“I’m on my way”: The System That Lifted Team Trust, Throughput, and NPS

On any given day at UCI Health’s Level I trauma center, everything moves fast: high-acuity admits, full surgical slates, and a discharge pace that can top 500 a week.

In that pace, the one truth still matters most. 

Patients need to feel seen, and teams need to hear one another.

Justin Wang, Manager of Experience and Operations, put the mandate plainly: “We’re very busy, so we honed in on team communication,” not as a slogan, but as the operating system for care. 

He adds, “We wanted something commonsensical, meaningful to both patients and care teams.”

So UCI Health did something refreshingly human. 

Rather than layering on new tech or staffing, they co-designed a plain-language rounding framework that both staff and patients could grasp in seconds. 

They called it “I am OMW” (“I’m on my way”). 

It’s easy to run. It’s memorable. And for four intense months, it helped teams make visible progress, gain higher trust, and move the NPS score from 61.8 to 68.3.

The hard part wasn’t getting the initial set-up. It was keeping it. 

“The toughest part isn’t the jump, it’s holding it,” adds Brad Giafaglione, Director of Experience and Operations. 

When the organizational focus temporarily shifted to discharge standardization, rounding gains dipped, serving as an honest reminder that human-centered change only lasts when it’s woven into daily workflow, governance, and recognition.

What follows is the day-to-day core of UCI’s approach, developed by frontline voices, supported by executive sponsorship, and designed to scale.

Key takeaways 

• Make communication the operating system. UCI Health addressed variability with a rounding playbook, “I am OMW,” so teams align in the room on one plan, one voice, clear owners, and a same-day close-the-loop.
• Simple standards, built with the frontline. Coverage rules (charge/breaker nurse joins if primary is busy), room placards, and quick Epic Chat cues keep rounds moving without new roles or scripts.
• Measure what matters daily. Nurses document rounds in the Epic flowsheet; a Power BI dashboard displays unit/service performance alongside PX KPIs, keeping rounding in sync with throughput and safety.
• Results followed, and stayed with reinforcement. In four months, key experience drivers (Nurse/Provider Listen & Explain, Trust) improved, and NPS rose from 61.8 to 68.3. When focus shifted, consistency decreased, proof that governance, recognition, and local champions are essential to sustain gains.
• Throughput and experience can rise together. Bedside alignment reduced paging and rework, supporting earlier discharge planning and helping weekly discharges increase from ~420 to ~500, while advancing HCAHPS communication composites, recommending the Hospital, and achieving a four-star rating in patient experience and quality performance.

Before UCI Health redesigned rounding, the story was evident on the units themselves. 

Patients didn’t always hear one unified plan, and nurses and providers didn’t always connect at the bedside in time to align on the day’s priorities. 

Justin Wang was honest, “There wasn’t really a standardized method of bedside rounding, and that’s where we focused.”

In Towers 3–5, variation appeared in predictable ways: rotating teams, shifting acuity, and competing demands (admissions, procedures, discharges) made it easy for each service to round differently or skip the connection altogether. 

Without a shared, easy sequence for how nurse–physician rounding should work, nurses often gathered plan details after the fact. 

That led patients to feel uncertainty about what would happen that day and what needed to be true for discharge.

Leaders could see the signal in unit performance, but frontline teams felt the friction at the bedside: too much variability, not enough shared rhythm. 

That’s the gap UCI Health set out to close. UCI Health started with a standard definition of what a round is, who’s included, and how information should flow so patients can hear one plan in one voice.

UCI Health answered variability with a shared playbook that teams could run under pressure. They named it “I am OMW” (“I’m on my way”). No scripts or new roles, just a reliable sequence that makes the plan visible, ownership assigned, and follow-through predictable.

Meet “I am OMW” (“I’m on my way”)

When the physician team arrives on the unit, they announce where they’re headed, stopping briefly at the nurse station, sending a quick Epic Chat, or alerting the charge nurse. 

That single cue prompts coverage, allowing the bedside nurse (or a breaker/charge) to join without scrambling.

With the right people present, the team aligns in minutes:

• One plan, one voice. Summarize the last 24 hours, define what matters today, and name the barriers that must clear for a safe discharge.
• Who does what, by when. Assign owners for the day’s key tasks and confirm timing.
• Close the loop. Agree on how updates will flow (Epic Chat or a brief page) and by what time that day, often set as a firm checkpoint (e.g., by 3:00 p.m.), so patients aren’t left waiting.
  

The power of OMW is its predictability. 

Patients hear a unified plan in the room. Nurses leave with the next steps. Providers reduce back-and-forth paging. And leaders get a repeatable pattern they can coach and scale across units.

From September through December, the Towers pilot implemented measures that mattered to patients, including Nurse Listen, Nurse Explain, Provider Listen, and Trust in Provider, all of which showed an increase. 

And the cohort’s Net Promoter Score rose by 6.5 points. 

Teams also reported fewer after-the-fact pages and cleaner handoffs at the bedside.

Then reality set in: when attention shifted to discharge work, rounding consistency declined. 

During that same period, UCI’s broader discharge effort increased weekly discharges from ~420 to ~500, a significant operational win that underscored a second truth: competing priorities can erode consistency without reinforcement.

UCI Health protected the gains by hardwiring ownership and clarity. 

A CMO/CNE–led steering group, sponsored by Dr. Carmichael, CMO, and Anne Marie Watkins, CNE, set a hospital-wide definition of “a round,” accounted for differences between medicine and surgical/step-down services, and made performance visible every day. 

Nurses document bedside rounds in the Epic flowsheet, which is then used to create a daily Power BI view by unit and service line.

Giafaglione noted that it’s “on the daily dashboard, leaders can see rounds and PX scores together,” which keeps rounding in the same operating rhythm as throughput and safety.

Rather than compete with progression work, OMW rounds are plugged directly into the “2.0” discharge playbook: earlier planning in the room, task ownership, and defined follow-up windows. 

Change stuck because the people doing the work shaped it. 

Charge nurses, medical directors, and residency leads acted as local champions, troubleshooting barriers on the spot. 

Same-day micro-recognition was happening with “golden ticket” $5 gift cards for positive bedside communication. 

And, practical coverage rules ensured the round still took place: if the primary RN was tied up, a charge or breaker nurse stepped in. 

Units also added small room placards to show the responsible nurse, so teams knew whom to page or tag in Epic Chat.

Wang summed up the approach: they “empowered local champions, and the positives overtook the negatives.”

How do you standardize nurse–physician rounding?

Define what counts as a round and who’s included. Use a sequence: inform the unit on arrival, align in the room on one plan, one voice, and set a 3 p.m. close-the-loop if a live round doesn’t occur.

What if the nurse can’t join?

Coverage rules apply: a charge or breaker nurse joins. Units use room placards to identify the responsible nurse, and teams coordinate via Epic Chat.

How do you track rounds?

Nurses document bedside rounds in the Epic flowsheet; that data flows to a daily Power BI dashboard showing unit and service-line performance alongside experience KPIs.

Does rounding slow throughput?

No. Aligning the plan in the room reduces the number of pages and rework, and supports earlier discharge planning. During the discharge push, the number of weekly discharges increased from ~420 to ~500.

UCI Health is scaling the model with agreed-upon expectations and modern tools. 

The system goal is to achieve 75% documented rounds per unit, tracked daily with service-line drill-downs, so leaders can coach where it matters. 

Two templates, one for hospital medicine and one for surgical/step-down, share standard operational definitions, a brief for house staff, and a charge nurse alert script. 

When a live round can’t happen, the closed-loop rule kicks in: by 3:00 p.m., nursing requests a plan update in Epic, while urgent issues still prompt a call. 

Justin Wang shares, “If rounds don’t happen, we still close the loop, patients get the plan.”

The payoff extends beyond patient experience drivers. 

By embedding rounding in daily management, UCI Health strengthened HCAHPS communication composites and Recommend the Hospital, contributing to system milestones such as 90th-percentile Recommend performance and four-star ratings for both patient experience and quality. 

Brad Giafaglione’s bottom line: “We’re now a four-star PX hospital and aiming higher.”

Leaders agree on what they’d repeat and what they’d avoid. They would co-design with the frontline, steer through CMO/CNE governance, and tie rounding to throughput so that it becomes part of how care is delivered. 

They would skip over-engineering scripts and chasing resisters; as Wang noted, it’s better to “focus on the supporters, momentum beats debating the few who aren’t ready.”