Monday, November 26, 2007

Rounding for Outcomes

It is a well known fact that the overwhelming majority of employees don't quit their job, they quit their bosses instead. Outcome-based rounding builds positive relationships with employees, and is thus destined to reduce turnover while improving quality. You've got to start off by building personal relationships with staff. When you see them, you know they've got a daughter who's about to start school, so you ask how the first day of kindergarten went. You know his father died, so you ask how he's doing. You get the picture. After you've talked to employees about life outside of work, say: "Tell me what's working well today". Don't focus on what's broken, but what isn't. If the nurse mentions how good the food is, go tell the kitchen and let them know. GOSSIP THE GOOD. The next question to ask is who should I (the NHA/DON) be recognizing. When you find out, tell them. GOSSIP THE GOOD. Then ask what can do better. This is what quality improvement is. The final question is, "Do you have everything you need to do your job?" I once worked for a facility where this was never asked, but the administrator would always get up at staff meetings and tell us we had everything we needed. Of course we didn't, and her comments lowered her staff's perceptions of her abilities as a leader. Don't tell, but ask. Outcome based rounding can also be used with residents. In Tennessee, the Standards for Nursing Homes require that the DON visit every resident, every day. Before rounding on patients, tell the staff and ask if there is anything you should know beforehand. After introducing yourself to each resident, tell them you want them to be satisfied with their care. Ask if they are satisfied and find out why or why not. Then ask which employees need to be recognized. GOSSIP THE GOOD. Finish off by asking if there is anything else you can do for the resident while you're there. Don't forget to mention that you have the time. Of course, this is only the brief version of the technique. You have to read the book (Hardwiring Excellence, by Quint Studer) to find out the details. And one last suggestion: schedule all meetings after 10 in the morning and do all of your rounding before that time.

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