Qualitative Research On Hourly Rounding

Hourly rounding is a systematic, proactive nurse-driven evidence-based intervention to anticipate and address needs in hospitalized patients (Meade, Bursell & Ketelsen, 2006). Research shows that hourly rounding or purposeful rounding seeks to increase the patient experience and patient satisfaction. According to Meade, Bursell & Ketelsen, effective hourly rounding can promote patient safety, foster team communication, and improve staff ability to provide efficient care. Despite, mounting research evidence demonstrating the benefits of hourly rounding it can be difficult to implement in the clinical setting.
Background and Purpose: A pilot study hourly rounding was initiated on a unit of a 981- bed multi-campus, regional health network. The
pilot study on that unit was successful and was fully accepted by staff and integrated into their workflow. Slowly, they added other units into using hourly rounding. Then, the organization introduced hourly rounding to all inpatient units. But, this implementation was with mixed reviews. There were two units that had not been successful with the hourly unit even though the pilot study went well. The first unit was a neurological and surgical unit and the second unit was a transitional trauma and surgical unit. Deitrick et al. (2012) explained, both units had 35 semi-private room similar staffing ratios and were located in the largest of the network’s 3 hospitals. Further investigation was needed to see why these units were unsuccessful with hourly rounding.
Method: There were interviews that were done before the observation period.
The interviews included nursing staff from both units, nursing leadership and those responsible for developing and implementing hourly rounds. The study team also reviewed material given to the front-line staff about the hourly rounding process. To further investigate the pitfalls that affected the change management there was more data collection needed. A methodology called ethnography was used , this allowed the study team to listen to staff, observe them and also get an idea about their perception of hourly rounding. Staff members were observed for 1 month from 2 to 3 hours at a time. The study team observed staff for 40 hours on each unit, all shift, even
weekends.
Results: The results from both units identified 5 barriers and challenges: dissemination, the purpose of hourly rounding, rounding process/workflow, accountability, staff attitudes about hourly rounding and patient safety ( Deitrick et al. (2012). The study team discovered through their observation and interviews that the information and education provided to staff did tell them how to do hourly rounding. Nursing leadership also knew of problems on the two units that included staff responsibility and documentation. Despite knowing this they believe staff had received adequate education and should be able to achieve hourly rounding.
Discussion: Nursing leadership thought they had thought out the process of hourly rounding because, it had worked with other units to be able to implement a successful change management but, there were pitfalls to these two units.
In addition, Deitrick et al explained, there appeared to be a gap in understanding the benefits of hourly rounding between administrators and front-line staff on the study units, as well as a lack of clarity about how to implement hourly rounding into the patient care flow. Pitfalls: One pitfall that I think nursing leadership did not do well was stakeholder engagement and communication: They were communication from the top –down. They did not listen to those of the front –line when staff said they were not fully aware of their duties when it came to hourly rounding. In order for staff to really buy-in to a process, they have to feel like that have a say in the process. Staff would like to know their opinions matter. Staff should be involved in the entire process of the organizational change process. According to Anderson & Anderson, when people have a stake in the answer, they naturally have more commitment to getting it implemented successfully. Once leadership knew that staff was having a problem there should have been more up-ward communication. According to Gau, managers who are not interested or fail to promote intra-organizational communication upward or disseminate information downward will create procedural and organizational blockages.
This is exactly what happened in this situation. They should have held meetings with the staff on these two units. This would have opened up the lines of communication and allowed for feedback. Once, it has been determined the problem, leadership should have prioritized what to work on first, develop a plan, execute the plan and continue to monitor and follow through with the plan until the desired results were accomplished. Since communication breakdown and not engaging staff was one of the problems. I would make sure the flow of communication was consistent. Keeping everyone informed and allowing them to provide feedback would help ensure that the goals and vision of each person and the organization of hourly rounding could have been accomplished. Anderson & Anderson emphasizes, “effective change communication entails much more than simply providing information in a “tell” fashion. It requires creating vehicles for people to react to what they have heard, discuss or internalize what it means to them, and then assess the implications on them and the organization. This often requires employees asking questions and getting answers relatively quickly”. 2nd Pitfalls: Capacity, laying the change on top of people’s already excessive workloads. Staff did not know how to incorporate hourly rounding into their duties. They had to divide the rounding up with other staff members but, there was support or instructions from leadership on how this was to be done. The unit managers need to buy into the process as well and be willing to coach their staff if need be. Meade, Bursell, and Ketelsen noted "a key factor to successful implementation of an intervention on a nursing unit is hospital leadership, especially that of nurse managers. Staff should have been educated about the process. They should have had champions from the units that had successfully rolled out hourly rounding to help in the process. Staff should have also been educated that hourly rounding allowed them to be proactive in taking care of the patients’ needs, which in turn could decrease their workload and increase the efficiency of their daily workflow, while also improving safety and quality of care.