I recently attended a conference given by
the Advisory Board Company entitled the
“Patient Experience Summit.” Approximately 80 healthcare executives from all
across the country flew to Washington,
DC to attend this all day event. The interest level by those in the room was off the
charts. This is only to be expected.
Most of us are already familiar with
the current trends in healthcare economics. The Federal government and
now some private insurers are partially
reimbursing hospitals based upon publi-cally reported quality indicators. As the
amount of money facilities receive for
their services decreases overall there is
tremendous pressure for sites to maximize payments to which they are entitled.
One specific area that hospitals are
concentrating on improving is referred
to as the patient experience. The term
relates to the satisfaction customers
express toward their inpatient stays, but
it is also applied to outpatient and emergency department encounters. There
are a couple of reasons for this emphasis. First, the Center for Medicare and
Medicaid Services (CMS) is tying reimbursement to HCAHP scores, which
derive from inpatient survey results the
organization conducts covering eight
specific areas or domains. The findings
of this survey are available to the general public, and individuals can go to a
website and compare the HCAHP results
of three hospitals at one time (www.
html). Hospitals are therefore also logically interested in this measure because
competition has increased significantly
How Do You Round?
By Mark Lerner
in recent years and facilities need every
visit that they can get.
There are multiple avenues institutions are utilizing to improve their
HCAHP scores. Many of them were covered in the Advisory Board conference.
Especially popular is the framework promoted by the Studer Group. The Studer
technique encompasses many components, but fundamentally it is based on
two types of rounding. First, the firm
encourages nurses to round hourly on
the inpatients under their care to make
sure their needs are being addressed.
The nurses then document their findings on a tool specifically designed to
capture this information. The second
rounding method has to do with staff.
Several research organizations, including Gallup and the Advisory Board, have
determined that employee satisfaction
has a direct correlation to the quality
of the care that is provided to patients.
High employee satisfaction translates to
better care. Therefore, groups are rushing to figure out how to enhance staff
Studer has an extremely structured
process for employee rounding, not
much different from that used with
inpatients. Management meetings with
employees are scheduled around an
established timetable. Staff is asked the
same questions during each session and
their answers are documented and tabulated. Action plans are developed around
the responses. It is a process that is far too
formal for my taste.
Now, before I continue I need to
point out that the radiology department
I manage has some of the highest
employee engagement scores of almost
any other work unit of the hospital. I am
proud of this fact, not simply because I
am the head, but primarily because the
managers under me have such great rela-
tionships with their subordinates. My
viewpoint on employee rounding takes
a much different form from that recom-
mended by Studer. I go out of my way to
find ways to talk to my staff. For exam-
ple, I spend an hour a week with my top
managers. I regularly hold a discussion
with the leads and supervisors of each of
my divisions while gathered in a room
together. Finally, I have general informa-
tional meetings that include everyone in
In addition, I do my best to spend a
significant amount of time out of my
office. I will stand at our front desk and
assist staff with patient questions and
concerns. I will interact with employees as I complete environment of care
rounds. In addition, I will go to them and
ask operational questions. I try my best to
steer my conversations about something
other than work, giving me an opportunity to learn something about their lives.
We are all busy and there is much to
get done. However, I have been able to
improve staff engagement through dialog with my employees. I can only hope,
as research suggests, that this communication is leading to improved patient
Mark Lerner is the director of diagnostic imaging at
the George Washington University Hospital. He can
be reached at Mark. Lerner@gwu-hospital.com.