by Stefani Daniels, Founder and Managing Partner
Published on May 08, 2019

Senior leadership rounds is a visible commitment of the executive team to hardwire a new cultural dimension.

During visits to several hospital over the past few years, I observed a new initiative that can only have positive consequences.  Leadership rounds seems to be gaining in popularity as hospital executives seek to transform culture and engage the staff. And from what I've seen, it's working.

I encountered a few different approaches:  One hospital exec used a weekly format in a large auditorium that was simulcast to other enterprise facilities. Every staff member was welcome and I was surprised at the large turnout. The exec team were all present and after an update on the latest 'news,' the discussion segued to patient safety and quality of care.  Comments from the audience were surprisingly candid with some very practical suggestions on how to improve both!  What was of particular interest to me was when I next attended the meeting, the exec reported back to the audience on what was done to remedy the concerns previously expressed by the staff members and what new initiatives were under way to avoid any reoccurrence.  Casual comments overheard after the meeting confirmed that the audience was impressed with the responsiveness of the C-suite with many of them acknowledging that they were aware of the changes taking place. 

Another organization held early morning meetings with department heads but what made it different from other 'department head' meetings I generally attend, was the presence of every medical leader - and this wasn't a very large hospital.  Both the medical and administrative director of radiology was present as was the laboratory, pharmacy, and hospitalist team. The theme of the meeting was quite simple; the CEO asked the group "Did anything happen yesterday that put any of our patients at risk and what was done about it."  I heard reports of both operational issues (medication refrigerator not meeting cooling standard) and clinical issues ("hospitalist on new rotation ordered diagnostic test that was not specified on the guideline despite being advised by the patient's nurse") and was impressed with the conversation that ensued after each report.  Clearly patient safety was high on this executive's agenda. 

In another hospital, every Tuesday and Friday,  one of the members of the C-suite leads a small group of department heads on 'walking rounds' to patient units.  I joined the group led by the COO and we trudged up and down the stairs to several units. At each unit, an imprompto conversation was held in the small unit conference room and everyone who could, joined in. The COO greeted everyone and then asked one question: "What should be done to make your work less stressful and how would that affect patient care?"  I heard some good feedback and very practical requests.  One nurse suggested that the clinical pharmacist should be accessible after 'normal' work hours to meet with some patients and their families to discuss medications. The housekeeper said she shouldn't have to go down to central supply every time she needed to refill storage closet supplies. And a respiratory therapist suggested that his worklife would be less stressful and he could be more productive, if he could join the hospitalist team during their morning rounds so he wouldn't have to take the time to read the EMRs to find out what therapy they prescribed for their patients.  When we got back to the COOs office, she began to take action to address each of the items brought to her attention. 

On another day at this same hospital I joined the CMO on his rounds.  He began by asking the staff "what they liked about working on this unit," followed by "what don't they like about working on this unit."  Surprisingly, these questions generated almost universal responses on each of the 3 units we visited. The staff 'liked' working with a designated group of staff members...they got along well, they helped each other out, and they functioned as a team. Responses to the second question was the exact opposite - failure of other care team members to participate as a real team. They repeatedly pointed fingers to the hospitalists who came and went and rarely spoke to any nurse nor considered the unit personnel as colleagues whose work they valued and appreciated.  As a result, the staff said, information rarely gets shared and they have to dive into the EMR to find out what transpired. At the end of rounds on that unit, the CMO asked to meet with the nurse managers of those 3 units and suggested that the nurse managers and charge nurses take the lead and set an example by accompaning the hospitalist when they make rounds. "That was tried before,"  one of the nurse managers reported, "but the physicians were reluctant to have anyone join them when they were visiting their patients." The CMO then gave the nurse manager his personal cell phone number and told him, "the next time any hospitalist refuses to allow one of the nurses to accompany him or her on patient rounds, you call me immediately."   

Culture change is a slow process but can be accelerated by a "Wow" event.  The CMO scenario reported above, reminds me of the story of Chuck Stokes, now CEO of Memorial Hermann Health System. Several years ago as Executive VP and COO, he took the lead in promoting a culture of safety and quality.  On one occasion, he was informed that despite peer-to-peer reminders, one of the more active surgeons regularly refused to take a 'time out' to confirm the correct patient, procedure, site and, as applicable, implants. When word of the surgeon's refusal reached Mr. Stokes, he had a chat with the circulating nurse, gave her his personal cell, and told her to call him the next time the offending surgeon refused the 'time out.'  Before long, he got that call and the story is that he ran down to the OR suite, told the anesthesologist to wake the patient up, stopped the procedure and told the surgeon that unless he participates in the 'time-out' safety process, he would not be permitted to schedule any more patients!  The threats by the surgeon to never use Memorial Hermann again were anticipated but word of Mr. Stokes' action spread like wildfire throughout the organization and sent a clear message, stronger than any memo or meeting, that Memorial Hermann will not tolerate any deviation in its quest for patient safety.   Oh, and by the way, after sulking for about 2-3 weeks, the offending surgeon started scheduling patients again and willingly participated in the 'time-out' procedure. 

I don't know if Memorial Hermann used a form of leadership rounds to let associates know of its committment to patient safety, but I do know, from personal observations, that when executive leaders listen attentively to informal feed-back from front-line hospital associates,it bests illustrates the value of an open culture to get the day-to-day work of high-quality patient care right.