Connecting to the "Why" of Hourly Rounding Through Competency

Purpose:
Our goal was to develop and utilize a competency to drive and coach Hourly Rounding on a consistent basis with a consistent message of "why". As a facility our frontline team struggled with hard wiring the process of Hourly Rounding despite knowledge of evidence supporting the practice.

Relevance/Significance:
Not only is Hourly Rounding been shown to affect patient perception(HCAHPS)but more importantly evidence shows decrease in hospital acquired conditions, patient falls, and an increase with nursing satisfcation. The gap we identified is communication of the "why" behind the practice and the coaching provided by frontline leadership. Development and use of the competency provides a framework for both the "why" and coaching.

Strategy and Implementation:
As an organization we continued to have inconsistent performance and varying levels of proficiency with Hourly Rounding. In the past staff received feedback in a narrative form, with emphasis on what things they did well and coaching on what could be improved. This resulted in variations in performance. The competency for hourly rounding was modified to provide an objective score, segregating employee's performance into a high, solid or low category. Demonstration of seven or eight elements of hourly rounding would be deemed a High Performance. The Leadership team was assembled and educated on the new strategy. High priority areas to initiate the new hourly rounding competency were identified and these were based on the volume of patients and areas that were not meeting the HCAHPS goal of the 50% percentile. A data base was generated to track all employees and their High, Solid or Low Performance. Goals were set to achieve validation of 100% of employees.

Evaluation:
The facility started 4th qtr 2014 with a grand composite score of 59.1; 13th percentile.Initial validations revealed that only 10% of the employees were able to demonstrate a high performance,completing all 8 elements of hourly rounding. Inpatient grand composite score rose to 70.4 with a corresponding peer ranking in the 34% tile. Final score for 2015 1st qtr was 82.9,the 73rd %ile ranking.

Implications for Practice:
Connecting the "why" for frontline nurses and providing coaching of Hourly Rounding to show how to incorporate the practice into delivery of care can be effective. Hourly Rounding is truly a model for bedside care delivery and not an addtional task to fit into a 12 hour shift.