Nursing Leadership and Management Field Experience
Introduction and Literature Review
Caroline Waweru
Western Governors University
Nurse Leader Rounding and HCAHPS score
Introduction
Communication is a multi-dimensional and a dynamic, complex process which serves as a key element in providing effective health care services in any health care environment in order to promote patients’ health and satisfaction. It is notable to mention that poor communication is one of the most prevalent issues in the health care system. Due to the lack of effective communication in the hospitals, there is a significant increase in poor health care services, which is crucial for not only the patients but also for the health care organization (Merrifield et al., 2016). The lack of communication between physicians and nurses, physicians and physicians, and nurse and patients are catastrophic for quality care. In the modern era, health care organizations are suffering from low Hospital Consumer Assessment of Health care Providers and System (HCAHPS) score. The significant decrease has been seen in this perspective, which indicates that health care organizations lack the ability to provide efficient health care services. Patients' advocates and payers are increasingly focusing on patient satisfaction rating in order to provide valuable data for patients to choose better health care in their region (Winter & Tjiong, 2015). HCAHPS is a publically available data set which can be used to evaluate the quality of the hospital. Many researchers have proved that effective communication in an organization is beneficial to improve the quality of care and other services (Merrifield et al., 2016). There is an immense need for proper communication between patients and a nurse leader in order to improve the quality of health care. It is notable to mention that there exists limited nurse to nurse communication and patients in plan care discussions. Healthcare future growth and viability depends on patients and nurse safety and satisfaction. Health care organizations are increasingly focusing on improving the experience of patients and their families in the hospital or clinical setting.
Problem Background
Hospital Consumer Assessment of Healthcare Providers and System (HCAHPS) survey in healthcare facility reveals with evidence that there is a need to improve communication between nurses and patients. It has been observed that the advocates and payers of the patients emphasize on better healthcare facilities for which they rely on patient satisfaction rating in order to provide valuable data for patients to choose better health care in their region. According to many professional and health care leaders, it is evident that better patient experience is essential in the modern world as everyone is concerned about their health. For this particular purpose, nurse leaders rounding for outcomes is an effective strategy to obtain actionable information in order to improve the experience of patients at the hospital (Reimer & Herbener, 2014). The communication between healthcare practitioners and patients and their families is unsatisfactory. The HCAHPS score shows that the relationship between health care specialists and patients is very disappointing. In order to attain better results and rating of HCAHPS score, it is essential to provide effective and satisfactory care to patients.
Patients and their families are familiar with the fact that higher management of the hospital is often not interested in visiting their patients in order to understand their concerns and issues in the medical facility. Researchers have found that nurse leaders rounding is an effective practice in the medical facility as it builds increased levels of trust among patients and their families (Babaev, 2016). The nurse leader rounding helps to create a positive environment in the hospital by letting people know that higher management is interested in improving the quality of the health care services in order to achieve better outcomes. There is an immense need to induce the practices of quality improvement in the healthcare organization for improving satisfactory HCAHPS score (Babaev, 2016). Clinical Nurse Leader is responsible for inducing such practices in the organization to make sure that patients are getting acceptable facilities in the hospital. Majority of researchers have found that leader rounding helps to understand the concerns of patients. Evidence-based practices can be integrated into the healthcare setting to improve care. There is a need to assess the microsystem of a particular hospital to determine various problems that need improvement. In order to provide patient-centered quality care, it is necessary to evaluate the communication within the microsystem (McClelland & Vogus, 2014). There are various factors that may obstruct the progress of effective health care services. These factors include the cultural, educational, and socioeconomic dynamics. The problematic situation of the health care organization needs concentrated efforts in order to improve patients and nurses satisfaction, which ultimately results in higher HCAHPS score.
Problem Statement
Lack of communication in health care facilities is problematic for both nurses and patients. In the modern era, nurse to nurse and nurse to patient communication is not satisfactory in the health care setting due to which certain issues are rising. The behavior of nurses with the patients and their families is sometimes unsatisfactory, which is catastrophic for an organization's HCAPHS (McClelland & Vogus, 2014). Patients and their payers often emphasize on the rating of the hospital in order to obtain better health care services. One must need to consider the fact that empowerment and engagement of hospital staff are associated with the general quality of care and patient experience (McClelland & Vogus, 2014). Winchester hospital located in Winchester, Massachusetts, is providing healthcare services to the population. This hospital is aimed to provide better healthcare services to their patients. However, their overall HCAHPS rating is 74 percent, which is far less than the average national HCAHPS score in the United States. In the United States, the average national HCAHPS rating is 80 percent, which determines that a hospital is providing satisfactory services to their patients and their families. The rating of the Winchester hospital indicates that higher management needs to implement some effective communication strategies in order to improve the health care services in the organization. These strategies can be effective to enhance the efficiency of healthcare services. It is notable to mention that the performance of Winchester hospital is less than the average performance of the majority of healthcare centers in the US. The implementation of nurse leader round will be beneficial for Winchester hospital to improve the medical services of the hospital by building a trustworthy relationship with patients. Moreover, the nurse leader rounding will be helpful to identify the areas of improvement to focus upon in order to achieve the objectives of the organization.
Practice Change, Quality Improvement, or Innovation
In the modern competitive era, it is necessary to implement certain quality improvement strategies to enhance health care services in the hospital. In order to improve the hospital culture and patient satisfaction, it is necessary to implement leadership rounding practices. The objective of the nurse leadership rounding is to achieve nursing goals and to note patient progress outcome. It is also beneficial to reinforce good behavior with positive reinforcement in order to improve the HCAHPS score of the Winchester hospital. Nurse leadership rounding helps in identifying the conditions of patients and activities of medical staff. The rounding is beneficial to interact with the patients in order to find out their issues and concerns. Professional behavior is highly recommended for nurse leaders when rounding. It is notable to mention that the nurse leaders serve as the warden of the hospital during their rounding to gather information about the wellbeing of patients. The nurse leaders have the responsibility to identify the areas of improvement in Winchester hospital. Winchester hospital lacks the practice of nurse leadership rounding due to which there is no one to monitor the practices and behaviors of medical staff towards patients and their families. It is notable to mention that many patients had provided unsatisfactory remarks about Winchester hospital while discussing their experience in the hospital. It is essential for the hospital management to promote the practices of nursing leadership rounding in order to manage the performance of medical staff and their behavior towards patients and their families. If Winchester hospital wants to improve the quality of care, then it must implement nursing leadership rounding to achieve satisfactory results.
The rationale for the Practice Change, Quality Improvement, or Innovation
Every individual wants to obtain efficient health care services to improve the quality of their work. In order to improve the overall performance of the medical staff and health care services, it is necessary for nurse leaders to practice rounding on various floors of the hospital to determine where the issue lies. Nurse leadership rounding set expectations and directions to medical staff so that they can provide adequate services. There is an immense need for higher management to implement quality improvement practices in the hospital setting to address the concerns of patients in a timely manner. Rounding energizes a health care organization by connecting the passion and compassion of staff and leaders. The health care organization can easily demonstrate the commitment of leader with the patients and staff through nurse leader round which helps in maximizing the performance of medical staff and health care services associated with them. The HCAHPS score can be improved with effective nurse leader rounding in order to provide satisfactory health care services in the organization.
Literature Review
Reviewing previous literature helps in understanding the topic under observation. It provides liable information about various aspects of that topic. In order to get a better understanding of the relationship between nurse leader rounding and health care services, it is important to review previous literature.
Best Practices
Direct observation and evaluation of patient, staff, and clinical environments help in determining the areas of improvements in order to provide satisfactory health care services (Merrifield et al., 2016). Hourly rounds have a significant impact on patient satisfaction scores (Dempsey, Reilly & Buhlman, 2014). The efficiency of effective communication skills during rounds in order to understand the concerns of patients (Tussing, 2015). It is notable to mention that the implementation of quality improvement in a health care setting is an energy-intensive and fraught process, but it can enhance the patient and staff satisfaction with the nursing service (Walker et al., 2015).
Evidence Summary
Nurse leader round with patients is an effective strategy that improves the overall satisfaction of patients with nurse leader (Brosey & March 2015). It is notable to mention that nurse leadership rounding involves direct observation and evaluation of the patient, staff, global view of patient status, clinical environment and unit functioning (Ciccu-Moore et al., 2014). It is noteworthy to mention that such leadership rounding helps in the identification of areas that needs improvements (Dempsey, Reilly & Buhlman, 2014). According to Merrifield et al. (2016), the efficiency of such nurse leadership rounding enhances the leader's capability to deliver effective care. The authors state that a leader can utilize such practice to move staff, mission, and goals in order to ensure the delivery of safe and high-quality practices. Day to day nurse leader rounds is valuable for proactive assessment of nursing quality regarding their care to the patients (Boissy et al., 2016). The results are taken from the study of Daniels (2016) illustrates that nurse leader rounding is associated with patient satisfaction and perception of care. Furthermore, hospitals are categorized on the basis of HCAHPS score in the modern era, where everyone is willing to attain better healthcare services. This assessment of quality helps in providing immediate feedback to particular nurses. Learning disabilities in patients, motivation, and readiness to learn affects satisfaction scores, especially when the patients do not understand the service delivery methods used by nurses and are unwilling to learn (Fabry, 2015). Rounding is a constructive way of understanding the quality of nursing care from patients' perspectives (Merrifield et al. 2016). Nursing leadership rounding is one of the effective strategies that have a significant impact on patient satisfaction scores (Goldsack et al., 2015). The patient population is diversified; hence, cultural competence becomes critical in improving HCAHPS scores. Structured multidisciplinary rounding positively impacts the satisfaction of patients and their length of stay (Mercedes et al., 2016). It is important to mention that structured multidisciplinary rounding uses a structured communication tool that helps to improve coordination and communication among the healthcare team and patients (Mercedes et al., 2016).
Technology advancements and improving healthcare prolongs patients' life and decreases the burden of chronic illnesses. Poorly educated patients may not understand the technology applied in their care plan. Implementation of significant health care practices is essential to enhance quality care. Healthcare organizations are increasingly focusing to integrate various methods to improve the experiences of patients in the healthcare system (Morton et al., 2014). Nurse leader rounds are associated with improved ratings from patients based on their experience in the healthcare system. It also helps nurse leaders to identify improvement opportunities and to harvest recognition opportunities. It is notable to mention that patients tend to share their feelings in an appropriate manner when they believe that nursing leadership is concerned about their healthcare in the hospital. Increase in the HCAHPS score signifies that a health care organization is performing well to give better satisfactory health care services to clients. The authors emphasize on implementing nurse leader rounds in the healthcare system in order to improve the perception of patients regarding health care. According to the authors, this kind of leadership practice allows leaders to proactively ensure the deliverance of high-quality care by keeping a check over the medical staff's activities and behaviors. Assurance of high quality of health care services is critical in modern society as everyone is willing to obtain better health care services. Regular production of patient experience data helps in identifying the areas of improvements and helps in managing these weak areas to promote better health care services among the population (Morton et al., 2014). Intentional Rounding has gained significant importance in the recent few years. Intentional Rounding is getting political and public support as it aims to improve patient outcomes and satisfaction (Morgan et al., 2017). Rounds provide valuable information regarding patients concerns and issues in the hospital and it helps health care leaders to recognize the activities of medical staff. Patients are motivated to share their concerns with leaders as they believe that nurse leaders are available for their help (Morton et al., 2014).
The importance of effective clinical leadership helps in ensuring a high-quality health care system. The efficiency of leaders in improving health care services is effective to increase the overall rating of the HCAHPS score. Clinical leadership round is a critical aspect to improve the quality and safety of patients. It is important to understand the significance of social dynamics in order to implement the practices of nurse leadership rounding effectively. The satisfaction of the patient towards nursing communication is significantly affected by social and economic status. Low socioeconomic status patients tend to have a low life expectancy, suffer from chronic illnesses, and poor self-reported health compared to high social status patients. Also, their access to healthcare is limited due to coverage and costs and diagnostics tests conducted on them are few. Hence, nursing leadership rounding provides opportunities to excel patients' life expectancy by listening to their concerns. It is significantly important for nurse leaders to round the hospital floors in order to identify the areas of concerns in the health care setting. The presence of a nurse leader on the floors helps in encouraging and motivating patients that higher management is concerned about their health (Bender, 2016). The short time span for round can help them to create strategies to improve the services in the hospital. By doing so, they can spend most of their time on administrative and management tasks to emphasize on the quality of care. Clinical leadership is a key driver of the health service, which results in increase HCAHPS score through effective implementation of health care services. Nurse perceive low-class patients as rational, independent, responsible, intelligent, and unlikely to comply with the treatment plan. Low-class patients are mostly neglected than high-status patients due to the assumptions of low reimbursement rates and uncooperative (Merrifield et al., 2016). These perspectives hinder HCAHPS scores improvement in nursing communication since the financially challenged patients are often dissatisfied with nursing services. It is essential to understand the perspective and concerns of patients. By doing so, health care practitioners can easily resolve the issues that are hindering the process of quality health care. Nurse leader rounding provides these patients with the chance to share their concerns in an appropriate way (Ross et al., 2014). The implementation of intentional rounding in the hospital setting clearly impacts the processes of care of the patient (Christiansen et al., 2017). Therefore, it is necessary to implement intentional rounding to enhance the capacity of nurses to keep patients safe.
Dempsey, Reily & Buhlman (2014) emphasize the interaction of nurse leaders with patients that can improve the patient's experience in the healthcare setting. The nurse leader needs to emphasize cultural characteristics such as language preference, race, and ethnicity as they influence HCAHPS scores (Merrifield et al., 2016). For instance, cultural diversity may be characterized with language barriers, especially in a hospital where the patient lacks knowledge of the common language. The authors illustrate that it is the core responsibility of the nurse leader to practice rounding in the hospital in order to integrate effective communication skills among staff members. A nurse leader needs to pay attention to better care of patients in order to successfully obtain a high rating in HCAHPS score (Winter & Tjiong, 2015). It is the responsibility of higher management to strong senior and staff leadership in order to implement nurse leader rounds in an effective manner. Nurse leader rounds practice increased the confidence of patients to share both positive and negative comments during rounding in terms of medical staff’s behavior and health care services (Tussing, 2015). Nurse leader needs to understand that comprehension of patient cultural competencies is effective to build a positive reputation in the country (Tussing, 2015). The inability to communicate effectively with the care provider deprives the patients’ participation in the healthcare plan (Dempsey et al., 2014). Effective communication with patients help nurse leaders to understand their experience in the hospital and it provides valuable insights about weak areas that might need some improvement to improve patient’s perception of care. Improving patient experience has a direct impact on HCAHPS score which can easily be achieved through effective nurse leadership communication with patients (Kennedy, Tevis & Kent, 2014). However, certain barriers exist that hinder the implementation of hourly rounding. These barriers include workload issues, missing staff buy-in, burdensome rounding logs, and lack of adequate staff education (Toole, N., Meluskey, T., & Hall, 2016).
Nurse leaders need to use effective communication skills during their rounds to understand the concerns of patients (Tussing, 2015). It is obvious that patients are unable to share their concerns if a nurse leader lacks the ability to engage in effective communication. It is obvious that the comprehension of patient cultural competencies could improve satisfaction scores. The optimizing nurse leader communication has a positive impact on the domains of HCAHPS (Dempsey, Reilly & Buhlman, 2014). Nurse leaders can integrate better communication skills in a medical setting to encourage medical staff to increase their efficiency in terms of better health care services (Pattison et al., 2017). The leadership of the hospital needs to make round among patients to promote a positive sense that higher management is concerned about the satisfaction and health care of the staff (Mann et al., 2016).
According to Walker, Duff & Fitzgerald (2015), rounding is proved to be an effective intervention in order to enhance patient-centered care. The needs of the patients are effectively handled when nurse leaders make rounds to check the performance of their medical staff and nurses (Walker et al., 2015). Implementing new methods of rounds and changing clinician behaviors are difficult, but the efficiency of rounding is far more valuable. Nurse leadership rounds are effective for patients to perceive attention to personal needs and their safety in a more accurate way (Reimer & Herbener, 2014). Integration of customer service rounding program in the healthcare setting helps provides the opportunities to solve problems and issue of patients (Pattison et al., 2015). Implementing quality improvement in health care is an energy-intensive and fraught process, but it can enhance the patient and staff satisfaction with the nursing service (Walker et al., 2015). Nurse leadership rounding is associated with patient experience, physician engagement, and clinical quality indicators (Reem, Kitsantas & Maddox, 2014). The psychological aspects of patients are easily understandable through nurse leadership rounding (Reimer & Herbener, 2014). Nurse leader rounding struggled to gain traction with the staff, which allows them to provide better health care services in the hospital without any interruptions.
Effective implementation of nurse leader rounds improves a patient’s perception of care as it promotes effective communication among nurse leaders and patients. Educational dynamics also influence HCAHPS scores (Merrill, 2015). The implementation of nurse leader rounding increased the level of patient's satisfaction (Babaev, 2016). His study shows significant results in HCAPHS score before and after the implementation of nurse leader rounding. Hence, it is the responsibility of leader nurses to make rounds on the hospital floors in order to indicate areas of improvement in terms of patient’s care and disabilities (Babaev, 2016). Thus, poor education hinders patients from understanding their care plan, which results in patient dissatisfaction.
Nurse leadership rounding provides the opportunity to get feedback about healthcare services in the hospital. Optimizing nurse engagement and improving nurse leader communication through rounding helps improving better outcomes (Pritts & Hiller, 2014). Highly reliable and exceptional patient experience is achieved through effective communication during nurse leadership rounding (McClelland & Vogus, 2014). It also provides the opportunity to improve the quality of patient care by monitoring the concerns about health care staff. Integration of nurse rounding programs helps in achieving a high rating of HCAPHS score (Tussing, 2015). It is evident that nurse leader rounds are beneficial to improve the health care services by mitigating the concerns of patients and their families. Using advanced technology to monitor the activities of medical staff and their behavior with patients helps in decreasing patient’s complaints against healthcare staff (Mehta, 2015).
Recommended Practice Change, Quality Improvement, or Innovation
The stats from the American health association indicates that health care services in the Winchester hospital are below average. There is an immense need to improve the services of health care in the facility in order to attain better HCAHPS score. Literature review suggests that nurse leader rounding is an effective strategy to identify the areas for improvement. The implementation of nurse leadership rounding is effective to improve the overall performance of medical staff, and it helps in increasing patient's satisfaction. Introduction of customer service rounding program in the healthcare setting helps provides the opportunities to solve problems and issue of patients. Nurse leader rounds are associated with improved ratings from patients based on their experience in the healthcare system. Nurse leader rounds promote the perception of effective care, which results in better HCAHPS score. Effective implementation of nurse leader rounds improves a patient's perception of care as it promotes effective communication among nurse leaders and patients. Nurse leadership rounding provides an opportunity for patients to provide feedback about the healthcare services of the organization. A visit from a nurse leader positively influences the perception of patients towards health care services. Leaders can utilize rounding practice to move staff, mission, and goals in order to ensure the delivery of safe and high-quality practices. Consequently, it is recommended to implement the nurse leader rounding strategy to improve the satisfaction of patients and HCAHPS score.
References
Babaev, A. (2016). Nurse Leader Rounds: Effect on Nurse-Related Patient Satisfaction Scores on Two Post-Surgical Units in an Acute Care Facility (Doctoral dissertation, Drexel University).
Bender, M. (2016). Conceptualizing clinical nurse leader practice: An interpretive synthesis. Journal of Nursing Management, 24(1), E23-E31.
Boissy, A., Windover, A. K., Bokar, D., Karafa, M., Neuendorf, K., Frankel, R. M., & Rothberg, M. B. (2016). Communication skills training for physicians improves patient satisfaction. Journal of general internal medicine, 31(7), 755-761.
Brosey, L. A., & March, K. S. (2015). Effectiveness of structured hourly nurse rounding on patient satisfaction and clinical outcomes. Journal of Nursing Care Quality, 30(2), 153-159.
Christiansen, A., Jacob, E., Twigg, D. E., Whitehead, L., & Coventry, L. L. (2017). A Systematic Review of the Impact of Intentional Rounding on Patient Safety in Acute Care.
Ciccu-Moore, R., Grant, F., Niven, B. A., Paterson, H., Stoddart, K., & Wallace, A. (2014). Care and comfort rounds: improving standards. Nursing Management, 20(9).
Daniels, J. F. (2016). Purposeful and timely nursing rounds: a best practice implementation project. JBI database of systematic reviews and implementation reports, 14(1), 248-267.
Dempsey, C., Reilly, B., & Buhlman, N. (2014). Improving the patient experience: real-world strategies for engaging nurses. Journal of Nursing Administration, 44(3), 142-151.
Fabry, D. (2015). Hourly rounding: perspectives and perceptions of the frontline nursing staff. Journal of Nursing Management, 23(2), 200-210.
Farley, H., Enguidanos, E. R., Coletti, C. M., Honigman, L., Mazzeo, A., Pinson, T. B., & Wiler, J. L. (2014). Patient satisfaction surveys and quality of care: an information paper. Annals of emergency medicine, 64(4), 351-357.
Goldsack, J., Bergey, M., Mascioli, S., & Cunningham, J. (2015). Hourly rounding and patient falls: what factors boost success?. Nursing2018, 45(2), 25-30.
Institute for Innovation (2014). Inspiring Innovation: Patient Report of Nurse Leader Rounding.
Kennedy, G. D., Tevis, S. E., & Kent, K. C. (2014). Is there a relationship between patient satisfaction and favorable outcomes?. Annals of surgery, 260(4), 592.
Mann, R. K., Siddiqui, Z., Kurbanova, N., & Qayyum, R. (2016). Effect of HCAHPS reporting on patient satisfaction with physician communication. Journal of hospital medicine, 11(2), 105-110.
McClelland, L. E., & Vogus, T. J. (2014). Compassion practices and HCAHPS: does rewarding and supporting workplace compassion influence patient perceptions?. Health services research, 49(5), 1670-1683.
Mehta, S. J. (2015). Patient satisfaction reporting and its implications for patient care. AMA journal of ethics, 17(7), 616-621.
Mercedes, A., Fairman, P., Hogan, L., Thomas, R., & Slyer, J. T. (2016). Effectiveness of structured multidisciplinary rounding in acute care units on length of stay and satisfaction of patients and staff: a quantitative systematic review. JBI database of systematic reviews and implementation reports, 14(7), 131-168.
Merrifield, J., Frier, R., Lewis, L., & Walker, E. J. (2016). Improving care and accountability in a busy Emergency Department through the use of intentional rounding: The journey so far.
Merrill, K. C. (2015). Leadership style and patient safety: implications for nurse managers. Journal of Nursing Administration, 45(6), 319-324.
Morgan, L., Flynn, L., Robertson, E., New, S., Forde‐Johnston, C., & McCulloch, P. (2017). Intentional Rounding: a staff‐led quality improvement intervention in the prevention of patient falls. Journal of clinical nursing, 26(1-2), 115-124.
Morton, J. C., Brekhus, J., Reynolds, M., & Dykes, A. K. (2014). Improving the patient experience through nurse leader rounds. Patient Experience Journal, 1(2), 53-61.
Pattison, K. H., Heyman, A., Barlow, J., & Barrow, K. (2017). Patient perceptions of sitting versus standing for nurse leader rounding. Journal of nursing care quality, 32(1), 1-5.
Pritts, K. E., & Hiller, L. G. (2014). Implementation of physician and nurse patient rounding on a 42-bed medical unit. Medsurg Nursing, 23(6), 408.
Reem, A. D., Kitsantas, P., & Maddox, P. J. (2014). The impact of residency programs on new nurse graduates' clinical decision-making and leadership skills: A systematic review. Nurse Education Today, 34(6), 1024-1028.
Reimer, N., & Herbener, L. (2014). Round and round we go: rounding strategies to impact exemplary professional practice. Clinical journal of oncology nursing, 18(6).
Ross, E. J., Fitzpatrick, J. J., Click, E. R., Krouse, H. J., & Clavelle, J. T. (2014). Transformational leadership practices of nurse leaders in professional nursing associations. Journal of Nursing Administration, 44(4), 201-206.
Toole, N., Meluskey, T., & Hall, N. (2016). A systematic review: barriers to hourly rounding. Journal of nursing management, 24(3), 283-290.
Tussing, T. E. (2015). Nurse Rounding: An Evidenced Based Practice Report.
Walker, K., Duff, J., & Fitzgerald, K. (2015). ‘Rounding for better patient care: An evaluation of an improvement intervention implementation. International journal of nursing practice, 21(2), 207-213.
Winter, M., & Tjiong, L. (2015). HCAHPS Series Part 2: Does purposeful leader rounding make a difference?. Nursing management, 46(2), 26-32.
