Administrative Rounding - The key to staying connected

Cheryl Boldt, RN, NHA

It is critical the Leadership Team Members of any Healthcare Organization develop a “habit” of rounding as a team to all Units and Departments.

This does not mean a team of 20 walks to all locations at one time. The rounding pattern calendar can be established by month or by quarter and the Leadership Team members can “divide up” who goes where, when, and with whom. Rounding patterns are customarily in sync with organizational goals and improvement projects. These goals and efforts will naturally guide some of the “teaming” assignments, determine who we interact with, and define what we seek feedback on during our rounds.

Organizational leaders typically underestimate how much it means to the front line staff on the units and in the departments to have the leaders present. You may also underestimate the impression that will be left with any patients you meet.

The rounding calendar should be coordinated throughout the year to touch all shifts in all departments.The rounding teams will find a group of 3-4 to be the most manageable. The rounding pattern is even more meaningful if you make certain you ask star performers on the unit or in the department, in advance, to join you on rounds.

The key to effective rounding is to schedule the time on your calendar in advance and protect the time as you do for any other important “meeting”.

Like any meeting, you need ground rules:

• The team members should know in advance, per the calendar of where they are rounding to.
• The team determines the amount of time to be spent on the rounds-  i.e. 30 minutes.
• A simple, focused agenda will be prepared in advance of the rounds by the team who will be rounding on the unit.
• The team members arrive on time on the unit or in the department at the designated location and we “start on time and end on time”.
• Appoint a Note Taker and a Time Keeper.
• Greet all team members  and patients who cross your path.
• If you know the staff, call them by name.
• Smile and make eye contact. Be a good listener.
• If you do not know the staff member, refer to their name tag so you are calling  them by name as you greet them.
• If staff members are not wearing their name tag, you can politely ask what their name is and what their role is.
• Compliment the staff you meet on what you notice is good and what you have been impressed with i.e. progress on an initiative they are working on.
• If you do find a problematic area, you can honestly (not in front of customers) discuss the problem area with the front line and ask for solutions or ideas on how to make certain the problem is resolved.
• Some things may be placed on a “follow up” for a leadership team member and front line staff member to update the team  on i.e. a week from now and do not fail to follow through.
• Ask front line team members to join you spontaneously if they can and it would not interfere with patient care.

Additional helpful hints:

• The areas you will round on typically are a mixture of environmental monitoring, interaction with staff and interaction with the customer.
• Take note of any “scoreboard” on the unit and do not hesitate to involve the front line in a discussion about what it means.
• Your demeanor must be friendly, courteous and engaging, not authoritative.
• Many leaders will indicate they do not have the time to do rounds. We consistently find the opposite to be true. You have to make the time to do rounds or risk losing touch with those we serve and those we lead.
• At your weekly leadership team meetings, it is important to share lessons learned this week on rounds, what is the “buzz” and any action that was triggered as a result of the rounding effort.

Other helpful relationship building efforts include:

• “Lunch with Leaders”  for front line employees (AKA Tuna with the big  Kahuna).
• Weekly Scoreboard celebrations on units with special appearances by Organizational Leaders.
• Handwritten notes or e-mails giving positive comments in follow up to rounds, interactions, or upon hitting targeted goals. This can be to individuals or teams.
• It is more fun to catch people doing things right, than focusing on what is wrong.
• Do not hesitate to give immediate feedback when you notice something good, in front of others.
• Do not “walk by” something that is not right, it will send a message that it is OK.
• If you need to speak with someone about something negative, do not do it in front of the customer.
• Do not forget that it is meaningful to an employee or customer to have the opportunity to interact positively with someone who they perceive as “in charge”.
• “Pilot” rounding and debrief on what worked or did not work until you refine the process.