Running head: QUALITY IMPROVEMENT 1

Leadership Quality Improvement Project

Katlyn Romero

Barbara Ellcessor, DNP, RN, RNC-OB

NUR 4144 Professional Role Development: Servant Leadership

March 25, 2018

I pledge.
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Quality improvement projects are constantly being created and conducted to meet needs

that arise in the clinical environment. These projects can have different desired outcomes, such

as increased safety or efficiency. A leader can take certain actions to ensure the projects are well

established. The four domains of leadership and five principles of exemplary leadership can be

utilized by an effective leader. This paper will address the “Visilert” quality improvement

project, as well as how these domains and principles can be applied to the project.

Quality Improvement Project

The specific quality improvement project being discussed is the Visilert technology for

hourly rounding. This device is placed outside of a patient’s doorway. There is a visible time

that can be set; hourly rounding should be set for 60 minutes. On the device are three colors:

green, yellow, and red. Green represents that the patient has been seen within the hour. Yellow

appears when it gets nearer to the end of the hour to signal that the patient must be rounded on

soon. Lastly, red lights up when it has been over an hour since the patient has been seen.

Whenever a nurse or other member of the health care team enters a patient room, they reset the

device. The purpose is not only to increase hourly rounding, but also decrease the amount of

excessive interruptions to the patient. The device alerts the nurse that they do not need to enter

the room again if someone has already seen the patient that hour. Another intention is to

increase patient satisfaction and safety.

Four Domains of Leadership

According to the authors of Lead like Jesus, “leadership is a process of influence”

(Blanchard & Hodges, 2007, p. 4). This influence can be either positive or negative. In order to

make a positive influence and implement the Visilert quality improvement project, a leader must
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identify the heart, head, hands, and habits. The following sections will discuss each domain in

further depth.

The heart domain is one’s motivation. In order to establish the project, one must be a

servant-leader. The motivation should be to help others. Hourly rounding’s sole purpose is to

serve the patients. Patients will benefit the most out of this intervention. A nurse leader must

identify that motivation within themselves and their team to truly implement such a project.

The head domain “examines your beliefs and theories” (Blanchard & Hodges, 2007,

p.32). The nurse leader must believe in collaboration and teamwork. This project requires the

involvement of the health care team as a whole. It is essential to communicate this need so that

the entire team is aware and willing to participate. Other important beliefs about leadership

include communication and education. These two things will be essential to teach the nurses

about the new project.

The hands domain consists of the actions one does to fulfill the goal. Actions taken in

this project include education of the nurses and other involved in the healthcare team. As

previously stated, everyone can participate by resetting the device after entering the room. The

act of using the device is also part of the hands. Hourly rounding is not only focused on simply

looking in the room however. It is important to inquire about any patient needs. These actions

are all part of the Visilert quality improvement project.

Lastly, the habits domain is “how you renew your daily commitment as a leader to serve

rather than to be served” (Blanchard & Hodges, 2007, p. 33). Maintaining good relationships is

a positive practice to remain motivated. Another way to do this is through the use of prayer.

The nurse leader can take time out of their day to pray about any issues or problems arising.
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Five Principles of Exemplary Leadership

Model the Way

The nurse leader must model the way; this is to set an example for the others. By

modeling the way, the leader can show others the standard of care. For example, the nurse leader

can perform thorough hourly rounding. They can also perform correct use of the Visilert. While

the timer can be set to any amount of minutes, it would be inappropriate to set the time for

longer. Doing so would delay the rounding for much too long. The nurse leader would lead by

example by setting the hourly timer and responding the light system if it appears yellow or red.

Inspire a Shared Vision

Members of the healthcare team, especially the nurses, must share the same vision as the

nurse leader in order to be motivated to participate. The nurse leader inspires a shared vision by

expressing the benefits of the quality improvement project. Through the use of visilert, hourly

rounding is much more efficient because it will be a clearer communication of whether anyone

has rounded on the patient. Another benefit that can be communicated is that the lights serve as

a visible reminder in the event that time gets away from the nurse. Sharing a vision is essential to

increase compliance.

Challenge the Process

Challenge the process is the action of challenging the status quo. The Visilert is an

innovative product, and a creation of this new technological age. In the past hourly rounding

was charted on paper, and now it is charted electronically. While documentation must still be

completed, it is a new concept to use an extra device. The implementation of this system would

challenge both experienced and new nurses equally.

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Enable Others to Act

Enabling other to act is utilizing the value of collaboration. The nurse leader should hear

out worries of the team. Some may see negative factors, such as visitors seeing red and

assuming something bad is happening. Allowing time for regular meetings can help address

these fears and create solutions. If nurses feel their voice is being heard, they may be more

inclined to participate and take ownership of this responsibility.

Encourage the Heart

Positive reinforcement is fundamental to encouraging the heart. For example, if all of the

lights are green throughout the hallway the entire team should be praised. Recognition can

refresh the nurses’ motivation for this quality improvement project as well as their self-esteem.

Huddle is also a great time to encourage the heart, when everyone is together to discuss goals of

the day.

Professional Practice Implications

Hourly rounding is an essential responsibility in nursing. This is a nursing intervention in

which the nurse performs systematic, purposeful rounding every hour. The goal of this

intervention is to increase patient satisfaction and safety. By performing hourly rounding the

nurse can improve many aspects of care. According to Mitchell, Lavenburg, Trata, and

Umscheid (2014), “proactive nurse rounding has been associated with decreased use of call

lights” (p. 3). Communication is increased; the patient can have the opportunity to ask any

questions they may have. Nurses can meet patient needs more efficiently this way.

Another benefit of hourly rounding is safety. By maintaining a close eye on one’s

patient, the nurse can identify any decline in condition. Patient safety is the nurse’s

responsibility, and proper rounding ensures this safety. A common adverse event is the
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occurrence of falls (Williams, 2014, p. 3). Falls can occur when the patient attempts to walk to

the bathroom unattended. A proactive nurse that regularly assesses the patient’s toileting needs

can eliminate this risk.

Outcome Evaluation

An evaluation of patient satisfaction can be conducted through surveys. For example

Hospital Consumer of Healthcare Providers and Systems (HCAHPS) surveys address patient

satisfaction, such as their views on communication (Mitchell et al., 2014, pg. 5; Cleveland

Clinic, 2017). Press Ganey (PG) survey findings can also offer information on the effectiveness

of this intervention (Mitchell et al., 2014, p. 5). Responses to these surveys reveal the patient’s

viewpoint on their healthcare in regards to rounding. Use of patient call lights can also be used

to evaluate patient satisfaction. A decrease in call lights would support the theory that proper

rounding increases responsiveness to the patient.

Other ways of evaluating the outcome of the Visilert system is to measure patient safety

as previously mentioned; this can be in the form of patient falls. A decrease in patient falls

would be a successful outcome. A decrease in rapid response or code blue calls can also be a

measurement. Nurses that properly round are more acutely aware of their patients’ status and

can act quicker to reduce the need for these calls. Another possible measurement would be to

calculate the average length of stay on the unit; a comparison would be conducted before and

after Visilert was put into use (Mitchell et al, 2014). A positive outcome, decreased length of

stay, would reflect more efficient care.

Conclusion

In conclusion, the implementation of this quality improvement project can have vast

professional implications. Both patient safety and satisfaction have the potential to be greatly
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improved. Proper leadership depends on the identification of the heart, head, hands, and habits.

The five principles of leadership are also vital to encourage teamwork. Through the proper

leadership and evaluation, any unit can determine the effectiveness of the Visilert system.
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References

Blanchard, K., & Hodges, P. (2007). Lead Like Jesus. Nashville, TN: Thomas Nelson.

Cleveland Clinic. (2017). Effects of visilert, a nurse rounding device. Retrieved from

https://consultqd.clevelandclinic.org/effects-of-visilert-a-nurse-rounding-device/

Mitchell, M. D., Lavenberg, J. G., Trotta, R. L., & Umscheid, C. A. (2014). Hourly rounding to

improve nursing responsiveness. JONA: The Journal of Nursing Administration,44(9),

462-472. doi:10.1097/nna.0000000000000101

Williams, Doshia B. (2014). Improving staff responsiveness to patient-initiated call lights.

Master's Projects and Capstones. 57.