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 Leadership Rounds: A Trigger For Relational Coordination

health care staffDespite all of the advances in technology, health care is still a people business. It’s about the residents and their families. Therefore, nursing home leaders must regularly connect, face-to-face, with the people doing the work and delivering the care. And they need to visit with and talk to the residents and their families.
 Leaders’ ability to prioritize their time and get out of their offices and conduct frequent and effective rounds is critical to the success of the organization.
 
Here are some tips to keep in mind in order to make more effective leadership rounds.

1. Mood/Posture/Paradigm

Leaders need to understand that they are in the spotlight when they leave their offices and walk onto the nursing units. Everyone sees them, listens to what they say, and watches what they do. With this fact always in mind, all leaders need to flip a switch and put themselves in a proper frame of mind before they conduct their rounds.
 
They need to conscientiously model the attitude and behavior they hope to see in their employees. Be a positive force. Leaders need to energize staff to perform better by their presence and influence—by what the leader says and does. Keeping employee morale up requires a constant effort. When leaders make consistent and sincere gestures of caring and listening to staff and the residents, it helps to put the staff at their best.

2. Content—What Leaders Say And Do

Do answer call lights; hold doors open for people; hand out granola bars; smile; wave to residents; make eye contact with everyone; sit in the break room; sit on the end of a resident’s bed and talk with them; shake hands; kiss residents’ cheeks; rub shoulders; carry leftover food trays back to the kitchen; move a linen barrel to where it should be; look in utility rooms, shower rooms, resident bathrooms, kitchen, and break room.
 
Say “thank you, can I help you with that, can I save you some steps, how’s staffing today, what’s frustrating you today, do you have all the supplies you need today, does all of the equipment work well today? I’m proud of you, how’s your son doing? Thanks a lot for helping her with that, thanks for being here today, thanks for all of your help today, I’m sorry about that, I’m worried about…. Is everyone treating you respectfully…”

3. Timing Of Rounds

Rounds should be conducted a few times throughout the day. First rounds should be conducted as soon as the leader arrives. Never get trapped in the office looking at email. It’s less important than getting out and seeing what’s going on out on the units. Leaders should conduct rounds before the morning stand-up meeting.
 
A second set of rounds is ideally conducted at the residents’ lunchtime hour. A third set of rounds is conducted at the change of shift from 2:30 to 3:30 p.m. At this time, shift hand-offs should be monitored and the day shift staff thanked, while welcoming the evening shift staff. Leaders should linger near the time clock and maximize their exposure to people.
 
Finally, conduct a last set of rounds before leaving for the day. Also, go in on weekends and conduct rounds and visit at night at least twice per month.

4. Keeping Notes And Following Up

Leaders should be making observations and receiving feedback during rounds that will require follow-up. Therefore, be sure to take along a pen and small piece of paper in order to make some notes. Don’t carry a cell phone during rounds. Be sure to follow up with people when necessary.
 
To build organizational trust, people need to feel that the leader is listening to them. Be open and honest with staff.
 
Even if every request cannot be honored, be sure staff know that thought was given to it.
 
Nursing home employees are highly sensitive and responsive to the immediate context of their physical and social environment.
 
Effective leaders positively influence staff by making specific changes that matter the most to employees and the residents. The key is to conduct more effective rounds. Be more conscious of how rounds are conducted. Adopt some of these tips, and self-reflect about your impact on people.
 
Source: David Farrell, director of the Green House Project
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