In healthcare organizations, leadership rounding is an essential staple for understanding levels of quality and safety at the frontline of patient care.  Effective leadership rounds build trusting relationships and create a means for obtaining situational awareness.  Through the rounding process, leaders can gather information on patient care, engage staff in how care is delivered, and directly see patient care in action.  In this article, we will cover the key elements of leadership rounding to enhance quality and safety.

Key Elements for Effective Leadership Rounds

Leadership rounds become effective with structure, consistency, engagement, and integration into organizational committees.  Our time in the field has provided many opportunities to observe effective rounds that work for leaders in staying well-informed and up-to-date with their processes.  Implementing these key elements are important for leadership rounds to not only be informative but also meaningful in cultivating patient and staff safety.

• Structure and Consistency

  – Creating a rounding schedule that is established well in advance helps leaders to be prepared and organized. It is recommended to round at least once per week.  Appoint leaders from all areas of the organization, including clinical and nonclinical areas, for well-informed viewpoints and fresh eyes on the various operations.  You can use rounding forms from the Centers for Medicare and Medicaid Services (CMS) and the Agency for Healthcare Research and Quality (AHRQ), as noted under Resources, that can be individualized to your organization.  Even though it is important to standardize the rounding form, diversify your rounding topics to avoid complacency with rounding.  Ask your rounding leaders: What do you want to learn from your leadership rounds? Are there any areas you are concerned about that should be included?  Train participating leaders on the process of rounding including completion of the form, engagement techniques, and follow-up actions.

It is critical for leadership rounds to be embraced as an organizational priority. Occurrence and participation by leaders should be given the same priority as attending a governing board meeting. Only under dire circumstances should rounding be cancelled or postponed.  Cancelling or postponing could be viewed negatively by staff and erode relationships. Consistency in the schedule can lead to ease in speaking up and sharing concerns.  Be sure to include all areas when rounding – from outside entry into your organization, such as off-campus hospital departments or services, through patient care areas, as well as courtyards.  Cover all shifts and rotate rounding equally throughout the month so that all shifts are well-represented and acknowledged. Determine the number of staff and patients to speak with to gather an adequate number of insights.  Additionally, consider using a rounding tool to ensure similar topics are explored and to allow the capture of information for reporting purposes.

• Engagement

  – Including your staff in the rounding process, at a convenient time for staff, promotes a robust culture of safety. Asking the right questions at the right time followed by careful listening and follow-up questions creates the foundation for an environment of psychological safety.  The AHRQ (2021) notes that leadership rounds are  “. . . an effective method for leaders to hear firsthand what is going well and what issues need to be addressed within the organization.”  During a site visit, we observed an organization that posted the results of their leadership rounds.  The leaders posted the staff’s feedback with corresponding actions taken on a large bulletin board prominently placed in the main staff breakroom.  A brightly colored sign, “YOU SAID IT, WE DID IT” showcased the collaboration between leaders and staff in discussing issues and deciding together on the best or most reasonable course of action.  At a glance, it was clear that leadership rounding was meaningful and effective from the degree of engagement.  Sharing the rounding data in a transparent manner recognizes commitment, ensures accountability, and encourages involvement.

Leadership rounding is a great time to ask what is working well and what can be done to assist or to immediately respond to safety issues. For example, a staff member may point out a door that is not latching properly.  Addressing the damaged door with the Facility Director during the round reinforces quick action and the importance of speaking up.  Ask staff to round with you to hear how their working environment affects the delivery of care.  Leadership rounds have been shown to increase employee satisfaction and retention through attentive inclusion and prompt response to concerns.

Examples of rounding questions include:

• Have there been any recent incidents of patient harm?
• What could be done to prevent an incident of patient harm?
• What could leaders do to make the work you do safer for patients?
• What is working well?
• How can we make leadership rounds more effective?

Include patients when rounding and addressing their concerns on the spot. For example, inquire about safety from their perspective.  What have they noticed during their hospitalization?  Is there anything that can be addressed to increase comfort and safety?  At one behavioral health organization, we observed leaders conducting a small forum with patients on the quality of groups.  Patients had the opportunity to make suggestions and to recognize staff who went above and beyond in providing care.  The leaders immediately responded to a concern regarding the unit temperature and posted the staff recognitions. By including patients, a wider perspective of quality and safety can be gained.

• Integration

  – In order to take full advantage of rounding data, it is important to aggregate, analyze, and trend your data. For example, rounding data can be added as a line item on committee and board reports to inform and facilitate discussion on the quality and safety of patient care from a frontline perspective.  Evaluate the data to identify process improvement projects.  Is there an issue with patient monitoring that was uncovered during leadership rounds?  Are call bells and alarms being answered quickly?  Is the environment of care clean and in order? Did the staff point out an issue with a new process that needs a possible redesign?  Issues like these observations can benefit from follow-up rounding and consideration of a process improvement initiative to address the concerns.  Include staff in the design of the initiative to defer to their expertise and involvement.  Follow-up on issues through subsequent rounding.

As we consider what leadership rounding is, it is helpful to also reflect on what leadership rounds are not.  Leadership rounds are not a time for finding fault or pointing fingers, but for uncovering issues to allow for prompt implementation of solutions.  Leadership rounding content should not be too rigid in preventing the rounding form to be updated with evolving issues. Leaders must also be mindful and allow for deviation from the rounding tool to address topics that staff feel the need to discuss. Importantly, leaders should look out for rounding that becomes a task instead of a highly interactive opportunity for trust-building, discussions, and inspecting expectations in the delivery of patient care.

Summary

Leadership rounding is a critical component of any quality and safety program.  Instilling a consistent structure with high involvement of the whole organization supports a caring, transparent culture.  Through effective leadership rounds, staff can feel more comfortable and confident in voicing concerns. Issues can be detected when small and more easily addressed with metrics integrated into informative reports and improvement initiatives.

Resources

Agency for Healthcare Research and Quality (2021). QAPI Leadership Rounding Guide: https://www.ahrq.gov/nursing-home/resources/qapi-leadership-rounding.html

The Centers for Medicare and Medicaid Services (CMS) QAPI Leadership Rounding Guide: https://www.cms.gov/medicare/provider-enrollment-and-certification/qapi/downloads/qapileadershiproundingtool.pdf

To learn more about Leadership Rounding contact the Courtemanche and Associates Team at 704-573-4535 or email us at info@courtmanche-assocs.com.