HOSPITAL OPERATIONS · PRODUCTION PRODUCT
Patient Rounding
Nurse and leader rounding for Elevra, the hospital operations platform at Compass Healthcare Digital.
Opportunities had been designed as a separate module. In a working session we separated the two ways sites rounded, so I made an opportunity a state of the follow-up record sites already used, with assignment that branches by who does the rounding. Engineering scoped one system instead of two. It meant reworking designs that had already been through review.
The turning point
A separate module became part of the existing record.
I was the lead product designer on the module, accountable for its product model and release structure, working across product, operations and engineering.
The essential distinction remained: completing a round did not close the concern it raised.
Bedside rounding
Was the room clean and well-maintained?
No
8:14 AM
A concern was raised
A rounder heard a No at the bedside, logged it, and moved on to the next room.
Follow-ups
Opportunities
It lived in two places
Opportunities had been drawn as their own module, so one finding could sit in two queues.
Rounding concern
Blanket warmer out of service
Owner
Nobody could see the owner
The rounder recorded the concern, with no way to know that someone was following up.
Service-line leaders
Patient-experience team
Sites rounded differently
At most sites service line leaders rounded. At the rest, a dedicated patient experience team did.
Production workflow recreated
Elevra's rounding surface
Production workflow recreated
Elevra's rounding surface
Where it came from
These are real screens from the shipped product, reconstructed for this site. Every patient, site, and record shown is demo data.
The nav stack
Flat, then grouped by workflow, then focused to the module you're in.
The card wall
A repeated card, then a comparable row, then a record you can act on.
My role
I defined the module’s product model.
My responsibility
I worked out how a finding is recorded, who owns it, how long they have to resolve it, and where it sits beside the follow-ups system sites already ran.
On that model I designed the nurse, leader and manager views.
Bedside finding
Blanket warmer out of service
- Round
- Complete
- Concern
- Open · awaiting owner
How I worked
Mapped how sites actually round. In a working session we separated the two operating models that every later decision was argued against.
Used the prototype to surface a failure. It showed that two rounders covering the same unit could log one concern twice.
Resolved the release scope with engineering. Core rounds first, then service history and question-level detail, and the patient module last, because it waited on the admit, discharge and transfer feed. Engineering scoped one system instead of two.
Outside my remit
- Manager portfolio direction
- Roadmap above the module. Final prioritization across the portfolio. Handoff plan.
- Engineering implementation
- Admit, discharge and transfer integrations. Estimation and production behavior of follow-ups.
On the floor
The round happens at the bedside, on the same record.
Leaders carry a tablet on the unit. Each answer they tap is the row the desktop above shows.
Rounds
My rounds, Monday, March 9
Brian Coleman
54, MMed-Surg 305-BRND-1042, Nurse round
6 questions, Nurse leader script v3
Before you begin
Is the patient ready for rounding?
Environment of care
Is the room clean and well-maintained?
Is the bathroom being disinfected regularly?
Was the housekeeper courteous and respectful?
Food and nutrition
Is the patient satisfied with the menu options?
Was the diet order delivered correctly?
Recording a round doesn’t tell the whole story.
In Elevra, completing the round and resolving a follow-up concern are separate states. The study below is context for that choice; it did not evaluate Elevra.
What was documented.What was observed.
Documented
86%
Written down
Observed, fully or partially
Each tile represents one percentage point. The two measures are compared independently.
Fully in 39 of 240 rounds: the nurse introduced themselves. In part in 87 more: only a general greeting.
Reading this comparison
Researchers shadowed 39 nursing staff on six English NHS wards across three sites and coded 240 rounds against the original US hourly rounding protocol. A tile is one percent of those rounds, and the two measures are counted separately across all 240. Documented counts rounds written down at any point: 181 straight after the visit, 21 later, and 4 before the nurse spoke to the patient.
Observed counts an action done in full or in part. Done in full, as the protocol describes it: opening with an introduction 39, comfort and position 48, personal needs 54, pain rated 0 to 10 15, items in reach 51, room check 13, “Is there anything else I can do for you?” 6, says when back 2. The authors caution that staff may have skipped a question they knew did not apply, so the actions can understate what nurses knew.
The problem
Six months of screens, with no agreed model behind them.
Rounding is a scheduled walk of a hospital floor. Anything the rounder finds becomes a follow-up that someone has to close.
It is one module of a larger hospital operations platform.
Already designed
A separate Opportunities module
Drawn over six months of informal conversation with stakeholders.
Still unresolved
How it connects to existing follow-up records
And with it, a release plan engineering could estimate.
Rounding platforms treat a recorded concern as work with an owner: Qualtrics turns it into an assigned ticket, and CipherRounds alerts the team responsible for resolving it.
RD-1184 / Leader round
Round completed
Diane Foster, ICU / 201-A
Follow-up
Finish the round. Keep the concern.
Keep unresolved concerns visible.
Service recovery
A concern becomes owned work
Was the room clean and well-maintained?
Make follow-up actionable.
Give follow-up an owner.
Follow-ups / FU-2481
One record throughout
Blanket warmer out of service
Record history
FU-2481
Two names for one thing, at two different moments of its life.
Six months of screens never surfaced it, because a screen cannot show you where a record lives.
The object under discussion
Blanket warmer out of service
Blanket warmer out of service
The same lifecycle, built a second time.
One record, carrying its own history, wherever the finding is in its life.
Who rounds, by site
Each mark is a tenth of sites, by the team's working estimate. At seven, service line leaders did their own rounds. At three, a dedicated patient experience team did. Drawn as a separate module, every one of them would have kept a second record.
- Records per finding
- TwoOne
- Ownership
- Split across bothUnchanged
- Assignment
- Same everywhereBy operating model
After the round
A finding becomes owned, timed work.
Rounding's weight sits in what happens after a “No”: the finding gets an owner and a clock, and the clock is why a finding has states at all.
8:14 AM0 min since the No
- Past due
- Resolved
Follow-upOpen
ED, room 102
Round answer
“Was the room clean and well-maintained?” No, 8:14 AM
Owner
EVS lead, day
Time left
2 h 0 min of 2 h, due 10:14 AM
- 8:14 AMNo on the round. Assigned to EVS lead, day.
The decisions
Three decisions changed the release.
A decision you can only see the outcome of is a claim. These carry what else was on the table and what each one cost, because that is the part a reader needs in order to disagree.
Stopped prototype iteration and mapped operating models instead.
Every review cycle re-opened the same questions about where things lived. In a working session we separated two operating models: at about a third of sites a dedicated patient experience team did the rounding, and at roughly 70% service line leaders did their own rounds, by the team's working estimate.
Rounding programs are staffed and scheduled very differently, from nurse managers rounding twice a day to food service teams hiring a dedicated rounding manager.
Nothing new to show in a review. A visible pause reads as a real cost in that kind of organization, and it was the right one to pay.
Made an opportunity a state a follow‑up can be in, rather than its own module.
The operating-model mapping showed an opportunity and a follow-up were the same object at different points in its life. A parallel module meant a second queue beside the follow-ups system sites already ran, with a finding raised in one place and closed in another.
Rounding tools route a finding to an owner: Qualtrics assigns a ticket, CipherRounds alerts the responsible team, and Aramark uses rounds for immediate service recovery.
Opportunities lost its own place in the navigation and the stakeholders who had been reviewing it as a distinct module lost the thing they could point at. It also meant reworking designs that had already been through review, which is the least popular kind of rework.
Phased the release around technical dependencies and pushed the patient module to last.
The patient module needed hospital census data from the admit, discharge and transfer feed, which came from a third-party record system on its own timeline. Patient lists and census-based dashboard metrics depended on it too.
Rounding platforms build their patient lists from hospital census feeds through ADT and EHR integrations.
The champion, who controlled pilot access, resisted the deferral. I reframed it as pilot risk: validate core rounds first rather than wait on a dependency nobody on the team controlled. The deferral was accepted once the dependency map was on the table.
Follow-ups
| Record | Finding | Location | Owner | State |
|---|---|---|---|---|
FU-2481 | Blanket warmer out of service | ICU / 201-A | EVS lead, day | Opportunity |
FU-2477 | Meal delivery missed | Med-Surg / 305-B | Nutrition lead | Scheduled |
FU-2469 | Room not turned over | ED / 102 | EVS lead, day | Resolved |
FU-2484 | Call light response time | ICU / 203-A | Charge nurse | Logged |
Fig. 02Release sequence
The round itself
History and question-level detail
The patient module
Nothing waits.
What shipped in each phase
Logging a round, raising a follow-up, closing it. The part every site does the same way, whichever operating model it runs.
The guardrails
Two guardrails the model still had to preserve.
Context is there before the round begins.
Before you walk in
ICU / 201-A
- Diet
- Regular, Low Sodium
- Language
- English
- Mobility
- Assisted, one person
Kudos on this patient's rounds
Explained the discharge plan to the son
Megan Alford, NursingAug 14
Waited so the family could finish saying goodbye
Tony Albright, TransportAug 13
Room turned over before the family arrived
Rosa Villanueva, EVSAug 12
What changed
What came of it.
A clearer architecture, a production workflow, and a stop before duplication.
- Diet order correct?NoRound, Med-Surg room 311-ANutrition lead, dayDue 12:14 PM
- Call light unanswered, 20 minFU-2507Complaint logCharge nurse
- Missed drink in meal orderFU-2519Dietary ticketFood & Nutrition
- Blanket warmer out of serviceFU-2481Opportunity moduleEVS lead, day
- Patient praised RN Denise WalkerFU-2533Kudos formUnit leader
Time to named ownership
The instrument I would add.
Time from a negative finding to named ownership.
FU-2481
Blanket warmer out of service
- Owner
- EVS lead, day
- Module
- Opportunities
Reflection
Next time the architecture is settled before any prototype exists.
The last two rows are the ones I keep returning to. Six months of screens had been standing in for an architecture.
The prototype did earn its place once. The sharpest objection to the design, that two rounders covering the same unit could log one finding twice, surfaced only because the prototype made the scenario visible.
Settle the architecture before prototyping. Use the prototype to expose failures you cannot see on paper.
Compare notes
Working on a product that’s still taking shape?
More work