already conducting leadership rounds, it’s a great time to start. If you have already started, we hope this presentation has provided you with additional specific tools to focus and record your interactions to achieve outcomes and successful action planning.
Again, the frequency and timing for performing leadership care rounds was arrived at through discussion with AMG and AUWMG leaders, managers, and administrators in the metro area. Rounding logs should be documented and discussed routinely between the leader rounder and their ‘one-up’. Additional leadership group discussions can be useful in identifying trends or areas for focused action planning and problem solving etc. Your ‘one up’ will discuss their preferred use of the tools and their preferred forum(s) to discuss findings. In the case of rounding, while the rounding itself is useful, the follow up that occurs has the potential to take that usefulness to even higher levels in enhancing our patients’ experiences.
The baseline measurement across all Aurora clinics was top-quartile (greater than the 75 th percentile) performance from 18% of approximately 145 clinics on the Press Ganey questionnaire item “Likelihood of Recommending the Practice”. Within eight months of rolling out the Leadership Rounding model 45% of Aurora clinics were achieving top quartile performance. Within 12 months, approximately 40% of Aurora clinics were achieving top quartile performance.
Thank you for your participation. (Ask if any one has any questions)
Thank you for your participation. (Ask if any one has any questions)
