University of Colorado Hospital leaders gathered Feb. 5 for the latest in a series of day-long “Hardwiring” events aimed at improving service to patients, families, staff, and faculty. At the heart of the gathering were presentations introducing a new take on a familiar strategy: rounding.
Patrick Kneeland, MD, medical director for Patient and Provider Experience at UCH, participates in rounding role play with Mary Mancuso, the hospital’s health literacy and patient and family centered care coordinator, at the Feb. 5 “Hardwiring” event.
Leadership teams will continue to round units, departments, and clinics, as they have since the hospital launched its “Service Excellence” – recently renamed “Patient Experience” – initiative in 2011. The idea is to regularly sound out staff about their work environment, log their issues and concerns, and assign appropriate individuals and teams to address them. The goal: engage staff on their own terms and their own turf.
“When you round, you build relationships and trust,” Chief Operating Officer Tom Gronow told the crowd in the auditorium of the Bruce Schroffel Conference Center. But he said it’s time for the hospital to reboot its approach to the strategy.
The new rounding program, which began the afternoon of the meeting, involves executives, directors, and managers visiting both staff and patients in selected areas. Each team member will have three rounding “opportunities” per month and must make at least two of them, Gronow said.
That means attending rounds at least 10 of 15 times through the end of the current fiscal year (June 30), and 24 of 36 times in fiscal year 2017, Gronow said. In addition, representatives from eight departments (see box) are required at every rounding session.
Instead of heading to their assigned areas and asking scripted questions, rounders will meet first to discuss things to look for. Forty-five minutes of rounding follows, with one team member speaking with staff and providers, and another with patients. Teams will change with each rounding session, encouraging a fresh exchange of insights and ideas.
Afterward, the entire group will gather to “debrief” about potential issues and quickly identify resources for addressing them, said Amy Searls, executive director of Patient and Guest Experience, whose team spearheaded the revitalization of the rounding program.
Feedback that is specific to a unit or clinic might lead to a direct discussion with the manager. Issues that require a broader effort will go to a representative from the appropriate area – critical care or Environmental Services, for example.
UCH Chief Operating Officer Tom Gronow speaks at the event.
“In post-rounding huddles, we will discuss in real time who is the person to connect with for feedback about a problem,” Patrick Kneeland, MD, a hospitalist at UCH who was named last year as medical director for Patient and Provider Experience – a position created to pair closely with Searls’ team. “We’ll also talk about successes we heard when we were out rounding,” he said.”
New questions
Kneeland said the original approach to rounding was useful, but the growing size and complexity of the organization demanded an “evolution” in the way leaders interact with staff and patients. The new model is designed to use leaders’ time as productively as possible, but it will not succeed without a commitment from leaders to meet the obligation and listen to and take seriously the messages they receive, he added.
“This will not be a perfect process out of the gate,” Kneeland said. “But it is a way for our leadership team to stay in touch with the people who are doing the work at this hospital. They are the experts, and we need their information to make strategic decisions.”
Similarly, the new model challenges leaders to enter the world of patients and listen to their feedback, Kneeland added.
“Many people in leadership have no experience with patients, and it can feel daunting,” he said. “It can even feel totally different for physicians. But we need to feel how patients experience their care and connect with them in meaningful ways.”
“Getting patient voices is vital,” agreed Patient Experience Manager Suzanne Kwekel. She said the success of rounding relies on picking up cues from patients that encourage relevant questions. “It is important to be receptive to what is happening with [them],” Kwekel said.
Kneeland and Mary Mancuso, the hospital’s health literacy and patient and family centered care coordinator, demonstrated how that might work during a role play at the Feb. 5 meeting. Mancuso played a patient visited by Kneeland. In the first encounter, Kneeland asked Mancuso a few perfunctory questions about how she was doing and if she needed anything – and came away with very little information that might improve her stay.
After feedback from the audience, Kneeland and Mancuso reenacted the encounter. Kneeland took more time to ask Mancuso questions about herself and her family and discovered she missed being able to Skype with her granddaughter. Kneeland said he would check on whether that could be arranged, gave her his card, and invited her to check with him if she needed anything else.
Learning to listen
It was an example of the value of engaging meaningfully with patients, a topic patient safety expert Michael Leonard, MD, addressed with the audience.
“Having the ability to be vulnerable and listen to patients is critical,” he said.
Similarly, leaders must have “meaningful conversations with front-line folks,” Leonard added. “That means you have to show up physically and mentally when you round. And if they tell you something, you have to follow through. If they tell you what they think and nothing happens, you’ll go backward.”
The new rounding approach is modeled after one that has been in place several years at UCLA Medical Center. Echo Vogel, project coordinator for the Patient Experience team, joined Searls and Kwekel in visiting UCLA to observe rounding in action. Vogel said she was impressed by the simplicity of the process, the networking between leaders who rounded, and the enjoyment they had in doing it.
“It was a big opportunity for them to share and brainstorm ideas,” she said. For staff, the process seemed well established and received, Vogel added. She watched the rounders observe a food service worker delivering a meal to a patient, then offer feedback on the interaction.
“[The worker] was used to being observed, and seemed comfortable with the comments,” Vogel said. “You could tell it is part of the culture.”
Later on, Vogel saw a rounder ask specific questions to gauge a patient’s experience and speak to his concerns – in this case, the scheduling of consults while his family members were out of the room.
Even if the problem can’t be solved immediately, the act of listening to patients’ concerns is crucial, Vogel said. “The idea is gain information that can help us to impact their experience,” she said.
Kwekel also came away impressed after spending a day at UCLA observing leadership rounding. “It gave me a good snapshot of their collaborative culture,” she said. The messages from staff and patients weren’t always positive, she said, but the rounders took them in stride.
“There were hard things to hear, but they didn’t take them personally,” Kwekel said. “There was a focus on being present when they listened to people.” In turn, she said, patients seemed receptive and offered suggestions for improving the hospital. Their input sparked energy among the rounders when they reconvened to debrief, Kwekel added.
Gronow said rounding at UCH can produce the same kinds of results, but it will require time and, most importantly, a commitment that shows the interactions aren’t mere lip service.
“Magical things can start to happen when people start talking,” he said. “We can’t be deaf to what they are saying.”
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Departments that are required at every rounding session
- Environmental Services
- Information Services
- Emergency Department
- Ambulatory Services
- Guest Services
- Med Surg
- Critical Care
- Food and Nutrition