Clinical executives have long been urged to “go to the gemba,” the Lean principle of going to the place where the work happens. Becker’s asked 10 health system leaders what executives should do, and avoid, once they get there.
Leaders said small habits, like carrying a clipboard or talking over the nurses’ station, can make executive rounding feel like an inspection instead of support. They also focused on the how, such as where to sit, when to show up, what to carry and what to do with what they hear.
Editor’s note: Responses have been lightly edited for clarity.
The do’s
Do: Ask patients about exceptional employees
Five leaders at Richmond, Va.-based VCU Health told Becker’s in a shared statement that recognition should anchor every round, and that patients are the best source for who has earned it.
“The last question I ask every patient is who has gone above and beyond to provide excellent care,” VCU leaders said. “It is rare that at least one team member isn’t mentioned. Being able to go to that person on the spot and share my gratitude, as well as the patient’s, is invaluable.”
The VCU leaders include Heather Masters, MD, chief medical officer of VCU Medical Center and associate dean for clinical activities for VCU School of Medicine; Lisa York, senior director of patient experience for VCU Health System; Nathan Cunningham, associate vice president of patient experience for VCU Health System; Elizabeth Mikula, MSN, RN, vice president of regulatory affairs, risk management and patient centered services for VCU Health System; and Jeniece Roane, PhD, RN, COO of VCU Medical Center.
Do: Come with a specific question
Aalok Agarwala, MD, CMO of Aurora, Colo.-based University of Colorado Hospital, said executives should arrive with one specific question, ask it and then listen to the full answer.
“Rather than asking, ‘How’s it going?’, ask, ‘What was challenging about the last shift?’ or ‘What got in the way of providing the care you wanted to deliver?'” Dr. Agarwala said.
Do: Commit to sit
At Tacoma, Wash.-based MultiCare Health System, leaders coach teams, including physicians and nurses, to sit down and talk with patients and families at eye level whenever possible, said Caren Lewis, BSN, RN, senior vice president and system chief nursing executive. Leaders are encouraged to do the same.
“You have a tight window in time to make a connection and non-verbals support verbals in creating presence,” Ms. Lewis said.
Do: Learn one thing beyond the job title
“Make at least one meaningful connection every time you round,” said John Bowles, PhD, RN, vice president and chief nursing officer of HonorHealth Deer Valley Medical Center in Phoenix. “Learn something about the person beyond their role, their interests, family, aspirations or hobbies, because those connections build trust and give you something authentic to reconnect around the next time you see them.”
Lauren Smith, MSN, RN, regional vice president of operations and regional CNO of Boise, Idaho-based St. Alphonsus Health System, said leaders should greet every colleague they pass. They shouldn’t be afraid to ask for a reminder of someone’s name or role.
“The important thing is to be personable and approachable,” Ms. Smith said.
Do: Show up without an agenda
“Build trust by visiting often without ‘purpose,'” Ms. Smith said. “Get to know the teams, and you will build a trusting relationship. If you only show up to ‘audit/inspect’ or when something bad has happened, the frontline teams will not trust their senior leader teams.”
Dr. Bowles said that when time unexpectedly opens on his calendar, he often uses it to visit a department and ask what’s working and what’s getting in the way.
The payoff can come quickly. VCU leaders said that after a couple of weeks of rounding on a unit and building relationships, nurse managers and advanced practice providers start stopping them at the door to ask for help.
“That’s when I know we are making a difference,” VCU leaders said. “I’m another person in their corner.”
Do: Close the loop, even when the answer is no
Dr. Agarwala said he documents concerns right after rounding, identifies who owns each one and reports back to the people who raised them.
“In my experience, a clear explanation builds more trust than a vague promise that something is being looked into,” he said.
Leaders don’t agree on taking notes in the moment. Ms. Smith almost always rounds with a pad of sticky notes and a pen. Back at her desk, she emails the people who can fix the problem. For bigger issues, she follows up with a handwritten thank-you card.
Meredith Foxx, MSN, senior vice president and CNO of Cleveland Clinic, said credibility depends on follow-through.
“People may not always get the answer they want, but they deserve to know their voice mattered and that someone listened,” Ms. Foxx said.
The don’ts
Don’t: Make rounding feel like an inspection
“The moment people believe you are there to evaluate them rather than understand and support them, you change what they are willing to tell you, and you lose the very insight that makes executive rounding valuable,” Dr. Bowles said.
Early in his executive career, Dr. Bowles rounded to check whether work was being done the way leaders expected. Now, he asks why the work is hard to do correctly in the first place, whether the cause is process, tools, staffing, communication or competing priorities.
Dr. Agarwala rounds without a clipboard or an entourage.
“Not having the clipboard means that my eyes and attention are fully on the person or group I’m with. I’m not distracted in the moment, worried about what I’m writing down,” he said. “It also feels less like an inspection and more like a conversation.”
Don’t: Go around unit leaders
Dr. Agarwala said executives shouldn’t bypass the unit’s own leaders to fix a problem they hear about on rounds.
“It may feel good to make a call and get something fixed immediately, but involving the medical director or charge nurse builds the unit’s ability to solve problems and avoids creating the expectation that every issue requires executive escalation,” he said.
He also schedules rounds around the unit leader’s calendar instead of his own. That means avoiding multidisciplinary rounds, shift changes and other busy periods. Once, he arrived at an ICU during two patient emergencies. He stayed to watch the team respond and came back another day to talk with its leaders.
Don’t: Do a drive-by at the nurses’ station
“Don’t ’round’ on your inpatient nursing teams by doing a ‘drive by’ at the desk and speaking over the desk at them,” Ms. Lewis said. “Walk around the desk and have a seat.”
Once there, she said, executives may find a chance to pitch in, even by answering the unit phone, which can open a conversation with staff and a chance to “be human.”
Don’t: Get defensive or make excuses
“When someone shares a challenge, they are trusting you with their experience. If we immediately justify why something is happening, we miss the opportunity to learn,” Ms. Foxx said.
VCU leaders said the same applies to patients and families.
“We can help explain processes but, in most cases, patients just want us to listen, empathize, and explain how we will address the situation,” they said.
Don’t: Dodge the hard topics
Ms. Smith said executives shouldn’t make promises they can’t keep or avoid units where they know they’ll be challenged.
“Don’t ignore a concern or run from tough questions,” she said. “Colleagues are looking for both integrity and authenticity from their executive leaders.”
Ms. Lewis brings up the hardest topic first.
“I ask how staffing is going first,” she said. “Everyone thinks I will avoid it, so I intentionally ‘go there’ and it leads to a more credible discussion.”
