Over the past decade, health care leadership rounding has become a best-practice staple for organizations that are striving to improve patient experience, employee engagement and the overall culture of performance. While in healthcare we sometimes act like we invented the practice, it has been pursued in different forms for many years in other industries. If you are a disciple of Lean Manufacturing and the Toyota Production System, you call it “going to the gemba.” Bill Hewlett and Dave Packard coined the term “management by walking around” in the 1960s when their rapidly-expanding technology company was growing beyond their capacity and ability to be involved in every detail of the business.
In health care, our name for the practice of going to where the most important work occurs and where value is created is borrowed from academic medicine. On the Johns Hopkins Medicine website today, you’ll find the following:
“The tradition of Medical Grand Rounds at Johns Hopkins can be traced back to William Osler, the first professor of medicine, beginning in 1889. The objective is to demonstrate the best in the analysis and treatment of difficult clinical problems in real-life patients who often tell their own story. The patient remains our link between current research and modern therapeutics.”
When thinking about how to make leadership rounding most effective, we can learn much from the wisdom of Toyota, Hewlett & Packard and Dr. Osler. They each appreciated the most powerful purpose of rounding is to learn and to increase our understanding of both what is working well in the business and where we have opportunities for improvement.
Too often, we see leaders confuse rounding with operational audits. In well-intentioned efforts to make rounding “purposeful,” they go to their gemba – the bedside – equipped with a detailed list of questions to pose and issues to inspect. When rounding is approached in this way, I’ve heard frontline staff in more than one organization remark, “It feels like they’re only here because they don’t trust us.” Obviously, that’s not the perception that we want leadership rounding to leave.
Following are five mistakes I’ve seen organizations make that are sure-fire ways to debase leadership rounding and diminish its effectiveness in the provider setting:
1. Approaching rounding as an interrogation instead of a conversation
Whether the conversation is with a staff member or a patient, if rounding is driven by pre-determined, scripted questions, it is seldom as beneficial as a real conversation about important issues. For the leader, rounding becomes an exercise in checklist compliance. And for the interviewee, rounding feels like an interrogation rather than a meaningful dialogue where the leader is more interested in their ideas than checking off boxes.
2. Asking “How are we doing?” rather than “How are you doing?”
Several years ago I was a keynote speaker at organization-wide quality conferences conducted by Universal Health Services across their large acute hospital network. I had the opportunity not only to present but to learn from some of the great work happening in UHS hospitals. I’ve always remembered the presentation by the leadership team from one hospital that was working on making rounding more meaningful and effective. They said, “When we changed our approach from asking, ‘How are we doing?’ to starting with ‘How are you (the patient) doing,’ it completely changed the nature of the conversation and what we learned.” By not probing intrusively about how well the care team was delivering on specific practices, the executives said the experience was much more beneficial to the patient. And they actually learned more because they gained patients’ trust and confidence.
3. Using rounding as quantitative instead of qualitative research
Some organizations try to track, chart and graph discrete responses to multiple choice or yes-no questions captured during rounding. The information captured during rounding can be insightful, but it is not reliably quantitative for two important reasons: the interviews are not completely random, and research proves that patients are reluctant to be candid while they are still in our care. Use the statistically valid results from Press Ganey or other patient experience surveys to quantitatively measure patients’ experience. Use rounding to provide qualitative insights behind the numbers and to identify real-time opportunities to address concerns or issues expressed by patients during their stay.
4. Failing to follow up on what we learn from patients and staff
If we are not disciplined about following up with staff and patients on the issues we learn about during rounding, credibility suffers. Recently I was completing as assessment in a health system that had just initiated leader rounding on staff. Their model was to send managers to departments for which they did not have direct responsibility in an effort to increase understanding of issues across the leadership team. One of the questions on their pre-determined survey was, “Do you have the tools you need to do your job.” One of the managers we spoke with admitted how uncomfortable she felt when she asked a nurse that question during rounds. The nurse tersely replied, “No, we don’t have access to the pulse oximeters we need to take care of the number of patients we have on our floor — just like I told the person who was rounding two weeks ago and asked me that same question!” If we can’t or don’t respond to the issues identified during rounding, we shouldn’t ask the question.
5. Expect “drive-by” rounds to make a difference
Increasing leadership visibility is one of the important goals of rounding on both patients and staff. But staff tell us that walking through a unit and casually saying, “How’s everybody doing today?” simply doesn’t count. We’ve labeled that practice “Drive-By Rounding,” and its benefit is questionable. Most staff say that if you can’t take time to talk, please stay in your office.
Healthcare leadership rounding done in a thoughtful, meaningful way can be powerful strategy to improve both patient and employee engagement. Done wrong, it can undermine the trust and confidence that is so essential in building a strong, high-performance culture.
Stamp & Chase offers unexpected solutions to universal challenges facing leading healthcare organizations. To learn more about our robust tools and approaches that help healthcare leaders transform patient and staff engagement, visit Stamp & Chase.
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