Getting the Most Out of Patient Rounds
July 09, 2013
By Susan Wessel, RN, MS, MBA, NEA-BC ; Consultant, Creative Healthcare Management
Patient rounds can have unexpected benefits when a few simple techniques are followed. Over time, as I began to refine my approach, I got better results: I noticed that patients became reassured and felt safer, I got meaningful staff compliments, and I learned useful ideas to make care even better because patients felt more comfortable sharing.
I invite you to try these simple strategies for patient or family rounds. They work for executives, managers, supervisors, or those in charge of a shift.
Knock on the door or door frame before entering the room. Sometimes you might ask the nurse in advance whether the patient is stable enough for a visitor depending on the situation. Once you enter the room, greet the patient (and/or family) by name and introduce yourself using your title. Patients like knowing that they are important enough to have a visit by someone in a leadership role. Finally, ask the patient if this is a convenient time for a brief conversation about how things are going. Be prepared to come back at another time if that is the patient’s preference.
Sitting at Eye Level
Sitting at eye level is a powerful caring behavior that is well documented to convey that you have time to listen, that you care, and that you are seeing the patient and family as equals in the conversation. It’s worth the time to find a side chair if one is not free in the room. I have also found that taking notes reinforces that you are listening and want to remember.
Start With an Appreciative Question
I have learned the value of appreciative questions in uncovering lovely examples of what is helping patients and families to feel safe and well cared for. These are questions that are worded such that the patient shares something positive. Appreciative questions follow the philosophy of Appreciative Inquiry, and are a powerful way to learn what is going well, and which staff members have provided care that has made a positive difference. I suggest starting every meeting with a patient or family with an appreciative question. Here are some of my favorites:
- Is there someone who has made a positive difference in your care who deserves recognition? Tell me about that.
- Describe a situation in which you felt really well cared for while you were here.
- We are focusing on “______”. Could you share an example of someone who did that well?
Ask the “Improvement” Question So that it’s Safe to Answer
After interviewing many patients after discharge, it became apparent to me how rarely they share the truth (if the truth reflects some kind of dissatisfaction) while they are still within our care. The fear of retribution is just too strong. This can never be completely overcome, and yet if the stage is set in an intentional way, we can uncover ways to improve care while patients are still within our organization.
When you are in a seated conversation and have built some trust, the patient is more likely to believe that you really want to know the truth. They won’t be as likely to give us the “fine” answer because they perceive that’s all we want to hear. Consider using an introductory sentence about your desire to provide the best care. Then ask the question using “even better” phrasing. Here is what tends to work for me.
“We take a lot of pride in our care, and we are always working hard to improve. Could you share with me what we could do to make your care even better? That would be very helpful.”
When patients offer concrete suggestions, thank them. It may also be appropriate to apologize if something did not happen the way it should have. If it’s realistic to solve the issue immediately, let the patient know. Otherwise your commitment may be to work on the problem for future patients, perhaps taking it to the right group or person.
Bring the conversation to a respectful conclusion, thanking them for their time. You can promise to pass on compliments you received in addition to following up on suggestions. In some situations, particularly if you are the first line manager, you might leave a card with your name and contact information.
The vast majority of time making rounds leaves me feeling proud and inspired about the quality of care, and I love passing on the compliments I’ve received.
As a consultant at Creative Health Care Management, Susan partners with hospitals to improve patient care through the design and implementation of Relationship-Based Care. She develops leadership teams to build trust, collaboration, and personal accountability. She also specializes in creating an engaged workforce and building professional practice environments consistent with Magnet® Recognition criteria.