Patient Rounding

Great healthcare depends on excellent customer service. But the industry’s insular nature creates unique challenges. As professionals we exist in silos and tend to compare ourselves to similar silos instead of breaking through to reach the patient. By starting a patient rounding program for your laboratory, you can do just that.

Break the Silos
A silo mentality is “A mind-set present in some companies when certain departments or sectors do not wish to share information with others in the same company,”1 according to the site BusinessDictionary. The term functional silo, coined by consultant Phil Ensor in 1988, describes the culture that creates this mentality. He wrote, “People across the organization do not share common goals. Their goals are primarily functional… The overall organizational mentality is one of imposing control on people rather than eliciting comment.”2 Rounding bypasses traditional command and control to share information and elicit comment.

Silo thinking is top down and linear; ideas and solutions travel up and down a chain of command. Systems thinking is the opposite, recognizing and acting upon complex interactions between departments. Patient rounding connects your laboratory directly to nursing units, enabling both to see those interactions.

In a silo culture, your laboratory has arbitrary rules about specimen collection and rejection, outpatient hours, and report interpretation. Your techs can be seen by doctors and nurses as phlebotomists, because that’s the primary interaction other staff have with them. Patient rounding strengthens your influence by helping your lab techs become a direct source of reliable information about diagnostic testing.

Barriers to Patient Rounding
Patient rounding can be a big change. Laboratories are traditionally insulated from direct inpatient care outside of phlebotomy, which may be performed by dedicated phlebotomists. The laboratory itself can be physically isolated on a different floor or wing of the hospital, away from patients. Bench techs can easily work a shift without visiting any patient wards or speaking directly to care staff on the floor.

Resistance to change is expected when implementing any new idea that pulls people from a comfort zone. Here are a five common reasons why, as pointed out by business consultant Lisa Quast in Forbes:3

  • Fear of the unknown — people push back if they don’t understand the reason for a change or how it affects their jobs.
  • Mistrust — people are more suspicious of a new manager or one who has not earned their trust.
  • Loss of control — this most often occurs when restructuring, but any big change leads to people feeling less secure.
  • Bad timing — too much change at once or not implementing a program at the right time causes resistance.
  • Predisposition to change — we all tolerate change at different levels, and those who prefer a routine tend to resist change more.

These reasons point to your management blueprint in designing the elements of your rounding program, which should include: why it needs to be done, how such a program benefits the laboratory and patients, how it fits with the organization’s strategic goals, what the long term goals of such a program are.

Follow the Lead
Your laboratory can follow the lead of nursing. Many nursing units have adopted a best practice of “purposeful patient rounding,” in which nurses make hourly visits to patient rooms. As Genesis HealthCare System in Ohio describes it, “During these room visits, nurses proactively identify patient needs: they check on a patient’s pain level, help them use the restroom and adjust their pillows or bed so they’re more comfortable.”4

Laboratory rounding adds another set of eyes and ears in a patient room to help nurses. Techs can make sure the call light, water, phone, and other items are within ready reach of the patient. A quick safety check can look for loose cords, spills, and other trip hazards in the room, especially between the bed and toilet. And before leaving it’s easy to ask, “Is there anything more I can do for you?”

Nurses will appreciate the help. To a patient, this is another person on the team who cares. And for your laboratory, patient rounding promotes your team in a clinical setting. Here are guidelines for developing a program:

  • Choose one time during the day that works for everyone and stick to it. For example, after patient breakfast and nursing rounds.
  • Choose patients to visit. Instead of visiting all patients — time consuming and difficult with limited staff — choose new admissions, patients who have received blood, patients who have pending cultures, or use other selection criteria that make sense from a laboratory point of view.
  • Choose staff members carefully. Culture and fear of the unknown are powerful resistants, and some techs won’t want to round at first. Select service champions to help develop and sell your program to nursing and lab staff before involving all staff.
  • Round with a purpose. Instead of walking into a patient room just to chat, bring a list: check patient identification, venipuncture site, skin integrity, etc. This data should be reported to your quality committee.
  • Introduce yourself. Along with explaining your purpose, introducing yourself and smiling in a relaxed, sincere manner conveys compassion and interest in the patient. Sending two techs rounding “buddies up” this process and conveys a sense of teamwork to the patient.

Laboratory rounding has the potential to improve HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) customer service scores, too. For example, asking “Is there anything else I can do for you before I leave?” addresses questions related to how often the patient receives help getting to a bathroom or with pain management (questions 11 and 14 on the most recent survey5).

Rounding is a chance for your techs to explain to patients why wristbands are important, what we do, and how we make a difference. It’s a chance to support team and family members. And it’s a chance to make our work relevant, timely, and vital to your hospital mission, always important in an outsourcing economy. Best of all, it leads to better patient care.

Scott Warner is laboratory manager, Penobscot Valley Hospital, Lincoln, Maine.

References

  1. BusinessDictionary.com. What is silo mentality? Available at: www.businessdictionary.com/definition/silo-mentality.html. Accessed June 26, 2014.
  2. Ensor P. The Functional Silo Syndrome. Available at: www.ame.org/sites/default/files/documents/88q1a3.pdf. Accessed June 26, 2014.
  3. Quast L. Overcome The 5 Main Reasons People Resist Change. Available at: www.forbes.com/sites/lisaquast/2012/11/26/overcome-the-5-main-reasons-people-resist-change. Accessed July 2, 2014.
  4. Genesishcs.org. Purposeful Patient Rounding. Available at: www.genesishcs.org/quality/quality-initiatives/purposeful-patient-rounding. Accessed July 4, 2014.
  5. HCAHPS Survey. Available at: www.hcahpsonline.org/files/HCAHPS%20V9.0%20Appendix%20A%20-%20Mail%20Survey%20Materials%20(English)%20March%202014.pdf. Accessed July 4, 2014.

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