Purposeful rounding? Or rounding with a higher purpose?

Has there ever been a single management practice that has promised to solve more problems than rounding?

Especially in the realm of patient experience improvement, leadership teams often turn to various interpretations of rounding — including “purposeful rounding” — as the silver bullet to turn around lagging 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 and Packard’s “management by walking around.” But more important than what we call the practice, all successful, purposeful leadership rounding approaches have one thing in common. They are about effectively connecting with frontline staff and customers to learn about ways to improve 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 leadership rounding was in making meaningful connections with employees, not in evaluating performance. (Their direct supervisors are in a better position to assess their strengths and weaknesses.)

When senior leaders force rounding to be too “purposeful” and come armed with checklists of scripted questions, 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 Universal Health Services (UHS) for their leadership teams. Individual hospital teams made mini presentations or shared PI posters prior 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 a list of questions posed to patients about staff behaviors, including hourly rounding, cleanliness, etc. They immediately ran up against patients’ hesitance to open up. Research 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. With a level of trust and rapport established, a question like, “Is there anything that could have been better?” elicited more candid responses.

Rounding to Achieve Higher Purpose

When leadership teams focus more on the needs of customers/patients and team members, very positive things happen. This reinforces a positive, performance-oriented culture. Clearly, the ultimate goal is to improve results and success. Approaching rounding in a way that starts with meaningful engagement is the most powerful, sustainable way to get there.

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