Best Practices in Hourly Rounding: White Paper

This blog post excerpts a HealthStream White Paper, “Hourly Rounding: The Critical HCAHPS Driver at the Frontline of Care,” by Leigh Ann Bradley, PhD, FNP, MA, RN, Director of Coaching, Continuum of Care, and April A. Blankenship, RN, MSN, CNOR, Executive Coach, HealthStream Engagement Institute.

NorthCrest Medical Center, an organization coached in the use of hourly rounding by the HealthStream Engagement Institute, offers us an opportunity to see hourly rounding best practices in action. At NorthCrest, hourly rounding is not just an expectation; it is a skill that is assessed yearly. Nurse Leaders conduct annual hourly rounding competencies during which a mock scenario is carried out. In a staged patient room, one leader plays the role of patient while a peer leader takes the part of caregiver.

They initially role model quality hourly rounding, then staff pairs are observed performing return demonstrations. The process is educational rather than punitive; additional coaching is provided as needed following the observation. This annual competency is placed in the employee file alongside clinical competencies and therefore earns equal status and importance. If, during the year, leader rounding on patients validates that hourly rounding is not being consistently performed in a thoughtful way, the leader refers to the annual competency and reestablishes the expectation. To ensure remediation, the leader then increases the number of patients rounded on for that individual staff member to determine his or her response to coaching.

NorthCrest also documents hourly rounding on its white boards (see example below).

Establishing hourly rounding as an expected practice requires time, attention, and commitment on the part of not only frontline staff but hospital leaders. It is only when the practice becomes the way we do business that we begin to see results and reap the benefits in terms of HCAHPS improvement. The benefits are far-reaching and they impact much more than the tasks accomplished by hourly rounding. The sustained practice of hourly rounding ripples through the organization and affects our work in ways we may not anticipate. It informs the way we treat patients in all settings, from registration or presentation at the ED through discharge. It also re-sensitizes us to the patient as a human being versus being seen as a disease. It allows us to spend more time in a thoughtful, planned activity versus rushing from one crisis to the next, and it helps us to stay in touch with the reasons we became caregivers.

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April 1, 2021