Running head: LEADERSHIP STRATEGY ANALYSIS

Leadership Strategy Analysis

OSP Assignment Team Two
Ferris State University

LEADERSHIP STRATEGY ANALYSIS

2
Abstract

The nursing profession is committed to quality improvement. The purpose of this paper
is to analyze a clinical activity from a quality improvement perspective. Hourly rounds are
becoming a new standard of care that involves regular checks of individual patients. This
proactive intervention helps to decrease patient falls, improve patient satisfaction and promote a
less stressful work environment for staff. This paper discusses the clinical need for hourly
rounding, the interdisciplinary team involved in hourly rounding, the method chosen for data
collection, the goal for improvement, strategy implementation, evaluation and supportive
evidence of theory and current research.

LEADERSHIP STRATEGY ANALYSIS

Leadership Strategy Analysis

Introduction
Hourly rounding helps in the facilitation of the building of trust between a nurse and
patient, reduced incidence of falls, reduced call bell usage, reduced patient anxiety and increased
patient comfort, and improved pain management (Harrington et al., 2013, p. ). All of these
outcomes promote patient satisfaction and patient safety. The main goal of hourly rounding in
this paper is to decrease call light use.
Clinical Need
Increasing technological advances have been identified as a contributing factor in taking
the focus away from nursing care, resulting in increased patient falls and high use of patient call
lights (Harrington et al., 2013). To lessen this deterioration in standards of care in the acute
care environment where nursing turnover stands at 19%, suggestions have been made that
intentional rounding may be a method for facilitating increased nursing care, lessening turnover
and leading to greater patient and nurse satisfaction of care provision (Harrington et al., 2013, p.
524). Studies focusing on hourly rounding have shown an increase in both patient and nursing
satisfaction.
Hourly rounds help to keep up on basic patient needs that include feeding, pain
management, and repositioning (Harrington et al., 2013). In the study performed by Harrington
et al. (2013), it was found that decreased call lights occurred with hourly rounding. In a study
done by Meade et al. (2010), there was a 35% decrease in call light use after the implementation
of hourly rounding in an emergency room. Duffin (2010) reported that regular attention given to
patients resulted in a more controlled environment and actually reduced nurses' workload due to
the decrease need to respond to call lights.

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Interdisciplinary Team Design

Quality necessitates maintaining safety in patient care, with a continual focus on clinical
excellence from the entire multidisciplinary team (Yoder-Wise, 2014, p. 390). The
interdisciplinary team for this quality initiative includes registered nurses, certified nurse
assistants (CNAs) and nurse managers. Registered nurses should be the main advocates for
hourly rounding. At each hourly round, staff should assess pain, toileting needs, thirst and
hunger and answer any questions the patient may have.
Nurses may perform basic needs or delegate them to CNAs. CNAs will collaborate with
nurses to ensure the rounds are completed and all needs are met. The nurse manager will be in
charge of monitoring hourly rounding documentation to ensure standards of care are met.
Additionally, the nurse manager can collect data and evaluate the outcome of hourly rounding.
Nursing management will report findings with hospital administration for collaboration. Each
person on this team is capable of helping with certain tasks in this process and they are all
necessary.
Data Collection
Data collection on hourly rounding can be done through patient satisfaction surveys. Due
to the fact that some patients may be confused or often have family at the bedside, surveys can
be completed by either the patient or their family member. Surveys should either be sent home
with the patient at discharge or mailed within seven days of discharge. The surveys should
remain private, unless the patient or family member wishes to be contacted for further questions
or comments.
Requested data for the survey would include identification as a patient or family member,
whether or not a staff member checked on the patient every hour, if needs were met when

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appropriate, if a fall occurred or if a skin ulcer developed during the stay, if pain was adequately
controlled and whether or not fresh beverages were provided. If a staff member did not meet the
expectation of an hourly check, the patient or family will be given a chance to comment if staff
provided an explanation. These surveys would also leave room for any additional comments or
concerns. According to Bradley et al. (2013), Those patients who did complete and return the
surveys rated their care very highly over all aspects of care (being seen promptly, provision of
assistance for meals, drinks and comfort, pain relief, safety and respect) (p. 527). Overall data
can be collected and improvement can be made to ensure patient satisfaction.
The frequency of call lights will be monitored before and after implementing hourly
rounds. Additional data to be gathered will include incidence of patient falls and staff
satisfaction.
Outcomes Established
The overall objective of hourly rounding is to improve staff working environment and
increase patient satisfaction by meeting their needs efficiently. According to Halm (2009),
attending to patients comfort, safety, and environmental needs may also prevent adverse events
like falls, pressure ulcers, or unrelieved pain; and contribute to patients satisfaction and nursing
care (p. 581). By addressing patients needs more often, not only is the nursing staff keeping
surveillance on their patients, but proactively meeting their needs and safety. Hourly rounding
also promotes organized workflow and helps anticipate patient needs.
Strategy Implementation
In a perfect world, a hospital would always be adequately staffed, whether it is day shift,
nights or weekends, to ensure hourly rounding is completed effectively. Since this is not the
case, we must find other efficient ways to round on patients. Halm (2009) has suggested that

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registered nurses make rounds on even hours and support staff make rounds on odd hours (p.
581). Because not all units have support staff to help with hourly rounds, another alternative
would is needed.
For units that do not have support staff, the registered nurse would need to make hourly
rounds. They could show that they are rounding by charting what the patient needed or if the
patient denied any needs. Documentation of needs during hourly rounds is also a good way to
show if the nursing staff is meeting their outcomes and patient satisfaction.
Halm (2009) has concluded, in 5 to 6 studies (83%) that examined use of call lights, the
use was reducedFall rates were also shown to reduce by 77% (2009, p. 581). Because
evidence supports hourly rounding, hospitals need to take this into consideration and educate
staff on its importance. When nurses have help on the floor, they are able to delegate a portion
of the rounds. Nurses also need to explain hourly rounding to both patients and families. By
providing education, it will help implement this strategy and hopefully become second nature to
everyone involved.
Evaluation
Our first step in the evaluation process will be to establish a baseline by collecting data in
the pre-implementation phase. We will measure the frequency of call light use, patient
satisfaction with specific areas of care, staff satisfaction, and number of falls that occur over a
period of six months prior to initiating hourly rounds. Call light usage will be measured through
the use of a log. Falls will be calculated from incident reports. Patient and staff satisfaction will
be calculated using the survey method. From there, an established leadership auditing process
will be created. According to Claude-Gutekunst, et al. (2012), things to establish include a fully
developed and clearly communicated protocol, annual competencies, new employee orientation,

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and remediation support for the process (p.). Qualitative and quantitative metrics should be
established to measure success and recognition of staff should occur with successes (ClaudeGutekunst, 2012). The evaluation will consist of a statistical analysis of scores prior to
implementation in comparison to scores over a period of six months after implementation. Staff
buy-in and dedication to participation in implementing the change will be key factors in the
success of this initiative.
Change can be very difficult for people, some more than others. Change requires staff to
put time and effort into the practice modification that they may not desire to if they do not
believe in the necessity of the change. According to the Transtheoretical Model, behavior
change is a process that one undergoes over time through stages. The stages progress from precontemplation and unawareness of the need for change to maintenance of the change upon
implementation. As an individual becomes aware of an issue in the contemplation stage and
takes part in the action to fix the problem, the success hinges on their willingness to make the
change habit.
Scholarship
Through incessant implementation of updates in evidence-based practice the unit is able
to function offering the highest quality and safest care possible. The focus needs to be on
continual transition towards clinical excellence. Thorough research was completed on the topic
of hourly rounds and the impact it will have on the frequency of call light use, as well as the
impact on patient satisfaction with the timeliness of call light response. According to
Harrington, et al. (2013), if nurses made more regular and frequent rounds of patients allocated
to their care through intentional rounding, then patients should be more willing to wait for
assistance. This approach in turn would reduce the frequency of call bell use (p.525). It is

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suggested that if nurses and other patient care staff completed consistent intentional rounds the
patients would likely decrease their overall call light use due to the security they feel in knowing
that the nurse will return in a timely manner automatically.
According to Krepper, et al. (2012), a number of studies measured call light usea 6
week nationwide study at 14 hospitals and 27 nursing units showed a significant reduction in call
light use demonstrated on the experimental units using 1-hour rounding (p.2). A decrease in
call light use supports the nurses during their time spent completing hourly rounds. The nurses
move from a reactive care strategy to a proactive care strategy anticipating the needs of their
patients.
Hourly rounds play a very important role in building relationships equally amongst the
patients. According to Harrington, et al. (2013), Intentional rounding thus ensured that all
patients received regular care instead of care unequally distributed among patients when focused
towards excessive call light use (p.524). One family member stated, We actually felt as if our
brother was the only patient on the floor. Everyone kept checking on him constantly (ClaudeGutekunst, 2012, p.). Building trust in the healthcare team, from the patient and their family,
results in a significant decrease in anxiety, an increase in patient compliance with care and an
overall satisfaction with the care provided. Providing patient-centered, relationship-based care is
vital to supporting the best possible outcomes for the patients as well as the best overall patient
satisfaction with care.
Conclusion
The change from the current reactive nursing practice to the more proactive form of
hourly rounding has received much applause in the studies. The impact that hourly rounds have
on the overall quality and safety of patient care, as well as patient and staff satisfaction, is

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paramount. A decrease in call light use results in a decrease in time and motion from staff. A
decrease in call light use is a direct indicator that the patients needs are being met more
proactively, resulting in an increased trust in the medical team. The benefits of hourly rounding
go way beyond the focused goals of this paper.

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10
References

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Halm, M. (2009). Hourly rounds: what does the evidence indicate? American Journal of Critical
Care, 18(6), 581-584. http://dx.doi.org/10.4037/ajcc2009350
Harrington, A., Bradley, S., Jeffers, L., Linedale, E., Kelman, S., & Killington, G. (2013). The
implementation of intentional rounding using participatory action research. International
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Meade, C. M., Kennedy, J., & Kaplan, J. (2010). The effects of emergency department staff
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Yoder-Wise, P. S. (2014). Leading and Managing in Nursing (5 ed.). St. Louis, MO: Saunders.