AMGA 2010 Annual Conference

Leadership Rounding: How to Hardwire Excellence,

Share Accountability, and Improve the Patient Experience

Thursday, March 18th, 2010

Presented by: Brad Kruger, Administrator , Aurora Health Care

Dan Bent, Improvement Manager, Press Ganey Associates

Aurora Health Care is a not-for-profit health care provider and a national leader in the efforts to improve the quality of health care.

Aurora health Care is a not-for-profit health care provider and a national leader in the efforts to improve the quality of health care.

Learning objectives:

• Define leadership rounding • Identify why leadership rounding is an important

tool for the practice• Identify roles and expectations for clinical leaders in

Implementing care rounds• Be able to coach clinical leaders on key

components of rounding and rounding for outcomes• Participants will take away sample tools for

implementation

Aurora health Care is a not-for-profit health care provider and a national leader in the efforts to improve the quality of health care.

Leadership Rounding

• Evolution of an idea

• Why does it matter?

• What have we seen?

• What have we learned?

• How have patients responded?

Aurora health Care is a not-for-profit health care provider and a national leader in the efforts to improve the quality of health care.

Aurora health Care is a not-for-profit health care provider and a national leader in the efforts to improve the quality of health care.

Our visionThere is a better way to provide health care:• Better access• Better care and service• Better results

Working together, the people of Aurora will find a better way

Aurora health Care is a not-for-profit health care provider and a national leader in the efforts to improve the quality of health care.

Aurora health Care is a not-for-profit health care provider and a national leader in the efforts to improve the quality of health care.

Our values

Our CEO, Dr. Nick Turkal, opens many meetings and presentations with our values. Values guide our behaviors.

• We believe every patient deserves the best care

• We believe in responsibly managing resources

• We believe in accountability, teamwork, and respect

Our promise to our patientsThe best patient experience … Our #1 Priority

Our patients deserve the best care. When we achieve top performance in our clinical quality, patient satisfaction and caregiver engagement measures, patients receive a better care experience than they can get anywhere else.

Aurora health Care is a not-for-profit health care provider and a national leader in the efforts to improve the quality of health care.

Aurora health Care is a not-for-profit health care provider and a national leader in the efforts to improve the quality of health care.

Getting to know Aurora, Integrated Health System Bringing health care to communities

throughout WI as one Aurora

Aurora health Care is a not-for-profit health care provider and a national leader in the efforts to improve the quality of health care.

Aurora Medical Group and Aurora UW Medical Group consists of:

• ~1150 employed physicians

• 145 sites that span the eastern

one-third of Wisconsin

• 2.6 million patient visits in 2008

Aurora health Care is a not-for-profit health care provider and a national leader in the efforts to improve the quality of health care.Aurora health Care is a not-for-profit health care provider and a national leader in the efforts to improve the quality of health care.

Aurora health Care is a not-for-profit health care provider and a national leader in the efforts to improve the quality of health care.Aurora health Care is a not-for-profit health care provider and a national leader in the efforts to improve the quality of health care.

Our promise to our patients

We measure the patient experience through patient feedback:• Real-time feedback• Call backs • Surveys• Focus groups

Aurora health Care is a not-for-profit health care provider and a national leader in the efforts to improve the quality of health care.

Aurora health Care is a not-for-profit health care provider and a national leader in the efforts to improve the quality of health care.

2009 to 2011 Strategic Plan

Key Action 2009 Target 2010 Target 2011 Target

Adopt and embrace • Achieve 40% of patient loyalty • Achieve 70% of patient loyalty • Achieve 90% of patient loyaltythe Planetree scores by survey type in the scores by survey type in the scores by survey type in thephilosophy of top quartile. top quartile. top quartile.patient-centered care. • Increase system-wide • Increase system-wide • Achieve top quartile

employee engagement index employee engagement index system-wide employeeto 68% agree. to 70% agree. engagement index

(70% agree).

Aurora health Care is a not-for-profit health care provider and a national leader in the efforts to improve the quality of health care.

Care Rounds

•Administrative Rounds on patients and caregivers

• Manager/Supervisor Rounds on patients and caregivers

Aurora health Care is a not-for-profit health care provider and a national leader in the efforts to improve the quality of health care.

Nine key elements for successful rounding on caregivers1. Communication with caregivers2. Knowledge of the area 3. Relationship building4. Remembering issues/updates5. Five questions with key words6. Communication of plan7. Recording issues8. Recognize and Reward9. Consistency

Aurora health Care is a not-for-profit health care provider and a national leader in the efforts to improve the quality of health care.

Nine key elements

Communication with caregiver- Caregivers should know that rounding is

occurring and why it is being done

Knowledge of the area- Leaders should talk to other leaders about

potential issues

Relationship building- Learn something about each caregiver

Aurora health Care is a not-for-profit health care provider and a national leader in the efforts to improve the quality of health care.

Nine key elements

Remembering issues/updates- Caregivers should have updates on progress

with successes and issues

Five questions with key words- Consistent questions can be focused on site-

specific issues and shape perspectives

Communication of plan- Assure caregivers that issues are being

investigated and addressed.

Aurora health Care is a not-for-profit health care provider and a national leader in the efforts to improve the quality of health care.

Recording issues- Maintain a log for follow-up and submission to other

leadersRecognize and reward

- Find as many stories and positive behaviors as possible to recognize and reinforce

Consistency- Regular rounding will reinforce behavior, trust, and

communication• Rounding regularly with a focus, for 30-60 minutes at

a time• Administrators-Once per quarter at each site• Managers-Three areas/sites/pods per week• Supervisors-Four areas/sites/pods per week

Nine key elements

Aurora health Care is a not-for-profit health care provider and a national leader in the efforts to improve the quality of health care.

Sample Leader Rounding Logs

Aurora health Care is a not-for-profit health care provider and a national leader in the efforts to improve the quality of health care.

The Five Questions using Key Words

• What would you strongly agree is working well today?

• Are there any caregivers, including physicians, that should be recognized?

• Do you have the tools and equipment you need to serve our patients and your colleagues?

• Is there anything that we could do better?

• Is there anything else that you would like me to know?

Aurora health Care is a not-for-profit health care provider and a national leader in the efforts to improve the quality of health care.

Aurora health Care is a not-for-profit health care provider and a national leader in the efforts to improve the quality of health care.

Using Key Words in Key Ways *

• Using key words in key ways is a powerful tool that can be used by all caregivers. It is the use of specific behaviors, phrases, and body language to help us succeed in providing an exceptional patient care experience.

• The caregiver will shape the message as opposed to robotically delivering a script

* Scripting can include any act or behavior that communicates (Baptist Health Care Leadership Institute, 2003).

Aurora health Care is a not-for-profit health care provider and a national leader in the efforts to improve the quality of health care.

Caregiver Engagement:

- Clear understanding of why decisions are made

- Make me feel as though I’ve been heard

Aurora health Care is a not-for-profit health care provider and a national leader in the efforts to improve the quality of health care.

Caregiver Engagement

Employee and Nurse Check-up Report, http://www.pressganey.com/galleries/default-file/Employee_Nurse_Check-Up_10-08-08.pdf, Press Ganey, 2008

Aurora health Care is a not-for-profit health care provider and a national leader in the efforts to improve the quality of health care.

Caregiver Engagement

Employee and Nurse Check-up Report, http://www.pressganey.com/galleries/default-file/Employee_Nurse_Check-Up_10-08-08.pdf, Press Ganey, 2008

Aurora health Care is a not-for-profit health care provider and a national leader in the efforts to improve the quality of health care.

Leadership Care Rounds How to Get Started

• Talk with your leadership team• Outline how the 9 elements will be

incorporated in your area• Develop a regular schedule that is blocked

for rounding• Have all of your tools/report data ready

before rounding• Identify issues that are likely to come up• Round in a wide-array of areas

Aurora health Care is a not-for-profit health care provider and a national leader in the efforts to improve the quality of health care.

Things to Start Doing Now

• Build care rounding into daily routine – have a definite purpose

• Look through the patient and/or caregiver lens

• Own the experience you see

• Use the 9 steps for successful rounding

Aurora health Care is a not-for-profit health care provider and a national leader in the efforts to improve the quality of health care.

Leadership Care Rounds:Your Responsibilities

• Rounding regularly with a focus, for 30-60 minutes at a time

• Administrators-Once per quarter at each site• Managers-Three areas/sites/pods per week• Supervisors-Four areas/sites/pods per week

• Using the rounding log• Supervisors and managers to discuss regularly• Leaders to present to their “one-up” for review

and action planning

Aurora health Care is a not-for-profit health care provider and a national leader in the efforts to improve the quality of health care.

Leadership Care Rounds:Your Responsibilities

• Problem solving using responsible freedom• Caregivers closest to the patients implementing

solutions with support from their leaders and each other

• Developing and implementing a recognition plan• Hard-wiring behaviors that support the

exceptional patient care experience• Recognition needs to occur in real time to be

effective

Aurora health Care is a not-for-profit health care provider and a national leader in the efforts to improve the quality of health care.

Aurora health Care is a not-for-profit health care provider and a national leader in the efforts to improve the quality of health care.

Aurora health Care is a not-for-profit health care provider and a national leader in the efforts to improve the quality of health care.

QUESTIONS?