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Leadership Rounds Don’t Work

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LEADERSHIP ROUNDS DON’T WORK…if you are not asking the right questions!! In order to maximize the time you spend on Leader Rounding make sure you make the interviews purposeful. Asking the patient “How is everything?” or “Are you doing OK?” or “Are we giving you excellent care?” will not get you the important information you need to truly understand WHY your CAHPS scores are fluctuating. We don’t allow the staff to only ask those questions when they do their rounds, so why should you? If you insist on asking those vague questions, patients will likely tell you what you want to hear, not what you need to hear, regardless if it is the truth or not. How do I know? Because, I see it daily. Managers tell me they don’t understand their CAHPS results, patients tell them they are great all the time… yet only 65-75% of the patients gave them the highest ratings on the survey. However, when I do the in depth interviews that show the patient we truly want to hear their perspective of the care we give, ask open ended questions and give them enough time to answer us thoughtfully … I see that your CAHPS results are right on target. You will definitely hear descriptions of individual staff members that are excellent but I bet it is inconsistent. You will hear episodes of greatness but perhaps only from one of the three units the patient has been on. And you will hear snippets of exceptional that when you dive deeper ends up simply being a description of sound basic clinical care. So how do you do your Leader rounding better?

Here are some helpful hints:

  • Carve out the time to thoroughly interview the patient. That can easily take 30 minutes per patient if done properly.
  • Decide what your focus is going to be on and have your questions prepared ahead of time so you can ask the same questions of all patients.
  • Ask the open ended questions so the patient does not give you the easy answer they think you want…and probably hope… to hear. And to be clear, the dreaded easy patient answer is “fine”.
  • Don’t ask leading questions. They suggest to the patient what an appropriate answer would be. For example, “Have my staff members been taking good care of you?”
  • Once you ask a question, just listen. Give the patient time to think about their answer. Remind them you have the time because this is so important. And don’t forget to “look” like you have the time, the patient can tell when you are in a rush
  • Be sure to get information from a large enough sample of patients. Don’t jump to conclusions. Listen for themes that are repeated over and over again…both the positive themes and the not so positive ones.
  • Finally, enjoy the interview. You are going to get powerful information!

Want to know why your HCAHPS are fluctuating? Ask your patients! REALLY ask them. If you rely solely on your CAHPS numbers without insight into the patient’s perspective of their entire experience, you don’t have backup when things go wrong. You could stumble down the wrong improvement path, because that’s where the numbers without explanation might lead.

And for those of you who are concerned that all you will hear are complaints….and trust me you will when you begin showing the patients you truly care about their experience, here is a simple way for you to approach it. If the patient verbalizes a complaint, follow this model using the acronym LAST.

L: Listen without interrupting. Do not immediately start to give excuses! Often the patient simply needs to be heard.

A: Apologize for the situation. Be sincere. Recognize internally that somewhere along the way the ball was dropped.

S: Solve the problem for the patient. Then assure the patient you will do your best to make sure it will not happen again to another patient. Fix the process.

T: Thank them for bringing this to your attention so you can prevent the problem from re-occurring.

Want to know why your HCAHPS are fluctuating? Ask your patients! REALLY ask them. If you rely only on numbers without insights, you don’t have backup when things go wrong. You’ll stumble down the wrong path, because that’s where the numbers will lead.