Several best practices drive improvement in what is called the human experience—the combination of both staff and patient experience. One such practice is Senior Leader Rounding (SLR). Seeing leadership conducting regular rounds in the hospitals has been shown to contribute to a psychologically safe work culture. When leaders look for opportunities to connect with staff, it builds a foundation of trust where employee engagement can thrive.
In 2020, the Office of Patient Experience noted a vast difference in rounding programs throughout the Mount Sinai Health System. While some hospitals already engaged in leader rounding, the programs varied in focus, structure, and effectiveness. Thus, a “Senior Leader Rounding Committee” was convened. The committee included designated participants from each hospital to act as a working group: to share best practices, collaborate on program design, and liaise back to their hospital executive team. Since its inception in 2020, the program has grown vastly, supporting key initiatives driving employee satisfaction and engagement, such as recognition and staff well-being.
The team soon realized that Senior Leader Rounding needed a foundation that provides meaning and serves as a true north, while allowing each site flexibility so that the practice could be sustained locally. In 2020, the Office of Patient Experience and Talent Development and Learning teams took an iterative and collaborative approach to designing and standardizing an SLR program. The framework was adopted by the sites in 2021 and saw remarkable success, which has continued into 2022.
The two main parameters of SLR programs are: that Senior Leader Rounding is not a time to meet with direct reports or to problem-solve; and that the primary focus is connecting with staff, showing support, and recognizing them for their efforts. Senior Leader Rounds are intentional and structured interactions between senior leadership and front-line staff and managers. Beyond these parameters, the programs needed a model to guide operations. In late 2020, the Patient Experience team and the Talent Development and Learning team created a model called “The Rounding Essentials,” which includes five key components of success:
1. Open: Introduce yourself, tell them why you are there, connect with the staff as peers rather than as leader to staff member.
2. Inspire: Use patient stories, feedback received, STAR Recognitions, and discussion of positive interactions they have experienced.
3. Ideate: Ask questions to help staff connect to progress and visualize steps toward resolution.
4. Agree: Restate what has been discussed, and next steps.
5. Operate: Move forward and plan to follow up with a status update during the next round or touch-base.
The Leadership Rounding Card suggests questions to prompt meaningful dialogue.
This framework has enabled each site to engage in this critical practice in alignment with the entire Health System, while placing a strong emphasis on bridging gaps and forging connections between leadership and staff. Humble Inquiry: The Gentle Art of Asking Instead of Telling by Edgar H. Schein informed the framework in three principal areas:
• More asking, less telling: Ask respectful and open-ended questions—avoiding leading questions.
• Ask, listen, and focus: Summarize what is being said, and listen intently—focusing on what the staff are saying and how they are communicating.
• It’s the person not the problem: Avoid making assumptions, and let the staff be the experts in telling you what they need.
“Empathy is the bedrock on which the framework we created sits. It allows our leaders to connect on a personal level with staff, creating trust and enabling leaders' situational awareness so that they can elevate the staff and listen to their concerns,” says Amanda Ognibene, the lead on this project and Program Manager for the Office of Patient Experience. “One of the biggest pieces of feedback we received was repeated throughout the Health System during our 2020 listening sessions. The feedback indicated that staff wanted to see their leaders on the units. The mere presence of leaders on the units made staff feel safer, empowered them to continue working hard to care for our patients despite the challenges experienced over the last few years, and led to an overall increased sense of resilience.”
In 2021, several sites embarked on the journey to customize their rounding programs, grounded in the Rounding Essentials and guided by humble inquiry. The sites below have been successful in this effort. With differing structures, the two achieve the same goal—connecting with staff and supporting their well-being.
Mount Sinai Beth Israel: Building Resilience and Recovery
At Mount Sinai Beth Israel, the Patient Experience Team provided the structure needed to make rounding successful. One hour of protected time was added to each of the executive’s calendars at the same time every week. The executive team meets at a custom-designed rounding whiteboard for a brief huddle to review the priorities and themes of the week. Rounding materials, including a rounding card with prompting questions and a building map, are distributed. Key themes throughout the year have included Mount Sinai mental health resources, the STAR peer-to-peer recognition platform, COVID-19 vaccine information, and the Your Voice Counts employee engagement survey. Executives round in pairs in all areas of the hospital, including in the clinical units and the Support Service departments. A five-minute debrief at the end of the hour allows time to capture staff feedback themes and address urgent issues.
Prior to the standardization of executive rounding, leaders were primarily firefighting and solving problems as they arose. With the expertise of the Patient Experience Team, there has been a shift in mindset to coaching and planning. Standardized rounding has helped executives anticipate problems early on and develop staff to solve problems. Leaders ask open-ended questions and build relationships with staff based on curiosity and interest in the other person, a practice known as humble inquiry.
A key priority for the executive team is to become a LEAN organization, full of scientific thinkers and individual problem-solvers. A partnership between the Patient Experience Team and the Health System Operations Team has created the space to focus on continuous improvement and experimentation. Using visual management boards helps track progress in the units and provides an opportunity for leadership to ask questions and for staff to feel empowered to share feedback.
The executive leadership team has embraced standardized rounding. They consider it a forum to connect with one another and to learn from each other and the front-line staff. They have also coupled rounding with appreciation events. “It’s the most fun we’ve had in a long time,” says Jeremy Boal, MD, Executive Vice President and Chief Clinical Officer of the Mount Sinai Health System and President of Mount Sinai Beth Israel and Downtown.
David Reich, MD, conducting Senior Leadership Rounding.
The Mount Sinai Hospital: Building Connection through Compassion
The Mount Sinai Hospital was the first site to transform and standardize their Senior Leader Rounding program. In November 2020, the hospital began rounding on its 50 inpatient units, to which 50 leaders were assigned.
To accommodate the size of The Mount Sinai Hospital, leader rounders range from executive and senior leadership to director level. These leaders are paired together with great attention to diversity in background and title; for example clinical leaders were paired with nonclinical leaders. This helps to engage staff in deeper conversations, with different leadership perspectives. The rounders are equipped with a leader rounding card, which shows the Rounding Essentials model, and a monthly leadership rounding guide with essential information to help the leaders engage staff in effective communication and foster deep connections with staff.
The rounding guide includes a patient story for inspiration and support to be shared with the staff, and hospital updates to promote consistent and accurate information sharing, especially for staff who do not have access to email during the day. As a result, Senior Leader Rounding has become a pillar of communication, enabling staff to hear about hospital happenings and to feel more connected. The leadership guide also gives information on how to approach sensitive topics, such as vaccinating children against the COVID-19 virus.
In 2021, SLR at The Mount Sinai Hospital became not only a best practice, but a communication method that was desperately needed during ongoing surges and change. The program also became a key way for staff to feel connected to their leadership, and to be recognized for their efforts. Leaders also noted that the program helped them to better understand the experience of those on the front lines, and they felt better prepared to support them than they had in 2020.
The leader rounders are supported in transitioning from rounding to problem-solving, inspiring staff, and elevating them to become solution-oriented and to see themselves as able to troubleshoot and engage in interdisciplinary relationships. This effort has deepened communication and teamwork and expanded the notion of “team” to include departments beyond their own.
In December 2021, The Mount Sinai Hospital’s engagement rate for Senior Leader Rounding reached a new height of 78 percent over the last year. The staff have felt deeply supported, and better able to handle the second COVID-19 surge, because they knew their leaders were behind them. In 2022, the Mount Sinai Hospital Senior Leader Rounding program will expand beyond inpatient units to include ambulatory and non-clinical areas of the hospital.
Looking Forward
SLR is continuing to evolve in 2022 and is expected to expand to additional Mount Sinai sites and will incorporate the Press Ganey iRound tool. This tool will align the sites in the questions being asked and the approach being taught. The iRound tool will further support leaders in humble inquiry and engaging in the Rounding Essentials model.
In 2022, the Office of Patient Experience is focusing on recognition and well-being as key areas. By partnering with experts like Jonathan Ripp, MD, and Lauren Peccoralo, MD, from the Center for Well-Being and Resilience, the team is learning more about how to create a psychologically safe space for staff and leaders to connect.
Senior Leader Rounding throughout Mount Sinai has evolved over time to meet the ever-changing circumstances of leaders and staff. Standardization has allowed the executive teams to round with purpose and shared goals. Regular rounding allows the executive team to move outside of meeting rooms, so they can understand daily hospital operations and get to know their staff. Issues that can seem unimportant in a meeting room often gain a different context when seen through the eyes of the staff on the front lines. SLR gives leaders the opportunity to learn from those who know best, their staff.
“Already, we have seen the impact of this important work, and we are looking forward to reporting on further success in 2023,” says Erica Rubinstein, MS, LCSW, CPXP, Vice President, Service Excellence and Patient Experience, Mount Sinai Health System.