Running head: LEADERSHIP STRATEGY ANALYSIS: HOURLY ROUNDING

Leadership Strategy Analysis: Hourly Rounding

Hillary Colbry, Megan Lammers, Maria Licari and Mary Skrypiec
Ferris State University

LEADERSHIP STRATEGY ANALYSIS: HOURLY ROUNDING

Abstract
The following paper analyzes the benefits, process of implementation, and nurses
use of hourly rounding in the hospital. The American Nurses Association [ANA] nurses role
is addressed in relation to hourly rounding. The clinical need to address patients concerns
via hourly rounding is explained not only with nurses but with the interdisciplinary team. A
tool for data collection, a SMART goal, and a tool for implementation is identified. A study to
enforce the clinical need and past success of strategies to improve hourly rounds is
reviewed.

LEADERSHIP STRATEGY ANALYSIS: HOURLY ROUNDING

Leadership Strategy Analysis: Hourly Rounding This whole section should be relocated to the
clinical need section. The introduction should provide the background and purpose of quality
and safety initiatives, and discuss the leadership strategy analysis to be performed in the paper:
5/10
The ANA defines the nursing role as the protection, promotion, and optimization of
health and abilities, prevention of illness and injury, alleviation of suffering through the
diagnosis and treatment of human response, and advocacy in the care of individuals,
families, communities, and populations (ANA, 2015). Spectrum Health currently uses the
relationship-based care model to ensure that nurses are following the ANA definition
(Relationship-Based, 2015). The relationship-based care model has nurses perform hourly
rounding to improve health outcomes, prevent new injury or illness, and increase patient
satisfaction. The problem at Spectrum Health is that there is no method to ensure that
nurses are performing hourly checks and that nurses can alter their charting to say they
completed them. The authors have seen that nurses alter their charting. The purpose of this
paper is to establish the importance of hourly rounding, create a tool that gathers staff
compliance along with patients opinion and to evaluate how these tools can help Spectrum
Health.

Identify Clinical Need

Hourly rounding focuses on addressing patient needs proactively in a cost effective
way for hospitals (Brosey & March, 2015). The purpose of hourly rounding is to anticipate
and meet patient needs routinely, and ensure patient safety (Ford, p.188, 2010). Hourly
rounding allows nurses to gather information in a structured way, addressing problems
before they occur. During hourly rounds, nurses have the opportunity to check patients

LEADERSHIP STRATEGY ANALYSIS: HOURLY ROUNDING

comfort, pain levels, nutritional intake, elimination, hygiene and establish a strong

relationship (Brosey & March, 2015). Rounding also leads to decreased use of call lights,
falls, and pressure ulcers (Brosey & March, 2015). There is no current method to check a
nurses compliance with rounding except charting, which can be altered. Rounding needs to
be a honest task because lack-of can severely hurt a hospital unit. This is because
Medicare will no longer reimburse hospitals for injuries related to falls in the hospital and
hospital acquired pressure ulcers (CMS, 2014). Hourly rounding can provide consistency in
patient care, leading to better outcomes and greater patient satisfaction.

Designs an Interdisciplinary Team No rationale for inclusion of several team members

12/15

Identifies and analyzes the inclusion of team members involved with the problem Rubric
In order for a problem to be tackled team members on a floor must all be educated
on the problem, and the proposed solution. An appropriate quality improvement (QI) team
for hourly rounding would include a quality assurance member, the floor manager,
registered nurses, and nursing assistants (NAs). According to Yoder-Wise (2011), QI team
members should represent a cross section of workers who are involved with the problem
(p. 368). These members would be exclusive to the floor that the hourly round initiative is
implemented, in order to have the best results measured. Nurses would be most involved
with hourly rounding first which gives them the opportunity to help in the patients plan of
care when interacting with interdisciplinary teams. This is why it is imperative that they are
compliant with the task by completing honest checks.
Data Collection Method Weak support: 12/15

Chooses and designs a method/tool for data collection. Provides support for collection method
as a leadership strategy Rubric

LEADERSHIP STRATEGY ANALYSIS: HOURLY ROUNDING

5
A tool used for data collection in regards to hourly rounding is surveying. Surveying
allows nurses to anonymously admit their feelings towards hourly rounding and gathers
patients opinions. Examples of the surveys are located in appendix A. This tool allows an
open discussion among staff, gives an opportunity to educate and gathers patient
satisfaction. Surveys will open a discussion to show how hourly rounding is impacting the
unit. Spectrum currently uses visual tools like graphs to show staff the benefits of hourly
rounding. Spectrum has implemented that call light averages be posted each week with the
goal to be average call light response time at or below 120 seconds. Another visual
representation on the floor is a calendar that shows the number of days the floor has gone
without a fall, and the days during the month that a fall occurred represented by a star. The
authors agree that surveys are a more beneficial data collection tool that checks staff
compliance among hourly checks, opens the door to educate nurses and a way to receive
patients opinions.

Outcomes
After identifying the need for a goal to measure the falls on the floor, the team
established a SMART goal after reviewing baseline statistics about call light responsiveness
and associated problems. A SMART goal method is a specific, measurable, attainable,
realistic and timely goal(Yoder-Wise, 2011, p. 296). The goals of hourly rounding are to
increase patient safety and have high patient satisfaction within the facility. This goals are
met when a unit demonstrates high compliance with rounding. The first outcome that needs
to be met is establishing staff compliance. After one year of surveying, the authors would
like 90% of staff nurses to answer yes to completing hourly rounds on every assignment via
an anonymous survey. Nurse managers can also check compliance through chart audits.
Then identify and follow up with nurses that do not complete daily risk assessment checks.

LEADERSHIP STRATEGY ANALYSIS: HOURLY ROUNDING

After one year the goal would be 95% of staff would not be receiving audits. Nurse

managers should also keep staff aware of call light responsiveness and falls. The Agency
for Healthcare Research and Quality [AHRQ] suggests that hourly rounding is proactive; it
reduces patients need to use the call light, to ask for help, and therefore decreases the
number of unscheduled call lights that require response (AHRQ, 2013). As a goal, in one
year the call light response time and falls for the unit should decrease by 50%. A quarterly
goal that can be set is increased patient satisfaction. Patients should use the survey in
appendix B and in one year 85% of patients should report satisfaction with the care, staff
members, and facility. Decreased call light usage, falls, and increased patient satisfaction
are positive outcomes that result from high nurse compliance with hourly rounding.
Implementation Strategies Did not address education: 10/15

Selects and describes a process for implementing change. Integrates theory and EBP to support
the identified process Rubric

Hourly rounds supported by the AHRQ

Toolkit supporting the 4 Ps when doing hourly rounds

o Systems theory mentioned by Yoder-Wise

o

We address education on the above processes for implementing change in the section: Evaluation
The AHRQ has toolkits that organizations can use so hourly rounds can be
implemented into nursing practice. A study was done on the AHRQ quality indicators and
was found to be successful. Several hospitals reported that the toolkit was particularly
useful for achieving staff consensus on the extent of quality gaps and on evidence-based
practices (Hussey, 2013, p. 7). The AHRQ toolkit includes checking the patient's pain,
personal needs, positioning, and placement of items while doing the hourly rounds (AHRQ,
2013, p.130). Placement of items includes making sure patients have the things they need

LEADERSHIP STRATEGY ANALYSIS: HOURLY ROUNDING

7
within reach so they do not need to use the call light or attempt to get up when they are a
fall risk. Pain level assessment, routine pain control measures, and positioning along with
placement of items reduces the need for assistance (AHRQ, 2013, p.130). Implementations
mentioned above will decrease the number of times a nurse is needed in the patients room
which decreases call light usage.
The AHRQ integrates the systems theory in their toolkit for hourly rounding. The
systems theorys goal is to explain productivity in terms of a unifying whole as opposed to a
series of unrelated parts (Yoder-Wise, 2011, p. 131). The framework focuses on the
mixture of inputs, throughputs, and outputs in solving a problem, this means integrating
resources, the process, and the products from a system to determine areas in need of
change (Yoder-Wise, 2011, p. 131). The AHRQs toolkit is a resource to help change the
process and the products of a problem identified in the healthcare system.

Evaluation Did not address evaluation of goals 10/15

Goals were stated to: Reduce falls by initiating hourly rounds and documentation of risk
assessments highlighted under outcomes

Identifies and designs a method for measuring improvement, integrates theory and EBP in
analyzing improvements -Rubric
o

Hourly rounding

Quarterly check-ins with staff to evaluate compliance and concerns

o Use of surveys for patient satisfaction and chart audits mentioned above and throughout paper
o

Systematic study of 16 published studies by the JONA supporting the use of hourly rounds and
also supporting our SMART goal to reduce falls, call light response, and chart audits.
Floors can initiate quarterly check-ins with staff to visually show the amount of falls
that have occurred during that period. With enforced strategies, a way to measure

LEADERSHIP STRATEGY ANALYSIS: HOURLY ROUNDING

compliance related to falls, nurses can be held accountable by documenting risk

assessment checks per shift. Documentation audits can show whether or not nurses are
completing their hourly rounds. Patient satisfaction surveys have been shown to be a tool
to measure true nursing attentiveness when documentation alone can be an unreliable
source if nurses are being unethical in their charting.
A systematic review of 16 published studies done by the Journal of Nursing
Administration (JONA) evaluated the use of nursing hourly rounds, resulting increased
patient satisfaction, and reduction in patient falls. In this review the evaluated hospitals
utilized some form of nursing rounding either hourly or every two hours. The hospitals also
utilized the 4 Ps mentioned earlier, as well as a discharge patient satisfaction survey
(Mitchell, Lavenberg, Trotta, & Umscheild, 2014). The authors found, Of the 11 studies that
reported overall patient satisfaction scores, 9 found improvements in that measure; none
reported any decrease (Mitchell, Lavenberg, Trotta, & Umscheild, 2014). In fact, each study
reported some form of increase, no study stayed stagnant (Mitchell, Lavenberg, Trotta, &
Umscheild, 2014).
Ten of the eleven studies reported some reduction in falls due to the hourly rounds.
A conclusion was made that because nursing staff would round hourly to evaluate the
patients need for toileting, positioning, pain, and item placement, patients were less likely to
use the call lights as well as get up on their own to try to toilet, and result in a fall (Mitchell,
Lavenberg, Trotta, & Umscheild, 2014). The authors found that The reported reduction in
falls ranged from 24% to 80%, with a median reduction of 57%. (Mitchell, Lavenberg,
Trotta, & Unscheild, 2014).
The conclusion of this study found the use of hourly rounding in inpatient care was
of low to moderate strength (Mitchell, Lavenberg, Trotta, & Umscheild, 2014). The major

LEADERSHIP STRATEGY ANALYSIS: HOURLY ROUNDING

9
issue with the reporting system of falls and hourly rounding is that nursing staff could lie on
their charting, and it is difficult to really evaluate the compliance with hourly rounding. The
best way to enforce the compliance for hourly rounding is to bring attention to staff the
results from studies that show that hourly rounding really does affect patient satisfaction and
reduces patient falls.

Conclusion
This paper reviewed the importance of hourly checks and how organizations can
create strategies to increase compliance among nurses. Using previously effective tools
and studies, hospitals can implement hourly rounds effectively for the patients and for the
staff. The process to implement effective hourly rounding requires truthful, active staff, that
are willing to better their floor and increase patient safety. The process does not include just
nurses, but the nursing manager, and the whole interdisciplinary team. If hourly rounding is
implemented effectively by all staff involved in it can be a great success.

Appendix A
Patient Satisfaction Survey
Overall satisfaction with

Excellent

Very Good

Good

Fair

Poor N/A

LEADERSHIP STRATEGY ANALYSIS: HOURLY ROUNDING

1. Our practice
2. Quality of medical care
3. Overall care

5
5
5

4
4
4

10

3
3
3

2
2
2

1
1
1

N/A
N/A
N/A

Nursing satisfaction with

1. Attentiveness to needs
2. Knowledge of needs
3. Time spent in room

Excellent
5
5
5

Very Good
4
4
4

Good
3
3
3

Fair
2
2
2

Poor
1
1
1

N/A
N/A
N/A
N/A

Aide satisfaction with

1. Attentiveness to needs
2. Time spent in room
3. Completion of tasks to meet needs

Excellent
5
5
5

Very Good
4
4
4

Good
3
3
3

Fair
2
2
2

Poor
1
1
1

N/A
N/A
N/A
N/A

Communication satisfaction with

1. Time answered when call light pressed
2. Ability to contact nurse
3. communication needs met

Excellent
5
5
5

Very Good
4
4
4

Good
3
3
3

Fair
2
2
2

Poor
1
1
1

N/A
N/A
N/A
N/A

Addition comments about satisfaction:

Appendix B
Nursing Compliance Survey
Compliance with new call-light initiative
1. I do not pass a call-light without going into turn it off
2. I address pt need while in the room

Always Most of the time Sometimes Not Often Never N/A

5
4
3
2
1
N/A
5
4
3
2
1
N/A

LEADERSHIP STRATEGY ANALYSIS: HOURLY ROUNDING

3. I feel call light initiative in beneficial
Compliance with hourly rounding
1. I conduct hourly rounding in a timely manner
2. I chart my hourly rounding in a timely manner
3. I feel hourly rounding is beneficial
4. I feel hourly rounding is time efficient
5. I feel hourly rounding reduces pt fall risk
6. I feel hourly rounding contributes to nurse/pt
relationship

11
3

N/A

Always Most of the time Sometimes Not Often Never N/A

5
4
3
2
1
N/A
5
4
3
2
1
N/A
5
4
3
2
1
N/A
5
4
3
2
1
N/A
5
4
3
2
1
N/A

Addition comments about compliance:

:

References
Agency for Healthcare Research and Quality (2013). Preventing falls in hospitals: A toolkit
for improving quality of care. Retrieved from: http://www.ahrq.gov/professionals/s
ystems/hospital/fallpxtoo lkit/fallpxtoolkit.pdf
American Nurses Association (ANA). (2015). http://www.nursingworld.org/EspeciallyForYou/
What-is-Nursing

LEADERSHIP STRATEGY ANALYSIS: HOURLY ROUNDING

Brosey, L., & March, K. (2015). Effectiveness of Structured Hourly Nurse Rounding on

12

Patient Satisfaction and Clinical Outcomes. Journal of Nursing Care Quality, 30, 153159. http://dx.doi.org/10.1097/NCQ.0000000000000086
Ford, B. M. (2010, June). Hourly Rounding: A Strategy to Improve Patient Satisfaction
Scores. Professional Issues, 19(3), 188-191.
Hospital-Acquired Conditions. (2014). Centers for Medicaid and Medicare Services.
Retrieved from http://www.cms.gov/Medicare/Medicare-Fee-for-ServicePayment/HospitalAcqCond/Hospital-Acquired_Conditions.html
Hussey, P. S., Burns, R. M., Weinick, R. M., Mayer, L., Cerese, J., & Farley, D. O. (2013).
Using a Hospital Quality Improvement Toolkit to Improve Performance on the AHRQ
Quality Indicators. Joint Commission Journal On Quality & Patient Safety, 39(4),
177-184.
Mitchell, Lavenberg, Trotta, & Umscheild, 2014). Hourly rounding to improve nursing
responsiveness: A systematic review. Retrieved from: CINAHL
Relationship-Based Care. (2015). Retrieved from http://www.spectrumhealth.org/relationnsh
ipbasedcare
Yoder-Wise, P. S. (2011). Leading and managing in nursing (6th ed.). St. Louis, Missouri:
Elsevier Mosby.