Why Rounding Works

When searching for clinical information, the best source is always the patient or family members. So why do EMS organizations avoid speaking to patients when searching for information about how they are performing?

The question needs to be asked, "How do you know if your organization is doing well in the eyes of the public it serves?" If the answer is anything other than "Because we talk to the people we transport all the time," I would say you are out of touch with your customers.

Many organizations I've worked for and with send a survey out with their bill to the patient's home. This is good and bad. It's great that the organization is looking for feedback on how they are performing, but bad that you are asking people to say nice things about you at the same time they are paying for your services. That's one of the reasons hospitals use a third party surveying vendor most of the time. The second problem with this strategy is that the data you receive is more than a month old. How will you correct any issues that come to light this late after the call was run?

Rounding

A simple answer on how to get quick feedback on your crews and deal immediately with any service issues that might arise is rounding. Rounding is a Studer Group tool I learned while working for that organization, which essentially means speaking directly to the patient or a family member after the call is run and asking specific questions to harness meaningful information.

This sounds like a simple exercise; however, it must be done strategically. First, the leadership team must discuss what they believe to be the most important things they want to know. I suggest looking at your organization's mission statement or concentrating on a particular aspect of care that the organization is focused on improving.

Next, craft specific behavioral-based questions centering on those key issues. (Focus only on two or three items. This isn't a chance to talk about every little thing.) Once you have selected your questions, develop a script for the supervisors or senior paramedics to use at the hospitals. This will ensure uniform communication so the patients all get the same message. Then, go out and talk to the customers!

Developing the Script

Assuming the organization is interested in pain control, ask specific questions like, "During your time with our paramedics, did we do everything in our power to ease your pain?" The patient's answer will give you tangible first-hand knowledge about how your paramedics responded to his pain needs. Asking "How was your transport," or "Did we treat you well?" are vague and meaningless questions that will not give you any data to work with.

Rounding is intended to only last approximately 3-5 minutes per patient. Here's what it would sound like: "Good morning, Mrs. Doe, my name is Patrick and I work for the ambulance company that brought you into the ER today. Do you mind if I come in and ask you a few questions?" Assuming the patient gives you permission, enter and begin: "I know that Mike and Danielle were your paramedics today, and they are some of our best (you're managing up your service without being blatant about it). Did either of them do anything special for you that you would like me to recognize them for? Mrs. Doe, as an organization we are really focusing on easing our patient's pain. During your time with our paramedics, did they do everything in their power to ease your pain? We also want to make sure that our people are taking away your anxiety. Did they explain everything that was going on so you could understand? Do you have any questions that I can answer for you? I have plenty of time. I want to thank you for allowing us to take care of you. It's our pleasure to serve you, and if you have any questions please feel free to call me. Here is my card."

Here's the secret gem in rounding: Not only do you have direct information from the patient, but you have harnessed wins to take back to your crews and reward them for anything positive Mrs. Doe may have told you. EMS professionals want to help people, so give them the kudos when they earn them. Also, if a service issue arises, you are in the perfect spot to do something about it in real time, whether it's speaking to the crew (accountability) or realizing that a particular process has broken down (quality assurance). If so, you can apologize and begin to repair that relationship immediately. For those of you who work in a government organization, the more "fans" you create the easier it will be to get a larger budget.

Conclusion

Rounding is not a new idea--it's been around for years. In fact, doctors have used it for decades, and hospitals have used this tool as a way to increase quality and service in their organizations for years, because it works and positively impacts the bottom line.

Rounding is an easy way to ensure your organization's quality and focus are being carried out by asking the experts--the patients.

Patrick Pianezza, MHA, NREMT-P, is a consultant experienced with Studer, HCAHPS, Gallup and Press Ganey principles. Along with nearly a decade of experience in the prehospital arena, he has worked for Johns Hopkins Hospital and Studer Group. He is currently the manager of service excellence for San Joaquin Community Hospital in Bakersfield, CA. E-mail ppianezza@gmail.com.

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