7 min read
Employee rounding is a powerful tool to form and maintain relationships in the workplace between leaders and their frontline staff. Progressive, participatory leaders began rounding or “checking in” with their employees long before the relationship between patient satisfaction and employee satisfaction was validated by data and research. The dynamic and costly healthcare environment makes it imperative to create a work environment where employees are empowered by information, resources and support so that highly skilled workers can be retained. With the average cost of replacing a certified nursing assistant estimated at $15,0001 and an registered nurse $52,100 (Range $40,300 - $64,000)2, high turnover can shackle an organization.
If employee rounding is new to your team, or your current rounding process is not impacting retention as much as you would like to see, it might be time to take a deep dive into your structures and processes. The Nobl Rounding Platform automates processes and provides flexible, dynamic data monitoring and reporting. More importantly, it makes consistent employee “touch” cost-effective and easy. Leaders using Nobl for employee rounding report that the game-changing value is in the time saved, while elevating the quality of documentation and the ease of interfacing the information with employee management systems, recognition programs, and turnover/vacancy data.
A framework of six key elements can help to evaluate or create an effective employee rounding program. Automating a poor process just gives you a faster poor process!
1. Defining the Purpose of Employee Rounding
The first concept to explore is the overall purpose for employee rounding. If employee rounding is introduced to fulfill an expectation of Human Resources or Senior Leadership, without the inclusion of all levels of leadership in program development, the initiative will have an uphill battle from the beginning. Frontline leaders who may already have up to 200 direct reports on multiple shifts may see the expectation of “rounding” on every employee monthly, quarterly, or even annually as “one more thing” to squeeze into their already overly busy role. Adding anything that doesn’t offer a complementary “take-away” may not be seen as a benefit, but as the “straw that broke the camel’s back” resulting in leader burnout or turnover. The use of focus groups or facilitated retreats to define program elements and earn the trust and buy-in of leaders may be a good place to begin.
Employee rounding can do a lot of things, but it can’t do everything. Soliciting input from employees on what is working and what needs improvement is only effective if you can implement programs to remove the barriers and remedy the concerns. Years ago, I once had a Chief Nursing Officer decline the opportunity to conduct a separate nursing staff engagement survey with nursing specific questions because “if they tell us what they want, we will have to provide it for them.” Her logic was that if we don’t ask, they won’t expect anything and we can continue as usual. That approach didn’t work for long!
Besides employee retention, other potential benefits of employee rounding are enhanced patient experience, improved safety and quality, cost savings, new innovations in care, and identification of strong candidates for advancement within the organization.
Define the purpose of employee rounding for your organization. That definition can’t just come from the top – all levels must see the rationale for asking questions and trust the process enough to provide honest answers. Organizations that use Nobl to keep track of employee rounding conversations typically structure their rounding process to achieve the following five objectives:
- Build relationships with the employee
- Capture wins to learn what is going well, what is working, and who has been helpful
- Identify process improvement themes
- Repair and monitor systems to ensure chronic issues have been resolved
- Ensure that key behavior standards in the organization are being consistently executed and hardwired
Learn more and preview questions to go along with each category here
2. Alignment with Mission, Vision and Values
Having clearly identified and communicated mission, vision, and values for the organization is commonplace across most industries, including healthcare. These documents are intended to define a common framework around which all who work at or associate with the organization can classify or model their actions and intentions.
If an employee rounding program is designed around “buckets” or best practices defined by a consulting firm, professional organization standards, or even safety and quality award programs, the staff conducting the round and the recipients may both feel that the exercise is robotic, insincere, and a waste of their time. If the mission, vision, and values (or their equivalent) are not internalized by every stakeholder to the point where the concepts resonate and inspire joy and passion for the work, they are merely hollow slogans used on flashy marketing materials and press releases. When everyone from the top to the bottom embrace, embody and model these key foundational beliefs then trust is developed.
For employee rounding to be successful the processes must support the core beliefs with questions that are straightforward, understandable, and which invite sincere dialogue, not just single-sided input. Rounding should not be used as a means to provide information to the employee that can be conveyed at a different time. Routine information can be provided in reports, emails or news briefs. If urgent messages need to be relayed, add them to the daily huddle or a group text. Staff time is sacred to them and expensive for the organization. Make the most of every encounter.
3. Connection to Strategic Priorities
Besides the mission, vision, and values, most organizations also have pillars of excellence and behavioral expectations around which strategic plans, tactical plans, and cascading accountabilities are clustered. After nearly two decades of work within healthcare facilities across the continental United States, I am amazed to find organizations that either don’t have a strategic plan, don’t have written tactics and expectations to successfully implement the plan, or only share the plan with the top levels of leadership.
How many frontline employees are invited to see the whole plan or are educated on how, why or by whom the plan was written? How many facilities assure that associates from all levels and all areas are part of that development, so that the plans are seen through multiple lenses, not just the lens of the Board, C-Suite or leaders. How do things appear or sound to an entry level employee or weekend only per diem worker?
These same considerations are important when developing rounding frequency, questions, or response options for employees. You want your rounding efforts to be more than a “howdy” or a list of wants and needs. Take the time to ask employees, at all levels, what they value and how best for them to provide feedback. The same employees who are involved in the development of the strategic plan can be great resources to create strong rounding processes and goals that meet frontline needs and serve as a gauge for both the communication and achievement of strategic priorities.
4. Formulating and Prioritizing Questions
Defining conceptually what categories or information to include in an employee rounding question set is easy compared to the actual construction of strong questions with trackable responses. Adult learning theory informs us that open-ended questions are preferred by the learner and provide non-biased responses to inquiries. But tracking and trending qualitative responses with no means to identify a positive or negative answer makes it difficult, if not impossible, to determine if responses are trending toward improvement, stagnating, or deteriorating. Asking the leader to make a ‘judgment’ of whether the open-ended answer is positive or negative opens the door for ambiguity, leader bias, and meaningless reports. If accountability expectations are associated with the percentage of positive responses, leader bias can falsely inflate staff satisfaction. When employees rounds indicate “happy campers” but the annual employee survey results reflect dissatisfaction, question the reliability and validity of your rounding process, not that of a nationally benchmarked, psychometrically tested tool.
Recently, the Nobl clinical team sat down to draft an employee rounding question set for a new client wishing to replace a list that was seen as “robotic and meaningless.” We were tasked to incorporate four key elements into the questions:
- Positive approach
- Open-ended
- Adding the “why” in the stem of the question
- Incorporate the health system mission, vision, and values
The order of questions is also a key consideration. If you ask for feelings or concerns too soon in the rounding process, the entire dialogue may spiral down quickly into a negative experience for the leader and the employee. If ideas for innovations or new solutions are asked too early, then other questions might be missed if the employee actually has ideas to share. Opening a dialogue about a positive or negative subject and then cutting the conversation short can be interpreted as very disrespectful.
Using a small focus group of employees to test the content and order of your questions and response options can help to create a survey that gets to the right results and flows smoothly from question to question.
5. Connecting Questions to Desired Outcomes
As previously stated, employee rounding can have many benefits besides retention including enhanced patient experience, improved safety and quality, cost savings, new innovations in care, and identification of strong candidates for advancement within the organization. Open-ended questions might provide information related to any one of these outcomes, if those topics are introduced by the staff participating in the encounters with the leader. But if specific outcomes are a high priority for the organization, attention should be given to create specific questions related to each. Creating questions that stimulate thoughts or welcome feedback, but which also aren’t biased or “leading” toward specific responses, can be challenging. Individual rounding on employees may not be the preferred method for all dialogue and the use of town hall meetings, focus groups, surveys, and open-door policies should always be investigated.
Value employee time and focus 1:1 employee rounds on topics of direct interest to the employee or to their work environment, employment expectations, or career progression.
6.Implementation and Monitoring Process Compliance
At Nobl, attention to all structures and processes for rounding is an integral part of our “gap analysis” phase, extending further than just the technology configuration, testing, and go-live support. I personally subscribe to the motto, “garbage in, garbage out” as it relates to training and preparation for rounding. If training is short-changed or leaders’ skills to respectfully and politely communicate with their staff in a rounding situation are assumed, there is a significant risk of disengaging staff with ineffective rounding.
Adults learn in a variety or ways. Not all leaders can master the rounding dialogue, technology use, and coaching tasks by hearing it in a crowded classroom or watching a computer-based learning module. Adults also don’t respond well to role-plays with their peers due to a fear of failure in front of the group. Experienced rounders can co-round with each leader for a few rounds to share observations of strengths and offer guidance. Especially if technology has been added into the process for the first time. A common concern with rounding is that the employee will feel that the leader is more concerned with filling boxes and taking notes than really listening. Newborns need to learn to suck, swallow and breath during a feeding to prevent aspiration. Leaders need to learn to ask, listen, and capture the feedback during a round. All steps don’t have to occur at the same time, and sometimes brief notes can be added in real-time for later elaboration, if needed.
Blog written by Teresa Anderson, EdD, MSN, NE-BC, Chief Nursing Officer
References:
1 US Bureau of Labor Statistics. Nursing Assistants. https://www.bls.gov/oes/current/oes311014.htm
Retrieved 11/25/2019.
2 2019 National health care retention and RN staffing report. NSI Nursing Solutions, Inc.
http://www.nsinursingsolutions.com. Accessed November 25, 2019.
