Executive Leadership Rounds: 9 Steps to Improve HCAHPS + Staff Engagement & Retention

In hospitals, where patient experience is important and quality of care is non-negotiable, a subtle yet profound practice has emerged as a catalyst for positive change: Executive Leadership Rounds.

This powerful initiative, often overlooked amidst the hustle and bustle of hospital operations, holds the potential to support the transformation of HCAHPS patient experience scores, breathing new life into the patient relationship while driving operational excellence.

In this post, we delve into the critical importance of how sustained leadership rounds positively impact HCAHPS scores and patient satisfaction, improve staff satisfaction & retention, and contribute to improving care outcomes.

The Significance of Executive Leadership Rounds in Hospitals:

Executive Leadership Rounding is a purposeful approach, allowing senior leaders to connect directly with staff.

Through meaningful interactions, these rounds encourage open communication, empathy, and accountability, leading to improved staff satisfaction and retention along with a clear and objective understanding of staff improvement priorities.

What You Can Expect to Takeaway from this Blog Post:

We will navigate the multifaceted landscape of Executive Leadership Rounds by covering the following:

Unpacking Leadership Rounds: We'll discuss the core concept of Senior Leadership Rounds, explaining its underlying principles and shedding light on how it bridges the gap between leadership, staff, and patients.
The HCAHPS Connection: Discover how Leadership Rounds align with and positively influence HCAHPS scores, enriching patient satisfaction and experience indicators.

9 Strategies for Effective Implementation: We'll provide actionable insights on how to effectively institute Leadership Rounds, offering practical steps and best practices to ensure seamless integration into your hospital setting.
What Not To Do: Crucially, we’ll also provide valuable insights on what to avoid while planning and implementing Executive Leadership Rounds in your hospital.

Unpacking Leadership Rounds:

Leadership Rounds is a dynamic practice in hospitals that brings leaders, staff, and together.

Leadership Rounds are designed to create a space for open conversations between leadership and staff, shared understanding, and everyone taking responsibility.

The primary objective of consistently having executives receive direct feedback from staff is to ensure that the staff has the tools and support needed to deliver exceptional patient care and provide a high-quality patient experience.

The HCAHPS Connection:

Leadership Rounds involve leaders talking to staff directly, on a routine basis.

When leaders engage with staff in a caring way, it boosts their morale and engagement.

By understanding this link, healthcare professionals can see how Leadership Rounds contribute to better patient care and higher HCAHPS scores.

It is unlikely to consistently improve and sustain patient experience without hardwiring the Executive Leadership Rounds process.

9 Strategies for Effective Implementation:

In this section, we'll give you clear and practical advice on how to make Leadership Rounds work well in your hospital setting.

We'll break down the steps you need to take and share the best ways to do it. By following these strategies, you can make sure that Leadership Rounds become a natural and seamless part of how your healthcare team operates.

Our goal is to help you turn this idea into a successful reality that benefits both your staff and your patients.

1. Get Unified Support

Picture a workforce that stands united, firmly supported by your leadership team.

The practice of leadership rounding, a responsibility primarily shouldered by senior leaders, proves to be a pivotal driving force in establishing this cohesive support network.

The participation of key figures such as the CEO, COO, CNO, CMO, CFO, and leaders from HR, Finance, and IT is indispensable.

Delegating this task is not an option. While some executives will initially resist, it's important to be clear about the substantial returns from an engaged staff.

The key outcome is to be sure that frontline staff have everything they need to deliver superior care and experience.

2. Visit All Staff & All Departments

Leadership rounds extend far beyond the realm of nurses and physicians. It's imperative that the practice encompasses all departments, from housekeepers to security officers, accountants and beyond. Allow all employees to be heard.

The scope of rounding should encompass not only patient care areas, but also non-patient departments, and outpatient locations. This acknowledges the value of all staff to the hospital mission.

This inclusivity is fundamental to cultivating dedicated staff who consistently contribute to an unparalleled patient experience, exceptional quality of care, and a heightened commitment to safety.

3. Create Time Allocation

“We are seriously stretched for resources, how much time are we talking about here?”

Have your senior leaders allocate 45 minutes each week.

Build it into their calendars.

One department per week.

Now, when you involve five leaders, you're looking at reaching 20 departments in a month. Naturally, this figure will shift based on the size of your hospital, but you catch the drift.

A crucial point to emphasize is the completion of all assigned rounds. It's imperative to ensure that this commitment is met.

To streamline the process, pre-assign the departments and establish a well-structured schedule. It's worth considering automation to avoid any scheduling hiccups.

Make sure to incorporate nights, evenings, and weekends into the rounds as well.

4. Leverage Technology

Incorporating technology is a non-negotiable aspect of this endeavor.

Utilize smartphones for optimal convenience, eradicating any "I don't have the necessary materials" excuses.

Implement automated scheduling, follow-up procedures, and reporting mechanisms.

The advantages of full automation are substantial, especially when presenting the concept to senior executives.

Partial automation leaves the process susceptible to breakdown due to a lack of transparent effort tracking, potentially succumbing to an overwhelming influx of paperwork.

5. Create a Structured Process for all Senior Leaders to Follow

Speaking generally, effective initiatives often falter due to a lack of structure. For this reason, to ensure a lasting impact for your executive leadership rounding, creating a structured process is imperative.

Our recommended Executive Leadership Rounding process is a structured methodology that embodies the essence of MBWA (Management by Wandering About), but adds an element of organization to it.

Creating a uniform rounding structure prevents the variance of individual questions and observations. Without structure Senior Leaders will stick to their comfort zones.

Begin with Closed-Ended Questions to Generate Open-Ended Discussions

Mandatory conclusions derived from observations and discussions should be an outcome of these rounds. The starting point is to get to a Yes/No or Pass/Fail conclusion. Study #7 The “If Yes” Technique below to see how this generates meaningful open-ended discussion.

Lastly, do not avoid known difficult issues in the process. Questions about staffing levels and availability of necessary tools should not be shied away from.

Here is a Sample of the Executive Leadership Checklist to give you an idea of the process.

6. Use All Staff & All Department

Educational support plays a crucial role in optimizing the outcomes of senior executive rounding, a facet often underestimated.

Contrary to common belief, many hospital executive leaders lack the requisite training or coaching for this type of rounding.

While individual styles may vary significantly, fostering a shared understanding through structured guidelines significantly amplifies the potential impact of rounding efforts.

Below is a list of leadership guidelines and coaching tips:

Make sure everyone understands the frequency with which they are expected to conduct rounds—weekly for 45 minutes.

Start on time and finish on time.
Don’t cancel or reschedule. Canceling or rescheduling transmits to staff that their time is not valuable.
Include evenings, nights and weekends.
Decide whether managers should participate or whether the staff would feel freer to speak without their manager being present. Ideally meet with staff without the manager present.
Review the last two or three visits to see what previous items have been discussed. See if they come up again as a recurring item for this department.
Provide feedback on any changes or solutions that were developed based on previous rounds.
Don’t lecture. Don’t be condescending. Check your ego at the door.
The leader should take up no more than 20% of the talking time.
Keep meetings small. More than 10 employees in a meeting and you will not get any meaningful interactions.
If employee numbers are an issue, insist that the department manager figure out how to rotate staff through the meeting. Have all attendees participate. Some staff will be intimidated and will need gentle coaxing to join the discussion. For staff who are reluctant to participate, ask them an easy question (e.g. John, are there any obstacles to doing your job?).
Don’t be afraid to take notes. Without taking notes you will never be able to follow-up on items that are discussed.
Finish all write-ups of meetings before you leave the department or unit. Ideally, you have the technology to enter into a rounding tool on your smartphone or tablet that will automatically generate follow-up actions for identified issues. If you leave the department without doing so, the accuracy of what you produce will drop at least 50% and you are in real danger of not getting items taken care of at all.
Secure unanimous commitment from the senior team to initiate performance improvement initiatives targeting areas identified with high failure rates.
Conduct a group training session for executives to discuss, enhance, and agree on approach.
Have a “coach” go with each leader on their first meeting and then at least once a year

7. The “If Yes” Technique

Engaging in meaningful discussions with staff is the cornerstone of effective rounding. A powerful approach to foster these discussions involves expanding conversations when staff feedback indicates that everything is “fine”.

Example of “If Yes” Technique in Use:

Original Question: “Are our communication methods effective?”

Staff Response: “Yes.”

Rather than simply moving on to the next topic if the answer is “yes”, the “If Yes” approach encourages further probing:

Follow-Up Question: "Excellent. Could you elaborate on the communication method you find most useful? I’d like to hear more about that."

Tips on Using the “If Yes” Technique:

Steer clear of any form of interrogation or testing.
Encourage open conversations. You may uncover issues that did not initially surface. Or you may get strong reinforcement of existing approaches. Either way the information is incredibly valuable.
To leverage the “If Yes” approach, be prepared with exploration questions for instances when the staff response is "Yes, everything is fine."
Make sure you have scripted follow-up questions to support the process. Through the “If Yes” technique, you can potentially uncover underlying issues that staff might not have been initially ready to discuss. Conversely, if effective communication methods are confirmed, this approach further reinforces the value of good communication practices.

8. Effective Follow-Up

An automated follow-up mechanism must be seamlessly integrated into the broader process.

A lack of proper follow-up will harm morale and yield unfavorable outcomes.

Avoid placing the responsibility on executives to manually draft emails or notes for matters requiring follow-up, as this consistency is unlikely to be achieved. Make it digitally automated.

9. Sustainable Performance Improvement

Ensure the Senior Team is committed to taking PI action on the results of their efforts. Without effective PI efforts at least 50% of the benefit of this approach is lost.

Performance Improvement hinges upon the unwavering commitment of the senior leadership team to initiate improvement endeavors against identified issues.

Ensure the Senior team has and is coached on their findings and possible PI priorities. Ensure Department Managers have full access to their department results.

While sharing anecdotal accounts and swiftly addressing departmental concerns holds value, their impact remains short-lived. Anecdotes cannot fuel enduring performance enhancement. Tracking and using PI data is where the long-term improvements are made.

While some challenges will have straightforward solutions, others may prove intricate. An objective yardstick rooted in staff feedback and a method to prioritize endeavors becomes essential to prevent overwhelming the team and encountering setbacks.

Be sure you have a strong process and supporting technology in place to deploy effective performance improvement.

4 Approaches that Will Almost Certainly Ensure Failure:

1. Lack Of Executive Commitment

Gaining initial senior leadership agreement is a clear step, yet sustaining the process is the challenge.

Ensure an established schedule for reviewing completions and always show a rolling 12-month record of individual completions.

Reinforce with the senior team that deviating from the schedule strongly signals to staff a lack of appreciation.

2. Not Automating the Process

Without automation the process will most likely collapse under the volume of the data. Manual production of schedules, checklists, follow-up and data analysis for PI quickly become overwhelming tasks that cannot be sustained

over time.

See how we support our hospital clients with all-digital, all-automated performance improvement.

3. No Performance Improvement Efforts

Unless the rounding results are used to implement meaningful, measurable and visible performance improvement it is difficult to keep senior leaders engaged over time.

4. Executives Rounding As a Team

Do not conduct in teams, instead assign individual leaders to departments. Rounding as a team intimidates the staff, significantly reduces coverage, and creates endless scheduling issues and excuses.

Key Takeaways:

Elevating HCAHPS Scores Through Leadership Rounds:
Implementing structured Leadership Rounds can significantly impact HCAHPS scores by fostering open communication, empathy, and accountability between leadership, and staff. Remember if senior staff want to visit patients, that can be worthwhile for their engagement but it will not improve patient experience. The volume and daily effort required is simply beyond their personal bandwidth. The senior leader's task is to ensure that staff have the tools and support they need to consistently deliver high quality care and experience.
The Power of Structured Approach:
A well-structured approach to Leadership Rounds is vital for sustainability and success. Senior executives should allocate time, engage all departments, and ensure automated processes for scheduling, follow-up, and reporting.
Inclusive Engagement:
Extend Leadership Rounds beyond clinical staff to include housekeepers, security officers, and non-patient areas. In other words: everyone. Use the “If Yes” technique to prompt meaningful discussions.
Training and Technology Integration:
Provide formal training for senior leaders on effective rounding techniques. Incorporate technology for automated follow-up and reporting processes to ensure accountability and continuous improvement.
Driving Performance Improvement:
Gain senior leadership commitment to launch improvement efforts based on identified issues. Objective measures, prioritization, and supporting technology are crucial for driving sustainable performance improvement. Without ongoing, meaningful performance improvement it is unlikely the process will be sustainable.
Engagement and Empowerment:
Leadership Rounds create a positive environment, build enthusiasm, and foster trust among staff, contributing to a patient-centered and quality-focused healthcare.

Readiness Rounds supports our clients through their Executive Leadership Rounding processes and their performance improvement initiatives. We would be delighted to be a partner in your patient satisfaction improvement journey. We’re here to chat anytime.

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Curious to see the rest of the Readiness Rounds Patient Satisfaction Approach looks like?

At Readiness Rounds, we’ve developed a proven approach to improving Patient Satisfaction and Experience. We call it the 9 Approaches. Watch the short video series here.

We’ve also put together a free 24-page step-by-step proven approach to improving patient satisfaction. You can get your free copy of the 17 Proven Strategies to Improve Patient Satisfaction here.