For years, hospital leaders have been leaving their offices and hitting the hallways to try to improve patient safety. But despite the prevalence of executive rounding programs, consensus on best practices is hard to come by and studies on their effectiveness are scarce.
Researchers are trying to fill those gaps, and they’ve already identified a few keys to success, including making sure all members of the C-suite participate.
Especially critical is closing the feedback loop so clinicians who raise safety concerns are kept informed of how the hospital is addressing those issues. A recent study of executive rounding programs in 44 neonatal intensive care units found that higher levels of feedback by hospital leaders were associated with stronger safety and teamwork environments, better staff perceptions of safety in their hospitals, and lower burnout among clinicians, according to the analysis, published in the May issue of the British Medical Journal of Quality & Safety.
“Anything that you do that is a one-way street is going to be less effective,” says Jochen Profit, M.D., a lead author of the study and assistant professor of pediatrics at Stanford University’s Lucille Packard Children’s Hospital. “When front-line providers share their experiences with executives, that already requires a fair amount of trust. And then if they feel that whatever they voice goes into a giant void, even though people are working on making things better, it doesn’t provide them with the satisfaction they might derive if they actually get specific feedback about the points they raised.”
The Joint Commission has worked to try to perfect the art of executive rounding through its hospital engagement network. It’s found that, in addition to providing feedback, celebrating savings and improvement in quality of care, rather than solely focusing on the negatives, is important to any rounding effort, says Deborah Nadzam, R.N., project director of the Joint Commission Resources Partnership for Patients HEN.
Consistency also is critical. All members of the C-suite should participate in the program, she says, and rounds should take place at least once a week for a minimum of one year.
“It has to be continuous and not let up because when you tell the staff the purpose and it breaks down, that doesn’t foster trust,” Nadzam says. “And, it’s trust that is eventually going to make staff feel comfortable opening up about what they think is unsafe.”
Harrisburg (Ill.) Medical Center, one of the Joint Commission HEN participants, uses two different types of executive rounds. The first is patient-focused, with one of the four C-suite leaders taking a week each month to visit newly admitted patients to ask them about the quality of their care.
In the other approach, hospital leaders gather each day to visit staff at several project management white boards, like those used through Lean methods, scattered throughout the hospital. Already, in about eight months of their use, the boards have helped Harrisburg to eliminate about $1 million worth of waste, says President and CEO Rodney Smith.
The efforts have produced results because they’re front-line-driven, and continuous. “It’s about constant improvement because you never get to the end. It’s a journey; you just get better and better and better, hopefully,” Smith says. “I don’t think you should just go through the motions and do it because it’s something on your checklist to get done for the day. This is valuable time spent — more valuable than any conference you would ever attend.”