In the healthcare sector, leader rounding on patients is considered to be a patient experience best practice initiative. Studies support this is one of the most effective ways to improve HCAHPS scores. Leader rounding on patients embeds a patient-centered culture across the organization, increases employee morale, advances patient safety outcomes, and increases productivity and financial results. With so many benefits identified, you may be wondering why I am suggesting that healthcare leaders stop leader rounding on patients.
As a patient experience consultant, I am fortunate to work alongside of many passionate, smart and caring leaders. I partner with leaders of organizations who do not understand why their HCAHPS scores are not improving, despite all the best practices they have in place. What I’ve learned across my travels is that it’s not the number of best practices an organization has implemented, but the quality of the best practice that has been embraced. This may seem very rudimentary, but it is not. Consequently, this is the issue, the majority of the time. The key driver to the dichotomy between quality and quantity boils down to proper patient rounding training and education.
Patient Experience Training and Education
Leaders need training and education not only to understand the ‘why’ we should round on patients, but also the ‘how’ to conduct the actual patient round. In other words, just because leaders understand the importance of patient experience best practices, such as leader rounding on patients, they may not be adept in actually conducting a round. In all fairness, who’s training and educating the leader? Sadly, many leaders are typically placed into leadership roles without the training or education needed. As a result, they learn by trial and error, which is unfair and unsafe.
I’d like to share an example of why leaders need patient experience education and training before conducting patient rounds. I participated in a department leader rounding on patients for a busy med-surg unit. The department leader rounding initiative included the nurse director of the unit as well as leaders from EVS, food and nutrition and physical therapy. I stood outside the patient room and listened to the nurse leader facilitate the patient round. The leaders gave a soft knock upon entering the patient room and they all introduced themselves. While they were all kind and professional, I sensed the rounding wasn’t well received by the patient or their family.
Maybe consider this scenario from your own perspective: you are laying in a patient bed with 4 people representing leadership standing around you. Imagine you are half naked in a gown, in pain or uncomfortable and you are asked the following questions:
- On a scale of 1-5 (5 being the best) how courteous were our nurses?
- On a scale of 1-5 (5 being the best) how would you rate the food?
- On a scale of 1-5 (5 being the best) how would you rate the cleanliness of the room?
Keep in mind, the leaders asked about 5 more similar type questions, but I think you get a good idea of how the round went. In addition, if the patient gave less than a 5, the leader asked what they could do to move score X to a 5. Also, each leader documented responses into their own mobile rounding software. Now, ask yourself, do you want a flood of questions aimed at you? Maybe you don’t see the issue with this, but let’s talk a bit about perception versus reality.
While the concept of leader rounding on patients has good intent and the potential to improve outcomes, it is often blurred from an organizational and patient perspective.
Leader Rounding on Patients
LEADER ROUNDING ON PATIENT ORGANIZATIONAL PERSPECTIVE
|Conduct multi-department leader rounds to decrease patient interruption||“There are a lot of leaders surrounding me. I’m feeling overwhelmed /afraid of retribution”|
|Ask 1-5 questions to quantify data and when patients give less than 5, find out why for improvement purposes||“I’ll just give them a 5 so they don’t continue to interrogate me if I give lower score”|
|Expand rounding beyond nursing so the patient sees our organization is committed to excellence||“I only ate once since my admission, why is the food and nutrition leader asking me all these food related questions?”|
|Enter data in real-time into rounding tool to aggregate the data||“Everyone is typing something and at different times. What are they saying about me and who will see this?”|
Arguably, patient perceptions could be different than what is written here, but the point is to put yourself in the patient’s shoes. Empathize with what they see; what they may feel. In an effort to promote empathy in organizations and to show our patients and families that we care about them, below are reasons why leaders should stop rounding on patients.
7 reasons why leaders should stop leader rounding on patients
1) Leader didn’t ask permission to round
- Didn’t provide an explanation of what the word ‘round’ is (remember, that’s in our lexicon, not theirs)
- Never asked if the patient is strong enough or feeling well enough to talk (look at their body language as well as their words)
- Walked into the patient room without knocking or asking for permission
2) Hold a one-way conversation
- Question set feels like an interrogation
- Leaders don’t make eye contact and read from a clipboard or ipad (or even memorizing questions and sound like a robot)
- Rounders are dependent on using a likert scale without ever having a real conversation
- Use questions that mirror HCAHPS questions (ie. always)
- Asks patients what it would take to move score from X to X on every question
3) The leader ‘can’t handle the truth’
- Not versed in service recovery
- Make excuses for issues in lieu of a blameless apology
- Inadvertently throws another department or team member under the bus
- Forgets to close the loop on open issues identified by the patient
- Uses closed body language gesturing
- Sees trash on floor and turns away from it
4) Infection control and handwashing is not a priority
- Leader doesn’t wash in and out of patient rooms
- Pick up patient call button to help patient but without gloves
- Removes food trays without gloves / washing hands
- Touches the door handle or lights without washing
- Leans on bed rail
- Sits on bed – ugh!
5) Leaders don’t know the patient
- Do not ask a patient who has been NPO since admission about the quality of the food.
- Omit from asking a patient who was admitted less than an hour ago about the friendliness of the EVS staff (chances are they haven’t seen them)
- Understand what the different patient room identifiers mean (Isolation precautions, droplets, etc)
- Refrain from getting the patient any food /water without checking with their nurse
- If a patient is ‘falls risk’ – know what this means in your organization. We all have a role in patient safety.
6) Your data isn’t capturing the whole story
- Using different departmental patient rounding software may mean that the tools don’t interface with each other. In other words, one department may only see a report of the other department’s round, but that is only if:
- 1) they even get to see a report
- 2) the rounding tool can even generate a report that is meaningful or actionable
7). You haven’t received leader rounding on patient feedback
- Feedback is a gift. Ask another seasoned peer (who has been trained and educated on how to round on patients) to listen in as you round on a patient. Get honest feedback. I recommend getting feedback from at least 5 rounding sessions because feel people are typically ‘stiff’ knowing someone is listening / observing them. After about 3 sessions, you’ll feel more comfortable and progressively open to feedback.
In conclusion, it is better to not conduct leader rounding on patients if any of the aforementioned is the current practice. Do not continue with a broken process. Hence, simply checking off a box that a leader round was complete causes more harm than good. After all, we all know when someone really cares or doesn’t. Leader rounding provides a great opportunity to engage with staff and patients, but like any leadership role, training and education is paramount. In the next article, I will share solutions that leaders and organizations can adopt to improve leader rounding on patients.