I recently had the opportunity to hear Maureen Bisognano, CEO of Institute for Healthcare Improvement, speak at the Society of Hospital Medicine 2015 Annual Conference. In her keynote address, she challenged us to focus less on asking what's the matter with our patients and more on asking what matters to our patients. One way to do this, she noted, is to start asking our patients what a good day looks like to them. Why is this so important? As providers, we have a specific agenda we want to accomplish while in the room with the patient. As we've gotten busier, the time we spend just talking has decreased. Given the rush, we often don't stop to ask our patients what their actual preferences are. Taking a moment to ask our patients, What's a good day look like for you?, puts the focus back on our patients and their wishes. It's not complicated, and it only takes a minute, but the answers could be transformative.
Imagine a patient with pneumonia. As the physician, a good day in my opinion would be one in which my patient takes the antibiotics and doesn't spike a fever. However, in my patient's mind, a good day may be one in which he or she sits outside in the hospital's healing garden for a few minutes. You can see that my good day and my patient's good day are completely different. In fact, I may never suggest the healing garden on my own. By taking the time to ask the patient what a good day looks like, I now know one small thing I can assist with to make a huge difference for my patient. The nice thing about this question is it applies to both the inpatient and outpatient setting.
Maureen Bisognano challenged all of us at SHM to start asking our patients what a good day looks like for them, so now I challenge you to do the same.
To be honest, rounding with nurses is something I did in residency as part of team rounds, but I had gotten away from it since moving beyond an academic setting. Thus, when hospital leadership asked the hospitalist team to consider nurse rounding, I was a bit skeptical. I always thought it sounded good in theory, but I didn't think it would work in reality. As it turns out, I've really enjoyed it, so I wanted to share it with you so you can consider it as a way to improve your patient experience.
The exact logistics will vary based on your hospital's size, but for me, when I arrive on the unit, I find the nurse's portable phone number and call him or her. I let the nurse know where I'm headed, and he or she makes it a priority to join me. I spend a lot of time with my patients, so I try to respect the nurse's time by stating the plan while the nurse is present. That way, if he or she needs to move to another room, the plan has been discussed. I also make sure to ask the nurse his or her input and address any questions or concerns he or she has.
It's been working great, and one of the things I like most about it is that everyone can benefit - the patient, the nurse, and the physician. One of the challenges when introducing new initiatives for staff and providers is to show how it benefits them. Nurse rounding is a patient experience initiative where everyone benefits.
Everyone benefits * Patients benefit by having the nurse and doctor working together at the same time to discuss the patient's care. Rounding is done at the bedside with the patient so the patient is really able to participate and feel included. If the patient or family has a concern, they can express it at that time to the two members of the care team who are best able to advocate for them. It's also an opportunity to show the patient and family that you work together as a team. Patients want to know their entire care team is on the same page and focused on their care, and physician/nurse rounding is one way to accomplish this goal.
* Nurses benefit because they hear the plan directly from the physician, as it is conveyed to the patient. Oftentimes, nurses have information that would alter the treatment plan, so being in the room with the physician as the plan is being expressed helps both the physician and the patient.
For example, if I'm discussing discharge planning and my nurse tells me the patient is unsteady on their feet and requires 2 nurses to get out of bed, I'm going to think about rehab placement as opposed to sending the patient home to live alone.
Physician/Nurse rounding allows nurses to be more knowledgable of the plan, so they can reiterate important information to the patient and family about that plan throughout the day.
For example, if the nurse hears me tell the patient they will be going home on insulin, he or she can begin educating the patient on insulin and how to administer it.
Physician/nurse rounding also encourages nurses to raise questions and concerns during rounds as opposed to trying to locate the physician at a later point in time. This helps nurses to feel like valued members of the care team, which improves nurse satisfaction and retention.
Finally, physician/nurse rounding helps nurses to better learn their physicians' styles and preferences to better assist the physician in taking care of the patient.
*Physicians benefit because the nurse is more knowledgable about the plan, and can more easily answer patient and family questions. Pages to the physician are reduced. No more pages from nurses asking questions that have already been addressed in rounds, and fewer pages from nurses asking doctors to update families. It doesn't completely eliminate the need for physician/family updates, but having the nurse give a basic update eases family anxiety and often alleviates the need to speak directly with the doctor about every concern. As doctors are increasingly pressed for time, anything to improve efficiency helps. Physicians also benefit because nurses have a unique perspective, and this perspective can help the physician as they create the treatment plan. Common things nurses bring up are issues related to wounds, debility, nutrition, and discharge planning. However, as the physicians and nurses become more comfortable with each other, the relationship evolves and the nurse truly becomes a valued ally to help the physician with his or her work.
Regardless of how you implement physician/nurse rounding, I definitely encourage you to give it a try. It really is a win/win for all - patients, nurses, and physicians.
I recently had the opportunity to hear Dr. Peter Pronovost speak at the Society of Hospital Medicine 2015 conference. He's an expert in the field of quality and patient safety, so much of his talk focused on this. However, he also spoke about leading change, and I found this part of his talk to be particularly fascinating. One of the comments he made when discussing change was that people don't fear change, they fear loss. As someone who's job is to work with providers on improving the patient experience, I definitely found this to be true. Check out more of my thoughts on this subject in SHM's The Hospital Leader blog.