The Power of Rounding in the Emergency Department

Blog post by: Eric W. Heckerson EdD, RN, FACHE, Senior Manager of Learning and Content Development at HealthStream.

Leaders often ask which tool is most effective for improving the patient experience in the emergency department. If they were to select and implement just one item with the most impact for enhancing service in the ED, what would it be? The answer to that question is simple. By far, the most powerful tactic that high-performing leaders can employ to create a patient-centered service culture is rounding. While simple in its premise, the implications and effects of purposeful rounding are remarkably effective. Every leader, staff member, and physician in the ED can use rounding in their practice and should consider how the various types of rounding might work for them in their departments.

Rounding can take on many forms and functions in a hospital; to optimize its effects and ensure the activity is meaningful, rounding should be conducted with a clear purpose in mind. Purposeful rounding is connecting with another person (either staff or patient) with a specific reason or outcome in mind. Leaders can use rounding as the platform for communicating messages and eliciting feedback from others, depending on the type. Information gathered from rounding should be used to improve the department and its operation.

While having an insight into the definition of rounding is helpful, it is also important for leaders to understand what rounding isnot. Rounding is not “management by walking around” or a casual stroll through the department greeting folks as they pass. It is not simply asking, “How are you doing?” in the elevator, saying hello to a patient, or sitting down to have lunch with a direct report in the cafeteria. While such activities are appropriate and generally helpful, purposeful rounding on staff and rounding on patients are much more focused, intentional, and subsequently more effective in changing behavior and achieving desired outcomes.

Four types of rounding are particularly effective in the emergency department setting:

1. Leader rounding on staff (to build a relationship with and communicate with staff).
2. Leader rounding on patients (to validate performance & behaviors).
3. Leader rounding in the ED lobby (waiting room).
4. Staff rounding on patients (to keep patients informed and to proactively interact).

Regardless of the type of rounding, there are five steps leaders should follow and apply to the process. The first is to build a relationship (with staff or patient). The second is to set expectations with the person being rounded on, so he or she understands the goal and purpose of the process. The third step requires focusing the inquiry, which allows the leader to adapt questions to focus on a particular topic or purpose. The fourth step is to close the encounter by thanking the person and outlining what you intend to do with the information shared. Finally, the fifth (and arguably most important) step is to act on the information appropriately. These five actions can guide the interaction, but leaders should keep the process natural and relaxed. The hurried and hectic world of healthcare can tempt leaders into simply “checking the box” and going through the motions; resist that temptation and take the time to really get to know the other person. Also allow time for him/her to get to know you.