Running head: LEADERSHIP STRATEGY ANALYSIS: HOURLY ROUNDING

Leadership Strategy Analysis: Hourly Rounding

Hillary Colbry, Megan Lammers, Maria Licari and Mary Skrypiec
Ferris State University

Abstract
The following paper analyzes the benefits, process of implementation, and nurses use of
hourly rounding in the hospital. The American Nurses Association [ANA] nurses role is
addressed in relation to hourly rounding. The clinical need to address patients concerns via
hourly rounding is explained not only with nurses but with the interdisciplinary team. A tool for
data collection, a SMART goal, and a tool for implementation is identified. A study to enforce
the clinical need and past success of strategies to improve hourly rounds is reviewed.

Leadership Strategy Analysis: Hourly Rounding

LEADERSHIP STRATEGY ANALYSIS: HOURLY ROUNDING

The ANA defines the nursing role as the protection, promotion, and optimization of
health and abilities, prevention of illness and injury, alleviation of suffering through the diagnosis
and treatment of human response, and advocacy in the care of individuals, families,
communities, and populations (ANA, 2015). Spectrum Health currently uses the relationshipbased care model to ensure that nurses are following the ANA definition (Relationship-Based,
2015). The relationship-based care model has nurses perform hourly rounding to improve health
outcomes, prevent new injury or illness, and increase patient satisfaction. The problem at
Spectrum Health is that there is no method to ensure that nurses are performing hourly checks
and that nurses can alter their charting to say they completed them. The authors have seen that
nurses alter their charting. The purpose of this paper is to establish the importance of hourly
rounding, create a tool that gathers staff compliance along with patients opinion and to evaluate
how these tools can help Spectrum Health.
Identify Clinical Need
Hourly rounding focuses on addressing patient needs proactively in a cost effective way
for hospitals (Brosey & March, 2015). The purpose of hourly rounding is to anticipate and meet
patient needs routinely, and ensure patient safety (Ford, p.188, 2010). Hourly rounding allows
nurses to gather information in a structured way, addressing problems before they occur. During
hourly rounds, nurses have the opportunity to check patients comfort, pain levels, nutritional
intake, elimination, hygiene and establish a strong relationship (Brosey & March, 2015).
Rounding also leads to decreased use of call lights, falls, and pressure ulcers (Brosey & March,
2015). There is no current method to check a nurses compliance with rounding except charting,
which can be altered. Rounding needs to be a honest task because lack-of can severely hurt a
hospital unit. This is because Medicare will no longer reimburse hospitals for injuries related to

LEADERSHIP STRATEGY ANALYSIS: HOURLY ROUNDING

falls in the hospital and hospital acquired pressure ulcers (CMS, 2014). Hourly rounding can
provide consistency in patient care, leading to better outcomes and greater patient satisfaction.
Designs an Interdisciplinary Team
In order for a problem to be tackled team members on a floor must all be educated on the
problem, and the proposed solution. An appropriate quality improvement (QI) team for hourly
rounding would include a quality assurance member, the floor manager, registered nurses, and
nursing assistants (NAs). According to Yoder-Wise (2011), QI team members should represent
a cross section of workers who are involved with the problem (p. 368). These members would
be exclusive to the floor that the hourly round initiative is implemented, in order to have the best
results measured. Nurses would be most involved with hourly rounding first which gives them
the opportunity to help in the patients plan of care when interacting with interdisciplinary teams.
This is why it is imperative that they are compliant with the task by completing honest checks.
Data Collection Method
A tool used for data collection in regards to hourly rounding is surveying. Surveying
allows nurses to anonymously admit their feelings towards hourly rounding and gathers patients
opinions. Examples of the surveys are located in appendix A. This tool allows an open discussion
among staff, gives an opportunity to educate and gathers patient satisfaction. Surveys will open a
discussion to show how hourly rounding is impacting the unit. Spectrum currently uses visual
tools like graphs to show staff the benefits of hourly rounding. Spectrum has implemented that
call light averages be posted each week with the goal to be average call light response time at or
below 120 seconds. Another visual representation on the floor is a calendar that shows the
number of days the floor has gone without a fall, and the days during the month that a fall
occurred represented by a star. The authors agree that surveys are a more beneficial data

LEADERSHIP STRATEGY ANALYSIS: HOURLY ROUNDING

collection tool that checks staff compliance among hourly checks, opens the door to educate
nurses and a way to receive patients opinions.
Outcomes
After identifying the need for a goal to measure the falls on the floor, the team established
a SMART goal after reviewing baseline statistics about call light responsiveness and associated
problems. A SMART goal method is a specific, measurable, attainable, realistic and timely
goal(Yoder-Wise, 2011, p. 296). The goals of hourly rounding are to increase patient safety and
have high patient satisfaction within the facility. This goals are met when a unit demonstrates
high compliance with rounding. The first outcome that needs to be met is establishing staff
compliance. After one year of surveying, the authors would like 90% of staff nurses to answer
yes to completing hourly rounds on every assignment via an anonymous survey. Nurse managers
can also check compliance through chart audits. Then identify and follow up with nurses that do
not complete daily risk assessment checks. After one year the goal would be 95% of staff would
not be receiving audits. Nurse managers should also keep staff aware of call light responsiveness
and falls. The Agency for Healthcare Research and Quality [AHRQ] suggests that hourly
rounding is proactive; it reduces patients need to use the call light, to ask for help, and
therefore decreases the number of unscheduled call lights that require response (AHRQ, 2013).
As a goal, in one year the call light response time and falls for the unit should decrease by 50%.
A quarterly goal that can be set is increased patient satisfaction. Patients should use the survey in
appendix B and in one year 85% of patients should report satisfaction with the care, staff
members, and facility. Decreased call light usage, falls, and increased patient satisfaction are
positive outcomes that result from high nurse compliance with hourly rounding.
Implementation Strategies

LEADERSHIP STRATEGY ANALYSIS: HOURLY ROUNDING

The AHRQ has toolkits that organizations can use so hourly rounds can be implemented
into nursing practice. A study was done on the AHRQ quality indicators and was found to be
successful. Several hospitals reported that the toolkit was particularly useful for achieving staff
consensus on the extent of quality gaps and on evidence-based practices (Hussey, 2013, p. 7).
The AHRQ toolkit includes checking the patient's pain, personal needs, positioning, and
placement of items while doing the hourly rounds (AHRQ, 2013, p.130). Placement of items
includes making sure patients have the things they need within reach so they do not need to use
the call light or attempt to get up when they are a fall risk. Pain level assessment, routine pain
control measures, and positioning along with placement of items reduces the need for assistance
(AHRQ, 2013, p.130). Implementations mentioned above will decrease the number of times a
nurse is needed in the patients room which decreases call light usage.
The AHRQ integrates the systems theory in their toolkit for hourly rounding. The systems
theorys goal is to explain productivity in terms of a unifying whole as opposed to a series of
unrelated parts (Yoder-Wise, 2011, p. 131). The framework focuses on the mixture of inputs,
throughputs, and outputs in solving a problem, this means integrating resources, the process, and
the products from a system to determine areas in need of change (Yoder-Wise, 2011, p. 131). The
AHRQs toolkit is a resource to help change the process and the products of a problem identified
in the healthcare system.
Evaluation
Floors can initiate quarterly check-ins with staff to visually show the amount of falls
that have occurred during that period. With enforced strategies, a way to measure compliance
related to falls, nurses can be held accountable by documenting risk assessment checks per shift.

LEADERSHIP STRATEGY ANALYSIS: HOURLY ROUNDING

Documentation audits can show whether or not nurses are completing their hourly rounds.
Patient satisfaction surveys have been shown to be a tool to measure true nursing attentiveness
when documentation alone can be an unreliable source if nurses are being unethical in their
charting.
A systematic review of 16 published studies done by the Journal of Nursing Administration
(JONA) evaluated the use of nursing hourly rounds, resulting increased patient satisfaction, and
reduction in patient falls. In this review the evaluated hospitals utilized some form of nursing
rounding either hourly or every two hours. The hospitals also utilized the 4 Ps mentioned
earlier, as well as a discharge patient satisfaction survey (Mitchell, Lavenberg, Trotta, &
Umscheild, 2014). The authors found, Of the 11 studies that reported overall patient
satisfaction scores, 9 found improvements in that measure; none reported any decrease
(Mitchell, Lavenberg, Trotta, & Umscheild, 2014). In fact, each study reported some form of
increase, no study stayed stagnant (Mitchell, Lavenberg, Trotta, & Umscheild, 2014).
Ten of the eleven studies reported some reduction in falls due to the hourly rounds. A
conclusion was made that because nursing staff would round hourly to evaluate the patients
need for toileting, positioning, pain, and item placement, patients were less likely to use the call
lights as well as get up on their own to try to toilet, and result in a fall (Mitchell, Lavenberg,
Trotta, & Umscheild, 2014). The authors found that The reported reduction in falls ranged from
24% to 80%, with a median reduction of 57%. (Mitchell, Lavenberg, Trotta, & Unscheild,
2014).
The conclusion of this study found the use of hourly rounding in inpatient care was of
low to moderate strength (Mitchell, Lavenberg, Trotta, & Umscheild, 2014). The major issue

LEADERSHIP STRATEGY ANALYSIS: HOURLY ROUNDING

with the reporting system of falls and hourly rounding is that nursing staff could lie on their
charting, and it is difficult to really evaluate the compliance with hourly rounding. The best way
to enforce the compliance for hourly rounding is to bring attention to staff the results from
studies that show that hourly rounding really does affect patient satisfaction and reduces patient
falls.
Conclusion
This paper reviewed the importance of hourly checks and how organizations can create
strategies to increase compliance among nurses. Using previously effective tools and studies,
hospitals can implement hourly rounds effectively for the patients and for the staff. The process
to implement effective hourly rounding requires truthful, active staff, that are willing to better
their floor and increase patient safety. The process does not include just nurses, but the nursing
manager, and the whole interdisciplinary team. If hourly rounding is implemented effectively by
all staff involved in it can be a great success.

Appendix A

LEADERSHIP STRATEGY ANALYSIS: HOURLY ROUNDING

Patient Satisfaction Survey

Overall satisfaction with
1. Our practice
2. Quality of medical care
3. Overall care

Excellent
5
5
5

Very Good
4
4
4

Good
3
3
3

Fair
2
2
2

Poor
1
1
1

N/A
N/A
N/A
N/A

Nursing satisfaction with

1. Attentiveness to needs
2. Knowledge of needs
3. Time spent in room

Excellent
5
5
5

Very Good
4
4
4

Good
3
3
3

Fair
2
2
2

Poor
1
1
1

N/A
N/A
N/A
N/A

Aide satisfaction with

1. Attentiveness to needs
2. Time spent in room
3. Completion of tasks to meet needs

Excellent
5
5
5

Very Good
4
4
4

Good
3
3
3

Fair
2
2
2

Poor
1
1
1

N/A
N/A
N/A
N/A

Communication satisfaction with

1. Time answered when call light pressed
2. Ability to contact nurse
3. communication needs met

Excellent
5
5
5

Very Good
4
4
4

Good
3
3
3

Fair
2
2
2

Poor
1
1
1

N/A
N/A
N/A
N/A

Addition comments about satisfaction:

LEADERSHIP STRATEGY ANALYSIS: HOURLY ROUNDING

Appendix B
Nursing Compliance Survey
Compliance with new call-light initiative
1. I do not pass a call-light without going into turn it off
2. I address pt need while in the room
3. I feel call light initiative in beneficial

Always Most of the time Sometimes Not Often Never N/A

5
4
3
2
1
N/A
5
4
3
2
1
N/A
5
4
3
2
1
N/A

Compliance with hourly rounding

1. I conduct hourly rounding in a timely manner
2. I chart my hourly rounding in a timely manner
3. I feel hourly rounding is beneficial
4. I feel hourly rounding is time efficient
5. I feel hourly rounding reduces pt fall risk
6. I feel hourly rounding contributes to nurse/pt
relationship

Always Most of the time Sometimes Not Often Never N/A

5
4
3
2
1
N/A
5
4
3
2
1
N/A
5
4
3
2
1
N/A
5
4
3
2
1
N/A
5
4
3
2
1
N/A

Addition comments about compliance:

:

References

LEADERSHIP STRATEGY ANALYSIS: HOURLY ROUNDING

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Agency for Healthcare Research and Quality (2013). Preventing falls in hospitals: A toolkit
for improving quality of care. Retrieved from: http://www.ahrq.gov/professionals/s
ystems/hospital/fallpxtoo lkit/fallpxtoolkit.pdf
American Nurses Association (ANA). (2015). http://www.nursingworld.org/EspeciallyForYou/
What-is-Nursing
Brosey, L., & March, K. (2015). Effectiveness of Structured Hourly Nurse Rounding on
Patient Satisfaction and Clinical Outcomes. Journal of Nursing Care Quality, 30, 153159. http://dx.doi.org/10.1097/NCQ.0000000000000086
Ford, B. M. (2010, June). Hourly Rounding: A Strategy to Improve Patient Satisfaction
Scores. Professional Issues, 19(3), 188-191.
Hospital-Acquired Conditions. (2014). Centers for Medicaid and Medicare Services.
Retrieved from http://www.cms.gov/Medicare/Medicare-Fee-for-ServicePayment/HospitalAcqCond/Hospital-Acquired_Conditions.html
Hussey, P. S., Burns, R. M., Weinick, R. M., Mayer, L., Cerese, J., & Farley, D. O. (2013).
Using a Hospital Quality Improvement Toolkit to Improve Performance on the AHRQ
Quality Indicators. Joint Commission Journal On Quality & Patient Safety, 39(4),
177-184.
Mitchell, Lavenberg, Trotta, & Umscheild, 2014). Hourly rounding to improve nursing
responsiveness: A systematic review. Retrieved from: CINAHL
Relationship-Based Care. (2015). Retrieved from http://www.spectrumhealth.org/relationnsh
ipbasedcare
Yoder-Wise, P. S. (2011). Leading and managing in nursing (6th ed.). St. Louis, Missouri:
Elsevier Mosby.

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