TL6
Advocacy and Influence TL6
Provide one example, with supporting evidence, of the CNO’s leadership that led to a strategic organizational change beyond the scope of nursing.
Example: Leadership Rounds
CNO Leadership in Initiative
Catholic Health Initiatives (CHI) St. Vincent Hot Springs (SVHS) nurse managers (NM) were to round on every patient, every day on their units prior to April 2021. The purpose was to ask patients about their experience at the hospital and whether there was anything the NM could do to improve that experience. Evidence-based practice shows that patients are more satisfied with their care when they are rounded on by someone in leadership each day.
On the inpatient 30-bed units, CHI SVHS NMs were not able to consistently round on every patient, every day due to the workload. Teresa Lambert, MBA, BSN, RN, CHI SVHS Vice President of Patient Care Services/Assistant Chief Nursing Officer (role of CNO), initiated leader rounding to include all leaders in the organization rounding on all patients on the inpatient units every day to ensure consistency with leader rounding and to improve the patient experience.
In October 2020, CommonSpirit Health (CSH), the overarching organization for CHI SVHS, sent a playbook on patient satisfaction that included leader rounding. CSH’s plan included nursing and non-nursing leaders in the rounding rotation. Lambert presented the playbook to the leadership team at the October 2020 Leadership Forum meeting. (Evidence TL6-1, CSH Rounding Playbook) The Administrative Team developed a training plan in their November/December 2020 meetings, led by Lambert, to ensure newly added rounding leaders would be proficient in the process.
Lambert, who is also the Executive Sponsor of the Service Excellence Leadership Team, wanted to adopt this practice at CHI SVHS to ensure leaders round daily on all patients. A COVID surge in late 2020 and early 2021 impacted the team’s ability to quickly implement this change in leader rounding practices. Lambert brought the idea to the Service Excellence Leadership team in February 2021 to discuss the rounding plan and service recovery training for leaders. (Evidence TL6-2, Service Excellence Leadership Team Minutes and Roster, February 25, 2021)
the unit they would round on, when they would round, the questions they would ask during rounding, and the reporting process. The details and expectations of leader rounds were discussed and set into place during the March and April 2021 Service Excellence Leadership meetings. Lambert identified the rounding leaders, and a list of these leaders was created in collaboration with the Administration Team in March 2021. The leaders were scheduled on a weekly rotation, with the schedule made for six months at a time and distributed to the leaders in an email. The rounders are also announced in the daily Patient Experience Huddle in case of unexpected schedule adjustments. (Evidence TL6-3, Service Excellence Leadership Team Minutes and Rosters March and April 2021)
In addition, CSH sent rounding questions to go with the rounding process. Lambert and the Service Excellence Team adopted the questions for the leaders to use when rounding so everyone is consistent in their scripting. The questions focus on bedside shift report, intentional hourly rounding, nurse/physician rounding, medications, cleanliness, and discharge information. (Evidence TL6-4, Leader Rounding Schedule and Leadership Rounding Questions) A mandatory leader rounding Zoom was to be completed prior to March 31, 2021, with an official start date for the organizational change of April 5, 2021. All leaders were required to complete education on leader rounds, consisting of a 60-minute Zoom session led by Rob Loudermilk, MA, BS, Service Excellence Coordinator.
When the leader comes to the unit for rounds, the patient list is in the same area on each unit, and the NM marks the patients not appropriate for rounding. The leader gets their patients, places their initials, and begins the rounds. Daily rounds by a leader enables them to receive real-time feedback and address the patient’s experience before their discharge. The leader reports all issues to the department’s NM, who then addresses them.
Strategic Organizational Change Inclusive of Nursing and Other Disciplines The strategic organizational change beyond the scope of nursing to have non-nursing and nursing leaders round daily on patients was initiated in April 2021. CHI SVHS’s previous practice was to have only NM round daily on patients. This strategic organizational change beyond the scope of nursing, initiated by Lambert, is still in place. All CHI SVHS nursing and non-nursing leaders continue to round on patients daily. Leader rounds help with meeting patients’ needs in a timely manner, and they ensure a team approach through which all leaders are responsible for the patient’s experience. (Evidence TL6-5, Completed Patient Rounding Lists)