Has there ever been a single management practice that has promised to solve more problems than rounding? Especially in the realm of patient and employee experience, leadership teams often turn to various interpretations of rounding as the silver bullet to turn around lagging staff engagement or CAHPS scores. More often than not, they are disappointed.
So, is leadership rounding an ineffective strategy? Hardly. But like so many management principles, the magic is in the why and how we implement the practice.
Rounding has been tagged with many different monikers, including LEAN’s “Gemba walk” and Hewlett & Packard’s “management by walking around.” But more important than what we call the practice, all successful leadership rounding approaches have one thing in common: they are about making real connections with frontline staff and customers. Insights from these connections can be leveraged to identify opportunities for enhancing both performance and the work environment.
Check in on staff, not up on staff
Credit for this wonderful philosophy – and the clever phrase that captures its essence – goes to my friend Lanie Ward, the retired chief nursing officer from Summa Health in Akron, OH. Lanie understood that the real power in senior leadership rounding with staff was in making meaningful connections with employees, not in evaluating their performance. (That is better left to their direct supervisor.)
When senior leaders get too far into the weeds and probe on specific operational practices, we usually hear a troubling reaction from frontline staff: “It feels like they’re only here because they don’t trust us.” Ouch. Obviously, that’s not the impact we want increased leadership visibility to achieve.
“How are you doing?” vs. “How are we doing?”
Several years ago, I had the privilege of being the keynote speaker for a series of quality forums held by a major national health system for their leadership teams. Individual hospital teams made mini presentations or shared PI posters prior to my keynote, so I benefited from hearing about their experiences in addition to sharing my ideas on improving engagement.
I still remember the executive team that shared insights on making leadership rounding on patients more powerful. Their initial efforts started with questions posed to patients and family members about staff practices and behaviors, including hourly rounding, cleanliness, quietness, etc. They immediately ran up against patients’ hesitance to open up. Research from many industries tells us that customers are usually reluctant to talk about concerns while they are still with us. Why? Because they find it intimidating and are concerned about the potential for retaliation in some way.
This executive team found their conversations changed dramatically when they started by asking patients how they were doing rather than focusing on staff performance. When leaders develop a higherlevel of trust and rapport, a question like, “Is there anything that could have been better or that we should change?” often elicited more candid responses.
Conversation, not interrogation
While well intentioned and designed to make rounding more “purposeful,” interactions that are based on a checklist of standard questions are rarely well-received by staff or our customer/patients. We might be able to check off the boxes on our prescribed script, but staff rarely see these types of encounters as sincere, meaningful conversations with leaders that help build trust and relationships.
Poor follow up wipes out potential benefits of rounding
A few years ago, we were working with a hospital that required leaders to use a prescribed list of standard questions when all directors conducted rounds throughout the facility. One of those well-intentioned questions — “Do you have everything you need to do your job?” – prompted an immediate response from staff regarding the lack of pulse oximeters on the floors. Directors noted the answer in the required form. Check!
Two weeks later, another director rounding in the same area asked the same question and got the same response. By the third round of standardized rounding, frustrated staff answered, “No! We don’t have enough pulse oximeters … just like we’ve told you people multiple times.”
If you can’t or don’t respond to staff’s questions and requests, you’re better off not asking in the first place. Maybe more pulse oximeters weren’t in the budget immediately at that institution, but staff deserved an answer that would explore how the team was going to address their concerns.
Rounding to Achieve Higher Purpose
When leadership teams focus more on the needs of customers/patients and team members, very encouraging things happen. This creates and reinforces a positive, performance-oriented culture. While the ultimate goal is to collectively improve results and success for the organization, approaching rounding in a way that starts with meaningful engagement is the most powerful, sustainable way to get there.