Leader rounding on patients: What leaders should ‘know’ before they ‘go’

Last month, I wrote an article on 7 reasons why you should stop leader rounding on patients.  Although there is a vast amount of studies and evidenced based articles citing the benefits of leader rounding on patients, I wanted to bring awareness to the importance of training and educating leaders on how to conduct a patient round, before they enter patient rooms.  Whether it is the CEO, a director, manager or interim leader, we should not assume people with a leadership title are experts on how to conduct leader rounding on patients.  From displaying empathy to understanding infection control practices, there should never be a shortage of education and training to anyone working in healthcare on such vital topics.   To summarize my previous article, the 7 reasons why I encouraged leaders to stop leader rounding on patients and get training was if they were guilty of:

 

1. Entering a patient’s room without knocking / asking permission
2. Holding only a one-way conversation
3. Overlooking service recovery opportunities
4. Not washing their hands when entering or existing patient rooms
5. Neglecting to ask the nurse about the patient’s condition or any extenuating circumstances
6. Not using past and current data to better understand the ‘voice of the patient’
7. Overlooking opportunties for feedback from a peer / colleague on their ‘leader rounding on patient’ style

 

Patient experience training and education

Regardless of title, healthcare leaders benefit from patient experience training and education.  This includes how to conduct leader rounds on patients.  Since many leaders are typically placed into leadership roles without patient experience related training or education, they often learn by trial and error. This is unfair and unsafe for the leader and for our patients. Leaders need education on patient rounding basics before they start their leader rounding on patients initiative. Click To Tweet

 

For example, I recently observed a department leader rounding on patients session for a busy maternal-infant unit.  The department leader rounding session included the nurse director of the unit as well as leaders from EVS and Food and Nutrition.  I stood outside the patient room and observed and listened as the leadership team entered a patient room.  The leaders gave a soft knock upon entering the patient room and they did a good job introducing themselves.  Upon entering, the baby was crying, and the mother appeared very unsettled.  The mother apologized for the baby’s cry and commented several times that it was feeding time.  Instead of the leaders taking that cue to step out, they continued with their leader rounding.  The whole rounding session was rushed and awkward.  As soon as the leaders turned to exit, the mother comforted the baby the moment she put the baby to breast.

Leader rounding on patient expectations

If this was you in the aforementioned scenario, would you have completed the round or asked if you should come back at a later time?   Before you answer that, does your organization set an expectation that you (the leader) complete X% of rounds on all new admissions or discharges each week / month?  Do you ever feel pressured with achieving a certain number of leader rounds on patients? Do you have the flexibility to focus on the quality not the quantity of the round?  While the concept of leader rounding on patients has good intent and the potential to improve outcomes, it is often blurred from an organizational expectation and a patient perspective. When learning opportunities are needed, here’s what needs to happen:

5 Tips to optimize your leader rounding on patients initiative

 

1. Assess and discuss organizational rounding expectations.

1. Is the organization set on leaders meeting a certain number of rounds?
   1. Is it achievable?
   2. Feasible?
   3. Is the rounding expectations keeping the patient’s best interest at hand?
2. Empathize
   1. Put yourself in the patient’s shoes.
   2. Empathize with what they see; what they may feel or think.
   3. Assess the patient and the environment. For example, if the smell of vomit was emitting from the bathroom, ask yourself if you’d be comfortable talking to leadership if you were the patient.

 

2. Show and tell.

1. Mystery rounds.
   1. In mystery rounds, leaders listen from afar on other colleagues leader rounding on patients. This allows leaders to be natural when talking with patients because it mitigates the awkwardness and stress of knowing someone else is listening from the door.  It is important to conduct random check-in’s (not check-on). In other words, this is not about telling colleagues what they are doing wrong, but to focus on what they are doing right.  Obviously, any patient safety issue would be addressed, yet the point is to learn from others.  This should be part of the organization’s process improvement initiative and used as positive motivation.
2. Buddy Rounding.
   1. In Buddy rounding, a nurse leader is paired with a support or executive leader.  Both leaders spend time talking with staff, patients and families in a collaborative approach.
3. Observation Rounds.
   1. According to AHRQ, “Communication among disciplines can be improved if viewed through the eyes of an objective observer”. This type of rounding is different than mystery rounding since mystery rounding is not scheduled or known to the rounder.  Observation rounds are when the rounder knows their round is being observed by another colleague for feedback.

 

3. Crystalize the purpose of rounding

1. Provide training on the importance of rounding and making connections with patients
2. Assess how often staff and leaders apply service recovery (vs ignoring issues).
   1. Use a blameless apology. It’s not about ‘who did it wrong’,  it is about making it right for the patient.  Don’t blame others.  Apologize that the patient experienced the situation or feels upset.
3. Provide rewards and recognition.
   1. Recognize great behaviors and don’t underestimate the power of saying ‘thank you’ to colleagues
4. Turn the rounding question interrogation into a meaningful conversation.
   1. Unless your organization has clear understanding of what to do with a 4 versus a 3 (when using a likert scale), ditch the number and focus on the quality.
   2. For reporting purposes, use a drill down of common responses and either pick one of these (grow them as needed) or use open text.

 

4. Learn Body Language Basics

1. Use open body gestures
   1. Keep a relaxed posture whether you are sitting or standing.  Keep your back straight but not stiff and let those shoulders relax.  This will reinforce the idea that you feel comfortable with your surroundings.
2. Don’t use closed body gestures
   1. Use caution when entering a patients room with your arms crossed in front of you. Although you may just be cold, you can give an immediate first impression that you are defensive.

 

5. Take infection control seriously.

1. Spend time with your infection control (IC) department
   1. Learn how to protect yourself and others from bugs, viruses and bacteria
   2. Invite IC to buddy round, mystery shop or even participate in an observation round. This is especially helpful when rounding on patients in isolation.

 

In conclusion, when leaders are educated and trained on how to conduct patient rounding, patient and family experiences improve, employee and physician engagement increase, and clinical quality indicators are enriched.  Leader rounds also help the executive team to understand caregiver concerns, support additional resources that are needed, remove roadblocks, and solve problems.  So, before you ‘go’ up to patient floors, please take a moment to ‘know’ how to optimize your leader rounding on patients for improved patient experiences and for safety.