4 Keys to Effective Administrative Rounding

Alexander the Great was famous for riding his horse among his ranks of soldiers before combat, calling out individuals by name and exalting their bravery in prior battles. He connected with individuals and inspired his army as a whole when he rode into battle with them. Hospital administrators can learn much from this leadership style. Though it is advisable to leave the horse at home, administrative rounding has become a key to successful management over the years. Tom Peters coined the term "Management By Walking Around" in the late 1970s. The Japanese know it as taking the "Gemba Walk," and Quint Studer is famous for his "Rounding for Outcomes." No matter what it is called though, the same core principles of hospital rounding remain steadfast.

1. Commitment.

"Unless commitment is made, there are only promises and hopes … but no plans." — Peter Drucker, management consultant and author

Get out of your office! Physically maneuvering the corridors of your organization and interacting with staff seems obvious but is not executed often enough. Rounding needs to be performed at least once a day, preferably twice. Leaving openings in your schedule permits flexibility and ensures the opportunity to round. Too much time is spent hidden away in meetings rather than out on the floor. Any opportunity to be more visible within your organization should be utilized. Eating in the lunchroom, for example, is preferable to having lunch in your office or going out to a restaurant. It provides a chance to develop rapport with co-workers and glean insight from casual conversation.

Attempting to bridge the divide between administration and clinicians is not an easy task, but it is indispensable to quality leadership. Employees want leaders who share the same goals and are willing to struggle alongside them to achieve success. Committing to rounding as a daily necessity is a crucial first step in better connecting with your organization.

2. Observation.

"You can observe a lot just by watching." — Yogi Berra, legendary baseball player and manager

Despite its comical undertones, this quote retains an element of insight. Rounding provides a platform from which to view daily operations and learn from these observations. Merely going through the motions during rounding is not enough; focused awareness of your surroundings is required for successful outcomes. Dutiful observation often leads to identification of opportunities for improvement. The following are a list of approaches to keep in mind when observing:

•    Learn to view the hospital from the patient's perspective. Something as simple as outdated lighting fixtures can affect the perception of an entire organization.

•    Visit patients. Speaking directly with patients can provide an understanding of what is working well and issues that need to be addressed. (Be careful to stay within administrative jurisdiction and not encroach upon the clinical boundaries of the patients' physicians.)

•    Watch how work is actually performed. There is a large divide between comprehending a process on paper and understanding it in reality.

•    Celebrate jobs well done. Whether directly observed or informed by supervisor, publicly acknowledging exceptional deeds can improve the work environment.

•    Correct observed problems on the spot. Failure to do so validates the action as acceptable but be sure to respect the chain of command.

•    After rounding, create a specific action plan to resolve any issues observed. Diligent note taking will facilitate this process.

3. Approachability.

"You need to create a safe environment for people to speak up or you're not going to know what's going on." — Alan Mulally, CEO of Ford Motor Company

Being approachable is key to gathering information held by those on the front line. The ability to break down communication barriers will in part determine the overall success of rounding. This process begins with self-awareness. When walking through your organization, you are constantly communicating without ever saying a word. Body language and demeanor can have a large impact on how you are perceived. The following are a list of tips that may prove helpful:

•    Take a few minutes before rounding to get in the right state of mind. Stressful days may be common, but try to put the rest of your day aside when beginning rounding.

•    Try not to appear too stern! Smile. Your presence may make employees uneasy and have a negative effect if performed in a rigid manner. Do not to give the impression you are grading people when recording observations.

•    Be genuine. Poor acting is easy to spot. Simply being yourself is the best way to go.

•    Avoid the use of your cell phone or other personal electronic devices unless it is absolutely necessary. Your email can wait. Others will notice if you are rounding simply to be seen, rather than to be engaged and produce results.

4. Building Trust.

"Rounding has been the key to my success as CEO. How can executives understand the needs of patients, physicians and nurses without interacting with them on a daily basis? When I walk through the hospital, it is a great opportunity to gather information and build trust by listening and responding to concerns. Rounding takes me beyond the paper dashboard so I can get a true pulse on the health of the organization."  — Mike Sherrod, CEO of Coliseum Northside Hospital, Macon, Ga.

Developing relationships with key stakeholders in the organization must be a primary focus of senior leadership. Rounding provides an opportunity for administrators to engage physicians and nurses and build trust. Showing you are committed to providing patients with the best care possible is crucial. Clinicians want to know you are on the same team.

The following are some specific ways to help build trust while rounding:

•    Ask open-ended questions. They refrain from limiting the potential responses and open the door to candid dialogue.

•    Listening to concerns and acting on them is critical. Ensure prompt follow-up as well, either in person or via email, to explain how their concern has been resolved or is being addressed.

•    Be careful not to make promises that cannot be kept, for you will be held accountable to these claims. While it is difficult to gain trust, it is very easy to lose it.

•    Round on nights, weekends and holidays. Show that you understand the commitment hospital workers make and thank them for it.

•    Scrub up for the OR and observe a surgery. Make sure to get permission first, to ensure your presence will not create any problems.

•    Visit physicians in their offices. Taking the time to travel to them demonstrates your dedication to physicians.

Connecting clinicians to upper level management through personal interaction is paramount in aligning an organization's goals with daily operations. Visibility and approachability are essential to this connection. Being readily available through rounding opens up free-flowing, two-way communication channels, providing current organizational assessments on parameters dashboards may miss. Rounding can also build trust in administration, by demonstrating and reinforcing leadership's commitment to the same mission and values as clinicians.

Hiding away in offices and meetings only strains the rest of the organization's perception of administration and fuels distrust. Leadership better connected to the front lines offers a more integrated and united organization. Rounding provides this opportunity — and may suggest that going for a walk is exactly what the doctor ordered.

J. Stephen Lindsey, FACHE, was CEO at HCA Henrico Doctors' Hospital for 16 years. He has served as an affiliate professor in the MHA program at Virginia Commonwealth University. Mr. Lindsey is a principal of Ivy Ventures, LLC, a consulting firm that helps hospitals grow outpatient service lines. He is a fellow of the American College of Healthcare Executives. He can be reached for questions at: slindsey@ivyventures.com.

Brett Corkran holds a B.S. in Biology from Penn State University and is pursuing his MHA at Virginia Commonwealth University in Richmond, Va. Mr. Corkran has studied in Sydney, Australia, and participated in THON (the world’s largest student-run philanthropy aimed at battling childhood cancer). He has worked for the University of Pennsylvania Health System and volunteered at the Lehigh Valley Health Network cancer infusion center. He can be reached at: corkranbe@vcu.edu.

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