Posted March 30, 2015

Senior Leader Rounding That Makes a Difference: Rounding on Patients in the ED

By Don Dean, BSRT Linda Deering Dean, RN, MSN

There have been many articles and thoughts about the value of Senior Leader Rounding throughout the years. Historian Stephen B. Oates suggests that rounding began with Abraham Lincoln informally visiting his troops during the American Civil War. In the business world in the 1970’s, executives at Hewlett-Packard introduced the concept of spontaneous rounding to visit employees. In 1982, authors Tom Peters and Robert Waterman introduced in their book, In Search of Excellence, the concept of management by walking around (MBWA). The impact of MBWA is thought to make senior leadership more approachable, more knowledgeable of the operations of a particular area, more trusting, and to create accountability and improve productivity.

This insight shares Studer Group’s practice of Senior Leader Rounding on patients admitted through the Emergency Department (ED). The purpose is to better understand how well patients perceived their experience in the ED, as well as their transition to being an admitted inpatient.

Studer Group research shows a direct correlation between the ED and the Inpatient (IP) experience, as demonstrated in the chart below. We find that organizations looking to achieve high performance in IP Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) results must also provide a positive experience in the ED. Some statistics show that on average, more than 50 percent of patients are admitted to inpatient through the ED.

Emergency Department and HCAHPS Overall Rankings comparison

Through our coaching, there are two scenarios we frequently see that senior executives should be prepared to address during rounding:
  1. The patient and/or family’s perception of their care did not meet expectations. Maybe they had a long wait to be seen by the ED physician or, once determined that they needed to be admitted, there was a delay in that process. Through rounding, the executive is able to apologize and provide service recovery as appropriate, as well as ask questions to understand where the performance breakdown occurred.
  2. The patient and/or family had a wonderful experience. This allows executives to communicate that we are working very hard to take excellent care of our patients and appreciate the kind words about the care they received. Executives can then share the positive feedback with the high performing physician or employee in person, or via a thank you note to the employee or physician’s home. It’s a great way to re-recruit high performers.

We recently hardwired the process of executives rounding on patients that were admitted through the ED on the prior day with executives at Advocate Sherman Hospital. Each of the executives and some of their key directors now round on patients daily and is proving to have a profound impact on the care the patients receive. Rounding has also provided the opportunity for executives to thank both physicians and staff for the difference they are making for their patients.

We asked Linda Deering, President of Advocate Sherman Hospital, to share their experience. “When we first learned of the concept to have executives round on patients who were admitted through the ED, we were elated to have another tactic to improve care and service.” She continues, “This elation quickly turned to anxiety when we learned that we have an average of 50 patients admitted through our ED every day. What sounded like a great idea suddenly seemed impossible. How many executives have time to round on 10 patients each day? Yet our belief and desire remained strong. We just had to find a way.<

We shared the concept of key Leader Rounding on ED admissions with our director level leadership team who immediately offered to help. Within two weeks, we launched our process for Senior Leader rounding on ED admissions. This team, comprised of 20 executives and directors from all departments, including finance, human resources, food service, environmental service, nursing and more, have successfully hardwired this important rounding.”

When we asked Linda how the executives are utilizing the data gathered during rounding, she shares “The feedback received during ED admission rounding is used to deliver praise and thanks to the care teams, service recovery to the patients when needed, and make process improvements.” She continued “For example, one of our directors, Joan Kanute, rounded on an ED admitted patient and the patient shared what a wonderful ED doctor she had. Joan later shared with the ED physician the positive feedback and that he was mentioned twice this morning as being phenomenal. The doctor was so grateful, blushed at the kind words and said ’it’s always great to hear the positives’. It also helps to confirm that our patients have watched our admit video, have the fall precautions in place (impacts safety) and their communication boards are up to date.”

Linda shared that she was surprised by the feedback she’s received from the executive team since rolling out this tactic. “What we didn’t expect is the joy that we, the Senior Leaders, receive from this new rounding process,” she said. “It’s simply gratifying and affirming to hear the patients tell us great things about our care teams. The non-clinical directors, some of whom initially had hesitation, have verbalized pride and excitement with the opportunity to contribute to making a difference with our patients and families. Sometimes, it’s the best part of our days.”

Senior Leader Rounding is a very effective way to ensure that your ED admitted patients get a quality inpatient experience. It’s important to communicate with patients and let them know they can expect to receive a visit from staff each hour (Hourly Rounding®) to ensure that we are exceeding their expectations. We can also reiterate this during Bedside Shift Report, explaining that both the oncoming and off going nurses will involve the patient in their review of the plan of care so that there is a seamless handoff from shift to shift.

Additional Resources:

  • Achieve consistency and standardization across departments, facilities, and systems through structured rounding using MyRounding, a software accelerator.
  • See rounding in action at Studer Conferences. Studer Group coaches and experts show “what right looks like” during how-to sessions.
  • Gain complimentary rounding tools including a sample Senior Leader Scouting Report, Leader Rounding log and more.

Download the Insight


  • Don Dean

    Don Dean, BSRT

  • Linda Deering Dean

    Linda Deering Dean, RN, MSN

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