mistake number 1
Lack of senior leadership buy-in
It’s a common theme: a hospital (let’s say in this case, the Quality and Accreditation Department) purchases a shiny new rounding solution to maintain TJC compliance and improve performance, but senior leadership is not engaged and has no involvement or ownership of the process. Months later, completion of rounds is barely hitting 50%, and outstanding follow up items are not being fixed. Quality and Accreditation thought they had the clout to persuade nursing to utilize the tool to its full potential.
Whoops, they didn’t have that clout on their lonesome, and the compelling event of The Joint Commission showing back up isn’t for awhile. Quality and Accreditation is facing an uphill battle if they do not find some organizational support at the highest levels.
There could be many semi-legitimate reasons for nursing not getting it done (and how to solve that problem is probably another blog post or two). One obvious issue is that if senior leadership is not engaged, then you may not have the ability to get the proper utilization of an electronic rounding tool (or any rounding process for that matter).
A few questions to consider:
- Is a safety culture in place that is embraced and pushed down from the top of the organization? Upper management must commit to a culture of safety, not just maintaining accreditation when needed.
- If, like in this scenario, the initiative is led by Quality and Accreditation, is it a well-developed department and are the right reporting mechanisms in place? (Quality reporting directly to C-suite.)
- Does leadership have a feel for the front lines?
mistake NUMBER 2
lack of internal 'marketing' prior to starting
Another common scenario, even with senior leadership buy-in, is that management isn't “marketing” the new tool to staff prior to implementation. People in hospitals are extremely busy, and they usually want to excel at their jobs. If some new process is tossed their direction on top of their workload without reasoning (and heaven forbid it’s a duplicative process), then they are unlikely to embrace it or use it to its full potential.
Other than making sure you are actually streamlining the process and not adding duplicative work, the group utilizing the tool or those responsible for fixing follow up items needs to be made aware of the purpose of the tool and the positive effects it will have on the institution and your patients. Seeing the transparency gained from using an electronic rounding solution should also act as a motivator to the staff to complete their rounds and fix follow up items in a timely manner, (but this is less likely if you do not have support from the C-Suite).
MISTAKE NUMBER 3
NOT being used for improvement
...Moving away from just hospital accreditation, to also including improvement efforts in quality and patient safety.
The final scenario I want to talk about is conducting rounds without performance improvement in mind. If this is the case at your hospital, I urge you to reflect on why you’re doing rounds in the first place. Just to maintain compliance? Without focusing on performance improvement, you will quickly fall behind the times in the coming years. Most importantly, however, you’re missing an opportunity to improve the quality of care and safety at your hospital. With many people dying in U.S. hospitals due to medical errors, improving performance is a critical task for hospitals. Not to mention, your patient experience results will be closely tied to performance.
Mindfully implemented, a quality electronic rounding solution should allow you to see your top failing items and top failing Standards and Elements of Performance, all in real-time, which should cut out all the "noise" on what you need to work on, and whether or not it's improving once you do work on it. If your electronic rounding solution doesn't allow you to do this, then why bother?
Learn about The Detroit VA Medical Center improving Patient Safety through utilization of the Readiness Rounds platform: