1.
Inpatient Rounding
30 Minutes a Week to Amazing
Patient Experiences
Edward Pillar, DO, and Julie Lyall, RN

2.
When we asked hospital
administrators what keeps
them up at night …

3.
They ranked patient experience
among their
Top 3 Concerns

4.
Experience of care (as measured by the
HCAHPS survey) accounted for 25
percent of the federal value-based
reimbursement in 2016.

5.
Experience of care (as measured by the
HCAHPS survey) accounted for 25
percent of the federal value-based
reimbursement in 2016.
For a mid-sized hospital, that can
translate into tens of thousands of
dollars in lost revenue every year.

6.
Emergency Care Is Key
HCAHPS is an inpatient survey. However …
• Over half of hospital patients are admitted from the
ED.
• Patients admitted through the ED tend to be less
satisfied with their hospital experience.

7.
HCAHPS and ED Satisfaction

8.
And it’s not just about data and
quality metrics.

9.
Compassion Is Always Right
Patients sacrifice privacy and control over
most aspects of their lives when
entrusting themselves to our care.

10.
Compassion Is Always Right
Patients sacrifice privacy and control over
most aspects of their lives when
entrusting themselves to our care.
50 percent of patients and physicians say
that compassion is missing from the
U.S. healthcare system.
Source: Lown BA, Rosen J, Marttila J. An Agenda for Improving
Compassionate Care. Health Affiliate. 2011;30(9):1772-1778

11.
“We can provide the right
diagnosis and excellent service
every time. But if we don’t serve
it up with an experience where
the patient feels valued and
cared for, then the patient won’t
want to come back.”
Edward Pillar, DO

12.
So that’s where we come in.

13.
Edward Pillar
DO
Director of Quality and
Performance
Julia Lyall
RN
Patient Experience Program Manager

14.
Several years ago, we were
working together as the ED
Medical Director and ED Nurse
Manager of a Level II Trauma
Center in California.

15.
Back then, our admitted patients
weren’t scoring us very highly on
HCAHPS.
And we didn’t know why.

16.
After they left our ED, we almost
never heard their stories or
concerns.

17.
We felt that something needed to
be done to bridge the gap
between the ED and inpatient
experiences.

18.
So we created an
Inpatient Rounding
Pilot Program

19.
It’s Super Simple.
Each week, providers and nurses
round on their admitted patients.

20.
Why?
• Learn about patients’ transitions of
care experience.
• Identify opportunities for closer
integration between the ED and
hospitalist teams.
• Provide real-time service recovery.
• Gain feedback on initiatives and
outstanding providers.
And most of all …

21.
Exceed the expectations of
patients and families.

22.
At first, it was just two of us.
We didn’t spend a lot of time seeking
buy-in or forming a committee.
We just started knocking on doors.

23.
Eventually, others joined in.
It started with a few volunteers. But once
they tried it, they were hooked.

24.
From the first day of rounding, it
became apparent that this process
provided feedback that was
overwhelmingly positive.

25.
From the first day of rounding, it
became apparent that this process
provided feedback that was
overwhelmingly positive.
That was powerful. No one gets
enough positive reinforcement in
emergency medicine.

26.
“One woman ran into my arms
when we came to visit her
husband. He had just received a
terminal diagnosis and was
going into hospice. Knowing we
cared meant a lot to her.”
Edward Pillar, DO

27.
Soon we were rounding as a
team.
• Patient’s PA/NP
• Patient’s Primary ED Nurse
• Representative from hospital administration
• Hospitalist Provider
• Case Manager

28.
Any feedback, positive and negative,
was circulated back to individual
providers and staff in order to:
• Further hardwire our culture of caring
• Reinforce positive behavior
• Provide counseling and support for
negative behavior

29.
Negative patient experiences were
communicated in concept (no names
mentioned) in our daily shift huddles.

30.
While we got tons of positive feedback,
we also found that
Service Failures Happen.

31.
While we got tons of positive feedback,
we also found that
Service Failures Happen.
That’s a guarantee. So you’d better go
find them!

32.
Here are just a few we identified during
the 6-month pilot period:
• Poor communication
• Lack of introductions
• Inappropriate conversations
• Cleanliness issues
• Unexplained delays
• Noise
• Inadequate pain control

33.
How to spot more service failures:
• Make an authentic connection
• Watch for nonverbal cues
• Practice active listening

34.
Rounding gave us a chance to validate
patient and family concerns.

35.
Rounding gave us a chance to validate
patient and family concerns.
I can see how
that would be
frustrating.

36.
Rounding gave us a chance to validate
patient and family concerns.
Anyone in your
situation would
feel that way.
I can see how
that would be
frustrating.

37.
If you identify a failure …
• Try not to take it personally.
• Diffuse negativity by acknowledging
the concern and taking responsibility.

38.
If you identify a failure …
• Try not to take it personally.
• Diffuse negativity by acknowledging
the concern and taking responsibility.
It may not be my fault, but it’s my
problem. Thank you for bringing
this issue to my attention.

39.
The Good News
Most service failures were recovered in
real-time by the inpatient rounding team.
(We got great backup from our hospital’s
service recovery team.)

40.
So we know you’re probably
wondering
Does this get results?

41.
So we know you’re probably
wondering
Does this get results?
Well, during our pilot ...

42.
We saw improvement in both our
ED and inpatient
satisfaction scores.

43.
Patients weren’t the only
ones satisfied.
The entire hospital saw the
momentum of positivity and energy
that resulted from the project.

44.
“The ED nurses and physicians
were seen as leaders and role
models in the patient experience.
We became known as the team
to call upon when there was a
difficult situation with a patient.”
Julia Lyall, RN

45.
People were just really
fascinated.
Even some of our hospital board
members requested to round with us
and share the experience.

46.
We’ve presented posters on
inpatient rounding at the
conferences of:
We also wrote about it for
FierceHealthcare.

47.
So why exactly does
this work?
Here are a few thoughts.

48.
Maximizing the patient experience
requires providing authentic connections
at every touch point throughout the
patient’s journey.
Inpatient rounding meets this need.
Care Should Be Personal

49.
Maintaining a culture of caring requires
constant feedback to staff.
Inpatient rounding helps you provide this
feedback in real time.
Culture Takes Work

50.
Feedback on patient and family
perceptions of their experience is a
powerful tool for nurturing an
empathetic and engaged staff.
We Really Care
About Patients

51.
An effective service recovery program
will actually increase patient and
family loyalty.
Service Recovery Is a Gift

52.
Service Failures Are a Gift
Service Failure Service
Recovery

53.
We really hope you do. And it’s easy
to get started.
Ready to Give It a Try?

54.
The great thing about inpatient rounding
is that it doesn’t take a lot of money or
resources.

55.
Culture change.
Leading by example.
Getting out of your comfort zone.
Opening yourself to possible criticism.
What It Does Take

56.
It’s not always comfortable.
But at the end of the day, you’re building
a better patient experience — the kind of
experience you’d want for yourself and
your family members.

57.
Learn more about improving the patient
experience at the CEP America blog.

58.
Thank You!