Leader Rounding on Internal Customers Toolkit

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2 Table of Contents: A. LEADER ROUNDING ON INTERNAL CUSTOMERS - TOOLS: TOOL REFERENCE # TITLE LRIC1 LRIC2 LRIC3 LRIC4 LRIC5 LRIC6 LRIC7 LRIC 8 Guidelines and Key Words Rounding Standard Competency Checklist - Individual Competency Checklist - Summary Rounding Log Stoplight Report Internal Customer Preference Card Sample Internal (Example 1: From UAB) LRIC 9 Sample Internal (Example 2) LRIC 10 Sample Support Service Survey (Example 1) LRIC 11 Sample Support Service Survey (Example 2) LRIC 12 Sample Support Service Survey (Example 3) LRIC13 Example Support Service Survey Results or unregistered trademarks of Studer Group or its licensors.

3 LRIC1: GUIDELINES AND KEY WORDS (PAGE 1 OF 2) Why and How Rounding is a proactive activity conducted by leaders to evaluate performance and engagement, harvest reward and recognition, and identify trends and opportunities for improvement. Whether rounding with patients to verify clinical outcomes, with employees to increase engagement, or with areas served, rounding is a vital activity to keep one s finger on the pulse of the areas for which they are responsible. Rounding on internal customers (or on departments/areas served) is one of Studer Group s Must Haves because support and ancillary services play a vital role in the care delivered to patients. These areas take care of the people taking care of patients. Rounding by ancillary and support service department leaders is the tool that allows lines of communication to remain open and clear. It facilitates the removal of barriers so that caregivers are not being taken away from patient care to focus on non-patient care activities. Just as the nurse is evaluated by patients and families with a formal tool such as the patient experience survey, the ancillary and support service departments are evaluated by an internally developed support services survey (this tool is also often called the interdepartmental or support card survey). Each of these survey tools provides a compliment to the rounding process by identifying areas of focus in which the leader will implement best practices to resolve. This will provide additional areas to validate progress on during rounds. Key Words: AIDET : A: Acknowledge, eye contact and say hello. I: My name is <xxx> and I have worked in <dept.> for <x> years D: I will be rounding on you <state frequency> and wanted to spend: If introductory round: about 30 minutes with you. After our first rounding session, each time will be about minutes. If follow-up/subsequent round: about 15 minutes with you. If scheduling: When would be a good time for us to talk during the next week? E: Our goal is to provide excellent service to you and will discuss specifically how to best help you serve our patients T: Thank you for your time today... Your department is very important to us and to our patients.. Provide Examples of Improvements: Since I rounded with you last time, I wanted to highlight the following items/systems we have put into place based on feedback. An EVS Leader might say, Since our discussion 2 weeks ago, I have rounded on patients in your unit 5 days. I am seeing improvement in the consistency with which our housekeeper is introducing herself to patients. I hope you are noticing this improvement as well. A Food Service Leader might say Last month we discussed opportunity to improve on temperature of the food. We have begun checking temperatures on one tray from every cart as it leaves the kitchen, and one on every cart as it is delivered to the patient. It looks like your unit is having the most problem, because you are last to be delivered. We will confirm this in the next week and I will get back to you with our plans to address the issue by next week. or unregistered trademarks of Studer Group or its licensors.

4 What is my department doing well? Is there anyone specific I can recognize for doing great work? What have they done? What 1-2 things can my department do better? Any ideas on how we can improve? Our department wants to respond in a timely manner and we are focusing to improve our timeliness. Help us learn Can you explain a time when you had to wait for response from our department?, Now tell me, when we did not respond in a timely manner, what do you typically wait to receive.? Are there any other questions you have or anything else I can help with right now...? Thank you for your time and for making [organization name] a great place to work. I will be back in next month to talk again. If there is anything we can do before that time, please let me know. Key Actions: PREPARATION: Develop the Rounding plan for key customers Who to round on and Frequency of rounds. Guidelines include: Scope Leaders include EVS, Materials, Pharmacy, Imaging, Lab, Food and Respiratory Care, others as needed ( i.e. IT, Biomedical Engineering) Frequency Minimum expectation- 1 hour/week aligned with strategic imperatives, such as high volume/ high risk/interdepartmental survey results. One hour should typically allow a leader to round in 4 departments each week once introductory rounds have occurred. These areas are rounded on most frequently. All areas served will be rounded on periodically by cycling them in on a rotational basis with those rounded on routinely Schedule an appointment or identify the best time of day for rounding. If you are rounding with a nurse manager, an appointment will be necessary. If you have determined the best person to round on is a health unit coordinator (HUC), ask her what time of day she is most likely to be able to spend minutes with you. She will know when she has an opportunity to step away from the desk and have it covered by another team member. You might not need an appointment especially if the preferred people to round on are staff/ charge nurses and HUCS. Help them understand best time of day vs. appointment For Initial Rounding on the Customer visit: Use the rounding questions as outlined on Internal Customer Rounding Log or unregistered trademarks of Studer Group or its licensors.

5 Introduce the Customer Preference Card Review with own staff and post in the department Leader Rounding on Internal Customers Toolkit Next Rounding Visits Follow steps above Review Preference Card and how well you and the staff are meeting the defined service expectation Follow up with: Are there any other process or supply issues? What are your thoughts on how we can improve? Schedule follow-up rounding appointment Every 6 months review preference card and redefine customer expectations or unregistered trademarks of Studer Group or its licensors.

6 LRIC2: ROUNDING STANDARD INTERNAL CUSTOMERS LEADER ROUNDING ON AREAS SERVED Pillar(s) to Move Scope Frequency Validation Tools Comments People Quality Service Finance Growth Leaders include EVS, Materials, Pharmacy, Imaging, Lab, Food and Respiratory Care, others as needed (i.e. IT, Biomedical Engineering) Minimum expectation- 1 hour/ week aligned with strategic imperatives, such as high volume/ high risk/ interdepartmental survey results. One hour should typically allow a leader to round in 4 departments each week (however, if it is the first-time rounding in a specific area, 30 minutes should be allowed). These areas are rounded on most frequently. Rounding logs are validated by review with supervisor during 1:1 meeting using monthly meeting model. Monthly Meeting Model Support Service Survey Rounding Log Accountability Report 90-day Plan Preference Card or documentation of expectations Person on inpatient unit rounded on may vary depending on information to be covered, i.e. nursing manager, charge nurse, unit secretary All areas served will be rounded on periodically by cycling them in on a rotational basis with those rounded on routinely or unregistered trademarks of Studer Group or its licensors.

7 LRIC3: COMPETENCY CHECKLIST - INDIVIDUAL Note: Competency Checklist to be used to validate leader s skill in rounding on internal customers. Leader Name: Unit/Area: STRENGTHS IDENTIFIED/RATING ESSENTIAL SKILLS AIDET : Acknowledge, Introduce, Duration, Explanation and Thank you Establish Rounding Expectations Accomplishments: Review what has been accomplished Collect Wins: What is my department doing well? Harvest Recognition: Who from my dept. has impressed you lately? Why? Opportunities: What can my department do better? Any ideas on how we can improve? (Provide timeline) Focus areas: If a support service survey is in place, identify specific areas from the survey process to address. If your department is not surveyed, you can still assess key customer expectations. Teamwork: Is there anything I can help you with? Follow-up: Establish next rounding date and document the round Appreciation: Thank you for your time & making a great place to work NEED TO FOCUS ON IMPROVEMENT STRENGTHS IDENTIFIED/RATING NEXT STEPS A. What do you know about this internal customer? B. What must you do with this information? Who will you reward and recognize based on rounding? What are barriers/issues, etc. you need to resolve? NEED TO FOCUS ON IMPROVEMENT Competent Expert Rounder Would be a good mentor to others Evaluator Comments: EVALUATION SUMMARY Repeat Skills Assessment Evaluator: Date: or unregistered trademarks of Studer Group or its licensors.

8 LRIC4: COMPETENCY CHECKLIST SUMMARY Note: This form allows reviewers to summarize the feedback /scoring of leader s skill in rounding on internal customers. Each person s performance can be recorded from the individual competency forms for easy reference and follow-up. DATE NAME TITLE SUPPORT DEPARTMENT COMPETENCY MET? YES/NO SKILL REASSESSMENT COMMENTS or unregistered trademarks of Studer Group or its licensors.

9 LRIC5: ROUNDING LOG Date: Unit rounded on: Manager Name: Baseline Rating on Support Service Survey: Current Rating on Support Service Survey: AREAS OF FOCUS: AIDET : STEPS KEY WORDS AND GUIDE COMMENT / NOTES Acknowledge, Introduce, Duration, Explanation ( Why behind rounding), and Thank you Accomplishments: Review what has been accomplished Collect Wins: What is my department doing well? A: Acknowledge, eye contact and say hello. I: My name is <xxx>and I have worked in <dept.> for <x> years D: I will be rounding on you <state frequency> and wanted to spend about <amount of time (30 minutes for introductory round; for subsequent rounds)> with you today. E: Our goal is to provide excellent service to you and will discuss specifically how to best help you serve our patients T: Thank you for your time today... Ex: Since <date>, when I rounded with you last, I want to highlight the following items/systems put into place based on feedback. Ex: What is our department doing well? Harvest Recognition: Who from my dept. has impressed you lately? Why? Service Level Expectations Opportunities: What can my department do better? Any ideas on how we can improve? Is there anything I can help you with? Follow-up: Establish next rounding date and document the round Appreciation and Thanks Ex: Is there anyone specific I can recognize for doing great work? What have they done? Ex: When we reviewed our support services survey feedback, we noticed Can you tell me how we can provide better service in that area? Ex: What is one thing you would like us to address right now? OR What 1-2 things can my department do better? Any ideas on how we can improve? (provide timeline) Ex: Is there any other questions you have or anything else I can help with right now? Ex: I will be back <date> to talk again. If there is anything we can do before that time Ex: Thank you for your time or unregistered trademarks of Studer Group or its licensors.

10 LRIC6: STOPLIGHT REPORT Leader Rounding on Internal Customers Toolkit Note: The Stop Light Report is a way to communicate in writing how the ideas/concerns harvested in rounding are dealt with. It is excellent to place on communication boards and to use during your rounds. Green Light items are things that have been addressed and are complete. Yellow Light items are things in progress. Red Light items are those issues or ideas that cannot be done with the reason why. Department/Unit Supported by: Date: GREEN/COMPLETE YELLOW/WORK IN PROGRESS RED/CAN T COMPLETE AT THIS TIME AND HERE S WHY or unregistered trademarks of Studer Group or its licensors.

11 LRIC7: INTERNAL CUSTOMER PREFERENCE CARD Department: Date: Customer Names: What three things can we do to ensure that we meet your expectations in providing excellent/very good service to you and your department? What is one item you would like to have improved? To be successful, these are the things we need from you and your team: Date of next Rounding: Date of Update of Preference Card: or unregistered trademarks of Studer Group or its licensors.

12 LRIC8: SAMPLE INTERNAL COMMUNICATION (EXAMPLE 1: UAB) Reaching for Excellence in Action Leader Rounding on Internal Customers Toolkit Reaching for Excellence. Interdepartmental Rounding. You may have heard these or similar terms in town hall meetings or seen them on posters. To give you an idea of how these tools and initiatives affect both you and UAB patients, here s the breakdown of recent activity. The Background AMC 21 is UAB Medicine s strategic plan put in place so that UAB will become the preferred Academic Medical Center (AMC) of the 21st century (21). Reaching for Excellence (RFE), simply put, is the leadership development piece of the AMC 21 puzzle. Guiding and measuring successes of RFE is its steering committee. Members of the committee include: Committee Chairman Rodney Tucker, MD; Jeanetta Keller, PhD; Chris Brainard; Scott Buchalter, MD; Mike Waldrum, MD; Velinda Block, DNP, RN, NEA-BC; Marty Box; Reid Jones; Pam White; Brian Spraberry; and Anthony Patterson. Through development tools and progressive training, RFE will increase communication between department leaders, thus enhance employee performance, and ultimately improve patient- and family-centered care. The Survey In May 2011, for the first time in UAB Medicine history, 800 faculty leaders were asked by the RFE Steering Committee to complete an Interdepartmental Survey in which they evaluated 85 departments that don t receive direct feedback from UAB patients. From the 800 leaders asked to participate, 504 responded. We are very excited to begin getting feedback from our internal customers so that we can make improvements in the services we deliver, says Keller. We will be doing the survey twice a year and will add additional departments over time. Why an internal survey? According to Keller and members of the steering committee, the survey was designed to increase collaboration between operational and support areas (departments directly serving patients and their families with departments serving internal customers and patients through support of other departments) with goal of identifying areas of improvement, celebrating successes, and recognizing employees. The Next Steps As a direct response to survey results, the RFE Steering Committee has developed a plan called Interdepartmental Rounding. First, department heads meet with leaders who rated their department a 3 or below (on a 5-point scale) in one or more survey categories. From there, improvement ideas are discussed and feedback is documented in rounding logs. Each department head then submits an action plan for approval, and, once the plan is approved, the department head has 90 days to put the plan into action. The Ultimate Goal Ultimately over a period of time, the underlying goal of Reaching for Excellence is to hardwire evidence-based tools that change the manner in which we interact with each other as healthcare professionals, Tucker says. Rounding for engagement, interdepartmental rounding, rounding on patients, etc., are all tools that standardize and apply accountability to our actions with the ultimate goal of improved patient safety, quality of care, and the entire patient and family satisfaction with their experience. or unregistered trademarks of Studer Group or its licensors.

13 LRIC9: SAMPLE INTERNAL COMMUNICATION (EXAMPLE 2) Leader Rounding on Internal Customers Toolkit Dear Leaders, We are embarking on a new internal customer survey and would appreciate your assistance in providing feedback to the departments that support you and your team. In order to get the maximum value from the survey, we need your help. We are asking you to complete a quarterly survey to evaluate the following departments on communication, attitude, responsiveness and accuracy based on your interactions in the last 90 days. The time period is important as we want to ensure that we are evaluating the most recent interactions you have had with our teams. If you have not had the opportunity to interact with our department in the last 90 days, please mark N/A so that we can obtain reliable feedback based on recent performance. Please know that this is an evaluation of the whole department, not just the leader of that department. We will share our results and opportunities with our team so that everyone can be involved in solutions to provide the very best service. The survey result with be included in the evaluation of the department leader just as patient perception results are on many of your evaluations. The first survey to establish our baseline will launch on XXXX and close on XXXX. Future surveys will launch on the 1 st of April, July, and September and remain open for two weeks. Just as many of you receive feedback from your patients, we want feedback from you as our customers. Our goal is to provide the highest level of support and an always culture. We appreciate positive feedback and recognition for any team member that is providing excellent service to you. We will use your feedback to recognize and reward our team just as you use patient comments to recognize your team members. If we aren t providing the highest level of support, we ask you to provide one specific thing we could do to improve in the comment section. The survey is not anonymous because we want to know who is providing feedback so that we can follow up on any concerns and address them promptly and do service recovery just as you would do with patients and families. It is also important that you gather information from your team about our support so that we get feedback from everyone. We request that you discuss the survey process with your team and gather their feedback to share with us on the survey. We are only surveying leaders so you are the voice of your team. Definitions of these terms are as follows: My team communicates with you effectively. My team treats you with courtesy and respect. My team meets your needs with the appropriate sense of urgency based on the priority of your request. My team provides consistent and reliable services with appropriate follow up. Responses: Always Usually* Sometimes* Never* N/A (please choose N/A if you have not interacted with this department in the last 90 days.) *If you cannot rate Always, please provide one thing the department can do to improve. Please let us know if you have questions that we can answer about this new process. or unregistered trademarks of Studer Group or its licensors.

14 LRIC10: SAMPLE SUPPORT SERVICE SURVEY (EXAMPLE 1) Leader Rounding on Internal Customers Toolkit Note: Below is an example of a support service survey from a large, multi-region system. The system has a formal process of surveying end users (leaders of clinical departments) for each of their ancillary / support departments. Leaders of clinical departments rate, on a scale based on CAHPS survey ratings (with top box results being reported) how well these key customer needs are met. Results of these surveys are a goal for Ancillary/ Support department leaders in their Annual Evaluation. Organizations throughout the entire system are utilizing this survey in order to compare performance across sites in an apples to apples fashion. Each service department is responsible for creating their description of services; that is the only area of the survey that is customizable from site to site. Support Services Survey Please evaluate the following departments on communication, attitude, responsiveness and accuracy based on your interactions in the last 90 days. Definitions of these terms are as follows: My team communicates with you effectively. My team treats you with courtesy and respect. My team meets your needs with the appropriate sense of urgency based on the priority of your request. My team provides consistent and reliable services with appropriate follow up. Responses: Always Usually* Sometimes* Never* N/A (please choose N/A if you have not interacted with this department in the last 90 days.) *If you cannot rate Always, please provide one thing the department can do to improve. Department descriptions: Security: Provide secure environment; ensures safety of staff; monitors activities; includes protection of staff from external threats Environmental Services (EVS): Provides a clean environment for patient care areas and non-patient care areas Plant Operations/Facilities: Provides a safe environment for patients, visitors, physicians, and staff by providing repairs and maintenance for all departments based on submitted work orders Radiology: Provides timely imaging services and final reports to providers for ED, OR and nursing units Physical Medicine: Evaluates, treats and educates patients on therapy services (PT, DT, ST) on all units based on physician orders or unregistered trademarks of Studer Group or its licensors

15 Lab: Draws blood, test samples and communicates results for inpatient and outpatients Guest Services: Supports improvement of patient experience through PI, complaint management and proactive rounding Volunteers: Prepares volunteers to assist departments with discharges, deliveries, and staffing of gift shop Respiratory: Administers RT modalities to patients based on physician orders Hospitalist Service: Provides hospitalist oversight of patient-centered cost effective care, collaboratively working with PCPs to maintain continuum of care Quality: Accreditation & certification survey preparation; medical peer review; process improvement; core measure coordination; and regulatory compliance activities Staffing Coordinator; House supervisors and float pool: Coordinate floats to areas of competency for staffing; overall oversight of hospitality and flow of admissions; assists with staffing & sick calls & communicates agency needs Pharmacy: Assures safe & appropriate use of drugs, dosing, and validates accuracy of orders. Food Services: Provides food services for employees and patients, and collaborates with dieticians to assess nutritional needs of patients Medical Staff Office: Prescreening of all credentialing requirements for medical staff & AHPs; follow up to applicants; preparation of credentialing packets for approval; facilitate and analyze collaborative policies (administrative) approval process by appropriate medical staff Human Resources: develop, advise on and implement policies relating to the effective use of personnel within an organization (such as working practices, recruitment, pay, conditions of employment, negotiation with external work-related agencies, and equality and diversity) or unregistered trademarks of Studer Group or its licensors

16 LRIC11: SAMPLE SUPPORT SERVICE SURVEY (EXAMPLE 2) The majority of Studer Group partners utilize an electronic surveying tool for their Support Service Survey, however, following is an example of what a paper tool might look like if implemented. Security EVS Plant Ops/Facilities Radiology N/A Never Sometimes Usually Always What can this department do to improve (please make sure to answer for categories not rated always )? N/A Never Sometimes Usually Always What can this department do to improve (please make sure to answer for categories not rated always )? N/A Never Sometimes Usually Always What can this department do to improve (please make sure to answer for categories not rated always )? N/A Never Sometimes Usually Always What can this department do to improve (please make sure to answer for categories not rated always )? or unregistered trademarks of Studer Group or its licensors

17 LRIC12: SAMPLE SUPPORT SERVICE SURVEY (EXAMPLE 3) What Department Are You Representing? Accounting: Maintain financials for hospital; provide support and analysis related to hospital financial operations for hospital officers, directors, and managers Admitting: Responsible for activating patients in the system and adjusting patient accounts BioMed: Provides maintenance and repair services for equipment Case Management: Work with care coordination team to assess, plan, and evaluate the options and services required to meet the patient s health and human service needs or unregistered trademarks of Studer Group or its licensors

18 Education: Provides comprehensive education, staff development and training services to employees Environmental Services (EVS): Provides a clean environment for patient care areas and non-patient care areas Food Services: Provides food services for employees and patients, and collaborates with dieticians to assess nutritional needs of patients HIM: Maintains a safe and controlled environment for patient records. HIPAA standards are maintained to assure privacy and security of these records or unregistered trademarks of Studer Group or its licensors

19 Human Resources: Helps hire, develop, and retain the team that is best able to achieve division and facility goal Infection Control: Protects patients, visitors, staff and physicians from infections. Conducts education and surveillance for the prevention and control of infections. IT&S: To enable the business through the use of technology to serve our Patients, Physicians, Family Members and our Employees Lab: Draws blood, test samples and communicates results for inpatient and outpatients or unregistered trademarks of Studer Group or its licensors

20 Materials Management: Responsible for purchasing and managing health care supplies and equipment Pharmacy: Assures safe & appropriate use of drugs, dosing, and validates accuracy of orders Physical Therapy, Occupational Therapy, & Speech Therapy: Evaluates, treats and educates patients on therapy services (PT, OT, ST) on all units based on physician orders PICC Team: Provides in-hospital insertion of PICC lines in an environment, and manner, that adheres to infection control and prevention guidelines or unregistered trademarks of Studer Group or its licensors

21 Plant Operations: Provides a safe environment for patients, visitors, physicians, and staff by providing repairs and maintenance for all departments based on submitted work orders. Quality, Risk Management, & Regulatory: Accreditation & certification survey preparation; medical peer review; process improvement; core measure coordination; and regulatory compliance activities Radiology: Provides timely imaging services and final reports to providers for ED, OR and nursing units Respiratory: Administers RT modalities to patients based on physician orders or unregistered trademarks of Studer Group or its licensors

22 Security: Provide secure environment; ensures safety of staff; monitors activities; includes protection of staff from external threats Transport: Provides patient transportation in a safe and efficient manner or unregistered trademarks of Studer Group or its licensors

23 LRIC13: EXAMPLE SUPPORT SERVICE SURVEY RESULTS Food Services: Provides food services for employees and patients, and collaborates with dieticians to assess nutritional needs of patients. Answer Options Always Usually* Sometimes* Never* N/A Response Count Top Box % % % % *If you cannot rate "Always", please provide one thing the department can do to improve % answered question 33 skipped question 0 Number Response Date *If you cannot rate "Always", please provide one thing the department can do to improve. Categories 1 Jan 8, :56 PM Slow to deliver trays at times. 2 Jan 8, :40 PM Patient trays 3 Dec 17, :31 PM occasional mix ups with thickener/thickened liquids on trays 4 Dec 17, :27 PM Better communication around special event planning. 5 Dec 16, :56 PM We have a great team in FANS. 12. IT&S: To enable the business through the use of technology to serve our Patients, Physicians, Family Members and our Employees Answer Options Always Usually* Sometimes* Never* N/A Response Count Top Box % % % % or unregistered trademarks of Studer Group or its licensors

24 *If you cannot rate "Always", please provide one thing the department can do to improve % answered question 33 skipped question 0 Number Response Date *If you cannot rate "Always", please provide one thing the department can do to improve. Categories 1 Jan 8, :44 PM Slow to respond on some issues. Barcode scanner issues reported by staff member over a month ago-still not corrected (reconfigure barcodes) 2 Jan 8, :56 PM Response to requests often seems to delay. 3 Jan 7, :21 PM In-house IT department excellent. Help Desk is not as responsive. 4 Dec 29, :15 PM I think everyone would like to have better local communication with the techs to resolve minor, but (seemingly) urgent issues rather than wait to have to go through the system. 5 Dec 22, :55 PM Cannot always contact get response in house. 6 Dec 19, :01 PM Have a better attitude when staff request service 7 Dec 19, :22 PM They are spread too thin. 8 Dec 18, :30 PM This department could keep you updated on the status of a work order or why they haven't gotten to a work order better. 9 Dec 17, :31 PM sometimes have to call IT&S a second time to correct an issue, usually very good 10 Dec 17, :35 PM Not always sure when work orders have been accepted. Would prefer contact with in-house IT&S for service. 11 Dec 16, :56 PM Work with a proactive mindset. or unregistered trademarks of Studer Group or its licensors