Squaring up with rounding: What’s your data telling you?
Rounds, tours, tracers. These are all time-honored approaches to monitoring conditions in the environment, but how are folks using those approaches to verify the effectiveness/sustainability of their compliance efforts? As I ponder the potential impact of Joint Commission’s “new” accreditation process, particularly the increase of life safety surveyor days, I can’t help but think that folks are going to have to really start leveraging rounding data to identify their organization’s greatest vulnerabilities. But, to that point, how are we using rounding in the first place?
I suppose there was a time when the focus of rounding was more punitive than not—directing managers to generate work orders and then follow-up visits that could result in escalating items that haven’t yet been corrected, etc. Often these rounds weren’t “scheduled” or at least not scheduled with the department manager whose department was being visited. My philosophy relative to consulting is that, as a process/experience, it is much less helpful the more painful it becomes.
I daresay, the increase in the role of the life safety surveyors in the Joint Commission survey process means that you really have to be paying close attention to what’s going on pretty much any (and every) where patients are receiving care, treatment, and services. This includes leased spaces where you might not have as much control over work products like inspection, testing & maintenance documentation of things like fire alarm systems, suppression systems, and utility systems, including ventilation and water. I submit to you that your potential survey vulnerabilities have increased by quite a bit. And I have yet to meet the facilities/safety resources that have enough bandwidth to provide expansive “coverage” of these additional physical environments.
Much like my frequent returns to topics surrounding, say, emergency eyewash equipment (and don’t think for a moment that eyewash stations in your outpatient settings won’t be in the mix), I am going to default to my philosophy regarding the role(s) of the folks at point of care/point of service. I suspect that the only way to be successful with the next iteration of the process (is there really anything new to be found here; I think it’s just a shuffling of the deck) is to leverage the interest/participation of the folks who work in all those care environments, including helping them to “see” the typical deficiencies that can be found in the environment and to give you a heads up when something rears its ugly head. Rounding is when you make the connections with the folks in the environment. Show them the trick of not looking “for” anything in particular but looking “at” everything. If something’s not right, it will usually tell you—you just need to help the folks out there in the environment to “hear” the stories of the environment.
Ideally, you already know the many and varied ways that non-compliance manifests itself. Now all you have to do is bring those stone tablets of compliance down from the mountain and share them with the folks in the field. If only life were this simple.
About the Author: Steve MacArthur is a safety consultant with The Chartis Group. He brings more than 30 years of healthcare management and consulting experience to his work with hospitals, physician offices, and ambulatory care facilities across the country. He is the author of HCPro's Hospital Safety Director's Handbook and is an advisory board member for Accreditation and Quality Compliance Center. Contact Steve at stevemacsafetyspace@gmail.com.