Running head: QUALITY IMPROVEMENT 1

Quality Improvement Paper

Chelsea Lawson

Bon Secours Memorial College of Nursing

Servant Leadership NUR 4144

March 14, 2018

I Pledge the Honor Code

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Quality Improvement Paper

Purposeful hourly rounding is an initiative in hospitals across the country to increase

patient outcomes and decrease preventable injury in the hospital setting. Purposeful hourly

rounding is the best practice intervention in addressing patient needs and ensuring patient safety.

This initiative is not new, but it is an initiative that is not always completed correctly. Purposeful

hourly rounding is entering the patient’s room and communicating with the patient to address

any needs, questions, or concerns. The best way to remember to fully complete the purposeful

hourly rounding initiative is to remember to ask each patient about needs regarding toileting,

positioning, pain, and possessions. Research shows implementation and use purposeful hourly

rounding can decrease falls by 50% (Daniels, 2016). By completing purposeful hourly rounds,

nurses can increase patient satisfaction scores and decrease preventable injury.

Heart

Leadership starts in the heart. A leader’s heart is where his or her intentions live. I would

ensure that my intentions for the use of purposeful hourly rounding emphasized the increase in

patient safety rather than the increase in patient evaluation scores. As a leader, it is imperative to

hold the safety of a patient above the satisfaction of a patient (Ellcessor, 2018a). Emphasizing

the impact of purposeful hourly rounding on patient safety is how I would use my heart to lead.

Head

As a nurse leader, I would lead by example using my head, heart, hands, and habits.

Values and beliefs help to define a great leader. I would ensure that my personal values and

beliefs matched those of the health system that I was working for to ensure that I am leading in a

way that is beneficial personally and professionally. I would challenge my employees to care for

each patient as if he or she was the employees’ loved one (Ellcessor, 2018b). Education on the
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benefits of purposeful hourly rounding and instilling appropriate values and beliefs in my

employees are the ways that I would lead with my head.

Hands

Actions and work come from a leader’s hands. I would ensure that my hands are

completing actions that I would want my employees to repeat. I would complete actions that held

patient safety as the highest priority. I would incorporate organizational values and beliefs into

my work to ensure that my actions are upholding the mission statement of the organization

(Elcessor, 2018c). Modeling my actions and work to uphold the organization’s mission statement

is how I would lead with my hands.

Habits

I believe that habits are the most important aspect of a nurse leader. Habits are the actions

that one completes without thinking about it. Habits are the actions that others see and take

notice of. As a leader, I would use prayer and supportive relationships to guide me. I would pray

that God would give me the guidance and competency to be a strong leader, and I would form

supportive relationships within my unit to create a bond (Ellcessor, 2018d). By using prayer and

supportive relationships, I would create habits that would make me a good leader.

Model the Way

Modeling the way is the most effective leadership characteristic. As a leader, modeling

the way allows your employees to replicate your model of leadership into his or her daily

practice. When a leader is modeling the way, his or her beliefs and values are known, and his or

her words and deeds are consisted (Ellcessor, 2018e). As a nurse leader, I would use model the

way to show my inner beliefs and values. I would complete the purposeful hourly rounding
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initiative on my unit with my employees to ensure that I am showing exemplary leadership. I

would use my position as a leader to better the outcomes of the patients on my unit.

Inspire a Shared Vision

Inspiring a shared vision is a priority to ensure buy-in from the employees on the unit.

Leaders need to have their employees come together to think of the future and encourage others

to help with the shared vision (Ellcessor, 2018e). As a leader, I would gather my employees

together and have each employee envision a future with increased patient outcomes and

decreased sentinel events. Purposeful hourly rounding has the potential to fulfill a future with

increased safety when utilized properly. I would use my position as a leader to instill hope for a

better and safer unit in my employees. Incentives are also a way to increase participation and a

shared vison from staff. As a leader, I would include incentives to help employee compliance

with the new initiative.

Challenge the Process

Challenging the process can be the most daunting leadership characteristic. When an

individual challenges the process, change is inevitable. Change can cause chaos, but change can

also bring about tremendous results. Challenging the process requires an individual to look at all

opportunities and to take a risk on a new process (Ellcessor, 2018e). As a nurse leader, I would

implement purposeful hourly rounding for three months, and evaluate the outcomes of the

purposeful rounding using sentinel event data and patient satisfaction surveys.

Enable Others to Act

Having a supportive and receptive environment is imperative when enabling others to act.

Nurse leaders must encourage collaboration and team strengthening (Ellcessor, 2018e). Using

my position as a nurse leader, I would encourage my employees to work together to implement

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purposeful hourly rounding. I would talk with my charge nurse to pair nurses and techs together

to remind one another about completing the purposeful hourly rounding to allow for

collaboration and team strengthening.

Encourage the Heart

Encouraging the heart is one of the most important leadership characteristics. Leadership

starts in the heart (Ellcessor, 2018a). When a leader encourages the heart of an employee, that

leader in encouraging the leadership qualities of that employee. Encouraging the heart requires

recognition. (Ellcessor, 2018e). As a leader, I would have each employee write down how he or

she would like to be recognized and have multiple different ways for employees to be

recognized. Not only would I have ways for employees to be recognized based on performance

and compliance with the new initiative but also ways for peers to nominate each other for

recognition based on peer to peer interactions.

Implications

Compliance with purposeful hourly rounding will help with nursing time management

and help with clustering care. By using purposeful hourly rounding, a nurse can better manage

her time by gathering assessment and re-assessment data during his or her purposeful hourly

rounds. Purposeful hourly rounding includes walking into the patient room and communicating

with the patient about toileting, position, possessions, and pain (Daniels,2016). Carrying on a

conversation with someone is the easiest way to assess a patient’s level of consciousness.

Addressing pain in purposeful hourly rounding is an assessment or re-assessment of pain. Using

purposeful hourly rounding is a great way to gather assessment and re-assessment data

throughout the day.

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Patient satisfaction is important, and patients do not like to be continuously bothered.

Utilizing purposeful hourly rounding can cluster care. When a nurse has a medication to give, he

or she can utilize purposeful hourly rounding while giving medications. Utilizing purposeful

hourly rounding by itself is still clustering care because there are several components. This

quality improvement initiative has positive implications for nursing practice.

Outcomes

Purposeful hourly rounding is a cost-effective quality improvement initiative that can

increase patient safety and satisfaction. Research shows that when purposeful hourly rounding is

used patient satisfaction regarding nurse communication, pain management, and responsiveness

of staff increases. Patient safety also increases. When purposeful hourly rounding is utilized,

inpatient falls decreased by 50% (Daniels, 2016). Thirty-three percent of hospital falls result in

injury which can greatly impact a hospital both legally and financially (AHRQ, 2017). Using

purposeful hourly rounds, nurses are being proactive in meeting patient needs. This quality

improvement initiative is a simple way to increase patient safety and satisfaction.

Conclusion

Purposeful hourly rounding is cost-effective, assists with time management and

clustering of care, and increases patient safety and satisfaction. This quality improvement

initiative is a simple way to drastically change the way that a nursing unit operates. Purposeful

hourly rounding allows for patients to feel that staff is considering the patient’s needs. The four

components of purposeful hourly rounding are an excellent tool to use to improve the quality of

care and outcomes on a nursing unit.

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References

AHRQ. (2017, June). Falls | AHRQ patient safety network. Retrieved from

https://psnet.ahrq.gov/primers/primer/40/falls

Daniels, J. F. (2016). Purposeful and timely nursing rounds: a best practice implementation

project. The JBI Database of Systematic Reviews and Implementation Reports, 14(1),

248. doi:10.11124/jbisrir-2016-2537

Ellcessor, B. (2018a). The heart of a servant leader [PowerPoint]. Retrieved from

https://bsmcon.blackboard.com/webapps/blackboard/execute/displayLearningUnit?cours

e_id=_3707_1&content_id=_214216_1

Ellcessor, B. (2018b). The head of a servant leader [PowerPoint]. Retrieved from

https://bsmcon.blackboard.com/webapps/blackboard/execute/displayLearningUnit?cours

e_id=_3707_1&content_id=_214217_1

Ellcessor, B. (2018c). The hands of a servant leader [PowerPoint]. Retrieved from

https://bsmcon.blackboard.com/webapps/blackboard/execute/displayLearningUnit?cours

e_id=_3707_1&content_id=_214217_1

Ellcessor, B. (2018d). The habits of a servant leader [PowerPoint]. Retrieved from

https://bsmcon.blackboard.com/webapps/blackboard/execute/displayLearningUnit?cours

e_id=_3707_1&content_id=_214217_1

Ellcessor, B. (2018e). Five practices of exemplary leadership [PowerPoint]. Retrieved from

https://bsmcon.blackboard.com/webapps/blackboard/execute/displayLearningUnit?cours

e_id=_3707_1&content_id=_214218_1