Running head: LEADERSHIP STRATEGY ANALYSIS
Leadership Strategy Analysis: Improving Patient Outcomes One Hour at a Time
Amanda Chappel, Trisha Mast, and Jennifer Stankevich
Ferris State University
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LEADERSHIP STRATEGY ANALYSIS
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Abstract
The Internet, technology, enhanced mobility, changes in insurance reimbursement criteria, and
improved consumer knowledge have placed renewed emphasis on patient satisfaction in the
health care industry. Hourly rounding has been one proposed method of improving patient
satisfaction scores. Hourly rounding is associated with reduced patient falls and development of
pressure ulcers, improved patient satisfaction and enhanced nurse satisfaction.
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Leadership Strategy Analysis: Improving Patient Outcomes One Hour at a Time
Throughout history customer satisfaction has been at the forefront of quality
improvement initiatives in the United States. This is because, according to Yoder-Wise (2015),
“Customers define quality” (p. 366). Patients have started to see themselves as consumers who
can take their business elsewhere (Yoder-Wise, 2015). The Internet, sophisticated technology,
healthcare transparency, and consumer mobility have enhanced healthcare options. If consumers
are not happy with the quality of their healthcare, they can simply take their business elsewhere.
This coupled with recent changes in the health care system and insurance reimbursement criteria
have lead healthcare leaders to further research and trial methods of improving patient outcomes,
safety, and satisfaction. The quality improvement process involves, continual analysis and
evaluation of products and services utilized to reduce errors and improve patient outcomes to
achieve improved patient satisfaction (Yoder-Wise, 2015).
Hourly rounding has been one proposed method of improving patient satisfaction scores.
It is hypothesized that hourly bedside rounding is a proactive method of anticipating and meeting
patient needs regularly and ensuring their safety (Ford, 2010). Hourly rounding is a structured,
and intentional method of gathering information and addressing problems before they occur or
worsen (Ford, 2010).
Clinical Need
The Internet, technology, enhanced mobility, and improved consumer knowledge have
placed renewed emphasis on patient satisfaction in the health care industry. Health care
organizations are continually seeking and researching new approaches to improve patient
satisfaction scores (Ford, 2010). According to Ford (2010), “Patients value the nurse-patient
relationship, as well as time spent with them, continuity of care, trust, compassion, respect,
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safety, understandable instructions, and service quality. They also appreciate reliability,
responsiveness, and effective communication” (p. 188).
Patient satisfaction scores are also a key component in healthcare facility ratings,
percentage of reimbursement, and community reputation (Mitchell, Lavenberg, Trotta, &
Umscheid, 2014). Bedside rounding is one quality improvement initiative that has been
suggested to improve patient satisfaction, safety, and outcomes. Uniquely, bedside rounding is a
component of every nurse’s practice. However, policies and procedures surrounding bedside
rounding requirements vary between healthcare facilities. It is proposed that implementation of
hourly bedside rounding reduces patient falls, reduces adverse patient outcomes, increases
patient satisfaction, and decreases the number of times a patient pushes their call bell each shift
(Blakley, Kroth, & Gregson, 2011). In addition to positive patient outcomes, hourly rounding
can potentially leave nurses with more time to chart without interruption, which reduces errors
and improves clinical documentation (Blakley, Kroth, & Gregson, 2011).
Multidisciplinary Team
To achieve success in the quality improvement process, input is needed from all members
of the healthcare team. For this reason, hourly bedside rounding is best achieved through a
multidisciplinary approach. Gonzalo, Wolpaw, Lehman, & Chuang (2014) states, “Team-based
care delivery with providers of different professions functioning as one unit enhances
communication, coordination, and patient-centered shared-decision making, potentially
improving process measures and patient-level outcomes” (p. 1040).
Physicians
Many times, the physician is in and out of the room, and the patient feels uninvolved in
their care. Physicians and residents can do their part in enhancing the patient experience by doing
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their clinical rounds in the patient’s room at the bedside instead of using a conference room.
Physicians and patients reported a better understanding of education provided when done during
bedside rounds (Gonzalo, Wolpaw, Lehman, & Chuang, 2014). Conducting provider rounds at
the bedside also allows the nurse to be present, which enhances continuity of care (Ford, 2010).
Registered nurses
Registered nurses have the biggest and most important role in bedside rounding. Patients
are unaware of the demands of their nurse throughout the shift; this creates a level of anxiety for
patients when they don’t know how long the nurse will take to respond to their needs (Mitchell,
Lavenberg, Trotta, & Umscheid, 2014). Nurses can alleviate some of this fear by making
predictable rounds and addressing basic needs. The four “Ps” of basic patient needs are:
position, pain control, proximity to personal items, and bathroom needs [“potty”] (Mitchell,
Lavenberg, Trotta, & Umscheid, 2014). Patients are less likely to push their call button, and
more likely to be satisfied with their overall experience when they feel that their personal needs
are attended to. In addition to feeling taken care of, patients who anticipate hourly rounding are
less likely to fall, because they know that the nurse, or another member of the health care team,
will be in to check on them in the next hour (Mitchell, Lavenberg, Trotta, & Umscheid, 2014).
Certified nursing assistants
Certified nursing assistants (CNAs) are responsible for many patient care tasks. They
assist in passing and picking up meal trays, performing vitals, repositioning patients,
encouraging and assisting in ambulation, helping patients with activities of daily living, and
function as a liaison between the patient and the nurse. The CNA is a key player in effective
hourly patient rounding.
Risk manager
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The risk manager’s function is to identify risks and provide opportunities to improve care
(Yoder-Wise, 2015). The risk manager’s role will be to obtain historical data, provide evidencebased practice (EBP) for staff, measure employee compliance, and measure the effectiveness of
bedside rounding. Effectiveness can be measured in terms of patient safety data such as reduced
falls, reduced adverse patient outcomes, and improved patient satisfaction scores. The risk
manager will implement surveys to nursing staff to measure nurse satisfaction and potential
process improvements before and after implementation of hourly rounding. The risk manager
will also be in charge of working with the unit manager and reviewing patient satisfaction
surveys. Specifically it is the risk managers role to take patient satisfaction survey results and
transpose the data onto a comparative risk analysis graph that identifies patient satisfaction
scores, number of patient falls and adverse patient outcomes before and after implementation of
hourly bedside rounding.
Charge nurse
The charge nurse will monitor hourly rounding and compliance according to policy,
provide support to the staff during the change, and assist in rounding during the transition. The
charge nurse will work with the risk manager in communicating concerns of employees, convey
patient feedback, and assist in identification of actual and potential barriers to action. Assessing
barriers on the floor will increase compliance while alleviating the barriers will aid in success of
implementing hourly bedside rounding (Shepard, 2013).
Unit manager
The unit manager and risk manager will work together to develop a script and tactics for
hourly bedside rounding. Better patient outcomes are achieved through provision of a script and
tactics for employees to utilize during the initial implementation phase of the bedside rounding
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quality improvement initiative (Ford, 2010). Patient satisfaction surveys will be distributed to
patients within two weeks discharge. Evaluation of patient satisfaction surveys will be handled
by the unit manager and reviewed with the risk manager.
Data Collection Method
Data will be collected from all nursing departments within the hospital. To focus on
quality improvement, information will be collected specifically on the number of falls, level of
patient satisfaction, adverse patient outcomes (specifically development of pressure ulcers and
medication errors), as well as nurse and staff satisfaction. Fall data will be obtained through chart
audits, while patient and nurse satisfaction reports will be collected via surveys.
Comparison/relationship charts will be utilized to evaluate multiple variables: falls, medication
errors and pressure ulcers over a quarterly and yearly time period; specifically line charts. Bar
graphs will be used to display compliance data among the interdisciplinary team. Composition
charts such as pie charts and line charts can be used to measure compliance rates for bedside
rounding. According to Yoder-Wise (2015), “The use of statistical tools enables nurse managers
to make objective decisions about quality improvement activities” (p. 367). Composition charts,
bar graphs, and comparison charts are uncomplicated, clear, decisive, and easy to read. They are
great at displaying comparative data and trends over a period of time such as months or years
(Yoder-Wise, 2015). Each unit will display their data in staff break rooms or lounge area for
employees to see as well as reviewed at employee meetings and shared governance.
Outcomes, Goals and Implementation Strategies
Outcomes
The quality improvement process includes planning, implementing, and evaluating
changes in order to achieve positive patient outcomes (Yoder-Wise, 2015). By using this process,
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all members of the team can add to the planning, and be empowered to actively participate in the
improvement process. After data is analyzed regarding: adverse patient outcomes, patient falls,
patient and nurse satisfaction, and staff compliance, the success and effectiveness of bedside
rounding can be measured.
Goals
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Patient falls will decrease by 75% six months after implementation of hourly bedside
rounding.

Patient satisfaction surveys will conclude increase satisfaction with their hospital stay in
six months.
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Nurse satisfaction will increase and staff turnover reduced in one year.
Implementation strategies
Hourly bedside rounding will begin with a multidisciplinary team training the floor staff
on the objectives of the quality improvement initiative and how to proceed with implementation
of the plan. One strategy to improve compliance is to communicate and educate the staff on
evidence based practice and the “why” of quality improvement initiatives being sought. An
integral component of communication in change initiatives is to not only provide the “what we
are doing and why we are doing it”, but also actively listening to the concerns of the staff. While
change may provoke resistance, communication will reduce barriers (Yoder-Wise, 2015). Once
compliance is obtained, hourly bedside rounding can be implemented.
Staff will need to be educated on how to perform hourly rounding. Expectations need to
be defined, including the provision of scripts and tactics for staff to use during hourly rounds.
Providing education, establishing expectations, and specifying scripts and tactics for use, helps
improve consistency and continuity of patient care (Ford, 2010).
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Evaluation
A pre-established team consisting of the unit manager, risk manager, charge nurse, and
multiple floor nurses will evaluate hourly bedside rounding. Evaluation will be conducted on a
bi-monthly basis. According to Yoder-Wise (2015), “As the plan is implemented, the team
continues to gather and evaluate data to document that the new outcomes are being met. If an
outcomes is not met, revisions in the implementation plan are needed” (p. 374). Often once a
plan is initiated, new problems arise warranting changes to the process or procedures (YoderWise, 2015). It is imperative that floor audits be conducted to establish staff compliance as well
as individual performance appraisals be conducted to address barriers to action, and potential
areas for process improvement.
Conclusion
Hourly bedside rounding is a proactive method of anticipating and meeting patient needs
regularly and ensuring their safety. It is a structured and intentional method of addressing
problems before they occur or worsen (Ford, 2010). Hourly rounding has been shown to
significantly reduce patient falls and the use of call lights, as well as improve patient satisfaction
(Ford, 2010). The concept of hourly rounding addresses and applies Kolcaba’s comfort theory.
With hourly rounding, the patients’ needs will be assessed and addressed hourly, relieving pain,
anxiety and increasing comfort, ultimately allowing the patient to transcend to optimal function
(Kolcaba, 2010). Consistent hourly rounding is a key quality improvement initiative for
improving patient safety, satisfaction, and quality of care.
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References
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Ford, B. M. (2010). Hourly rounding: A strategy to improve patient satisfaction scores.
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