Table of Contents. Tool V1: Senior Leader Scouting Report 1. Tool V2: Internal Customer Rounding Log 2. Tool V3: Leader Rounding on Patient Log 3

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1 Table of Contents Document Page Tool V1: Senior Leader Scouting Report 1 Tool V2: Internal Customer Rounding Log 2 Tool V3: Leader Rounding on Patient Log 3 Tool V4: Hourly Rounding Log 5 Tool V5: IPC Rounding Log 6 Tool V6: Bedside Shift Report Rounding Log 7 Tool V7: AIDET Interaction Assessment 8 Tool V8: Leader Rounding on Employees Log 9 Tool V9: 30 Day New Employee Meeting Report 10 Tool V10: 90 Day New Employee Meeting Report 11 Tool V11: Direct Report Thank you Grid 12

2 TOOL V1: SENIOR LEADER SCOUTING REPORT Name Department Dept/Person Rounded on Date/ of Key Words or Questions Special Employee Issues Tips: Initially introduce purpose and commitment to rounding. Executive Assistant can help manage Senior Leader Rounding process and schedule by sending log to department leader in advance to complete the left side. Information to be completed by department leader in advance of Senior Leader Rounding 1. Accomplishments of the Department Comments 2. New Equipment Purchased 3. Staff to Recognize Who What/Why 4. Staff to Coach/Mentor 5. Tough Questions/Issues 6. Physician Activities or Issues 7. Current Patient Satisfaction Results 8. Current Employee Satisfaction Results Verification Tools - page 1

3 TOOL V2: INTERNAL CUSTOMER ROUNDING LOG Name Department/Unit Dept/Person Rounded on Date/ of Key Words or Questions Special Employee Issues Tip: Initially explain the commitment to excellent customer service! Steps 1. What s working well? Comments 2. Is there anyone I should recognize for doing great work? Who What/Why 3. What one or two things could we do better? 4. Accuracy in the delivery of service Timeliness in the delivery of service Anticipates needs of internal customers Positive attitude in providing service Excellent service recovery when system failures do occur Progress update from previous rounding 10. Issues to be addressed for follow up Thank You for making a difference! Review findings with your next level leader regularly. Verification Tools - page 2

4 TOOL V3: LEADER ROUNDING ON PATIENT LOG (Page 1) Name Department/Unit Date/ of Top Service Priorities Tips: 1. Talk to your staff before and after rounding. 2. Knock before entering and ask patient for a few minutes of their time. 3. Always look for opportunities to Manage Up staff and other departments. 4. Review white board information. 5. Dig deeper when needed, ask follow-up questions. 6. Capture the wins and recognize staff and physicians immediately when possible. 7. Look for opportunities to address issues for immediate service recovery. 8. Thank them before leaving. Examples of key phrases to use during your visit: 1. Good morning, I m (name), the nurse manager for this unit. It is our goal at (facility name) to make sure you receive excellent care. 2. I see (name) is your nurse today. (name) has been with us for (number) years. She is a wonderful nurse, and we love having her on our team. 3. We are concerned for your well-being and safety and want to respond quickly to your requests. Is there anything in particular you need? 4. Has there been anything about your stay so far that you have been really pleased with? 5. May I ask if there is someone who has provided exceptional care while you have been here? 6. Is there anything else I can do for you before I leave? I have the time. 7. Thank you for choosing (facility name) for your care! Review findings with your next level leader regularly. Verification Tools - page 3

5 TOOL V3: LEADER ROUNDING ON PATIENT LOG (Page 2) Date Patient / Room Staff or Physicians to Recognize (who and what) Issues/Follow up Notes Verification Tools - page 4

6 TOOL V4: HOURLY ROUNDING LOG Stamp Patient Information Date: Rm# Day: S M T W Th F S Bed# Time Staff Initials Time Rounding Pain Potty Position Possessions Comments EVERY 1 HOUR ROUNDS 6 AM 10 PM 6 AM 7 AM 8 AM 9 AM 10 AM 11 AM 12 PM 1 PM 2 PM 3 PM 4 PM 5 PM 6 PM 7 PM 8 PM 9 PM EVERY 2 HOUR ROUNDS 10 PM 6 AM 10 PM 12 AM 2 AM 4 AM RN Name (Print) Initials RN Name (Print) Initials RN Name (Print) Initials RN Name (Print) Initials Tech Name (Print) Initials Tech Name (Print) Initials Other Name (Print) Initials Other Name (Print) Initials Verification Tools - page 5

7 TOOL V5: IPC ROUNDING LOG UNIT Manager Date Patient Name (Introduce, Acknowledge) White board complete with staff names and Very Good Care = Who can I reward and recognize? What physicians can I recognize for giving you very good care? Is there anything else I can do for you? Thank the patient Action follow up Verification Tools - page 6

8 TOOL V6: BEDSIDE SHIFT REPORT ROUNDING LOG - STAFF Date: To: From: I have rounded on and watched some of your patients today and asked them about how their care has been and if bedside report is occurring as we planned. Here is your personal feedback, based upon your patients perception and my observations. Room # s: Activity/Behavioral Items % Excellence Achieved % with opportunities for improvement Introduced oncoming nurse to patient Managed up the oncoming nurse Included patient in the report Used key words appropriately Checked the equipment and supplies in the room IV s, monitors, etc. If visitors were in the room, explained that you are doing the Bedside Report and asked the patient if he/she wanted the visitors to step out Prior to leaving the room, the offgoing nurse thanks the patient for allowing you to provide them care. Incorporated SBAR in report Overall Comments: Staff signature Verification Tools - page 7

9 TOOL V7: AIDET INTERACTION ASSESSMENT Employee Name: Department: AIDET Auditor Name: Date of Observation: Y N Knocked before entering patient room Y N Called patient by his/her name Y N Introduced him/herself by name Y N Mentioned years of experience, certification or training Y N Checked and confirmed patient ID-(lab, x-ray, respiratory) Y N Used key words safety, comfortable, personal needs Y N Explained any pain or discomfort expected Y N Gave a time expectation of how long a test or procedure would take Or how long they would be in the room interacting with the patient Y N Managed up others (staff, physicians, depts, hospital) Y N Asked patient if there was anything they could do before leaving Y N Assessed room for any irritants and offered assistance (temp, noise) Y N Thanked patient for cooperation Y N Displayed good eye contact and listening skills Check Performance Rating: Excels at AIDET Competent at AIDET Repeat AIDET rounds Verification Tools - page 8

10 TOOL V8: LEADER ROUNDING ON EMPLOYEES LOG Name Department/Unit Employee(s) Rounded on Date/ of Key Words or Questions Special Employee Issues Steps 1. Personal Connection Comments 2. What s working well? 3. Is there anyone I should recognize for doing great work? Who What/Why 4. Are there any physicians that I should recognize? Who What/Why 5. Are there any systems that need improvement? 6. Do you have the basic tools and equipment to do your job? 7. Safety Issues Were you able to care for your patients this week as safely as possible? If not, why not? Can you describe the unit s ability to work as a team? Have there been any near misses that could have caused the patient harm, but didn t? Is there anything we could do to prevent the next adverse event? What do you think this unit could do to improve patient safety on a regular basis? For example, would it be feasible to discuss safety concerns, e.g. patients with the same name, near misses that happened, etc. during the report? Have you discussed patient safety issues with patients or their families? Do patients and families voice any safety concerns? What specific intervention from leadership would make the work you do safer for patients? 8. Behaviors Coached AIDET/Key Words Customer Service Priorities Standards Other: 9. Is there anything I can help you with right now? Thank You for making a difference! * Review findings with next level leader in one-on-one meetings. Verification Tools - page 9

11 TOOL V9: 30 DAY NEW EMPLOYEE MEETING REPORT Name: Date of Hire: Department: Title: 1. How do we compare with what we said? 2. What is going / working well? 3. Have there been any individuals who have been helpful to you? 4. Based on your prior work, what ideas for improvement do you have? 5. Is there any reason that you feel this is not the right place for you? Leader Signature Date Verification Tools - page 10

12 TOOL V10: 90 DAY NEW EMPLOYEE MEETING REPORT Name: Date of Hire: Department: Title: 1. How do we compare with what we said? 2. What is going / working well? 3. Have there been any individuals who have been helpful to you? 4. Based on your prior work, what ideas for improvement do you have? 5. Is there any reason that you feel this is not the right place for you? 6. Do you know of anyone who would be a good fit for our organization? 7. As your supervisor, how can I help you? Leader Signature Date Verification Tools - page 11

13 TOOL V11: DIRECT REPORT THANK YOU GRID Name: Department: Directions: Write your direct reports names under the names column. Once a week or the time you have designated, check off those who sent you a name/request for thank you. In the second section below, capture and summarize some particular great wins that you will share with your supervisor. Name of Direct Reports Home Runs and Other Recognition: Verification Tools - page 12