Ward rounds – A socio-technical system informed analysis of the perceptions of intern and senior house office doctors

Abstract

BackgroundWard rounds (WRs) are a daily organisational process in hospitals. Studies have found variation however in the definition and objectives of WRs, where they take place, who partakes in them and how they impact patient care. ObjectivesThis study was undertaken as part of a longitudinal improvement project in relation to WRs taking a socio-technical systems approach. The objective of this study was to explore junior doctors understanding of the goals, process sequence, social relations particularly understanding of roles and responsibilities, and information and knowledge in relation to WRs. We also wished to hear junior doctors’ perceptions of how WRs may be improved. MethodsOur study took place in a large 1000 bed acute teaching hospital. A survey was developed by the improvement project team and administered to junior doctors at the hospital (n=148). ResultsA response rate of 30.4% was achieved (n=45 completing the survey). Junior doctors perceive the primary goals of WRs to be reviewing patient history and current status (39%) and progressing care plans (38%). They believe their main role on WRs to be writing notes (46.5%). 75% of participants reported that they fully understood their responsibilities on WR, while 67% fully understood the responsibilities of others. 80% reported learning on WRs lower than all other forms of learning. ConclusionsThe findings of this study will help inform our current ‘AS IS’ understanding of WR practice and co-design of improvements. We would argue that further systems level research is needed to examine the impact of lack of agreed goals; clarity in relation to roles and responsibilities; involvement of nursing and health and social care professionals in the WR, and perceived educational value of WRs on staff and patient outcomes.