Carilion Clinic, a not-for-profit health system based in Roanoke, Virginia, serves nearly one million people through its network of hospitals, practices and specialty services. Like many organizations, Carilion relied on leader rounding to improve patient experience and support quality outcomes. But over time, the process had lost some of its impact.

During our recent webinar with the health system, CipherHealth had the pleasure of speaking with two of their leaders: Brandon Jones, MSN, RN, CPXP, NEA-BC, Director of Patient Experience and Sybil Calhoun, MSN, BSN, RN, Director of Nursing Quality Management.

They shared what went into reimagining leader rounding and making measurable improvements using CipherRounds. One of the clearest signs of progress? Patients reporting that a leader visited them daily rose from the high 60% range to nearly 80%.

The need for structure, ownership and strategy 

At Carilion, leader rounding was happening, but not in a consistent way. 

As Calhoun explained, “The nurse leader rounding and quality device rounding were combined in one script. There were no consistent device usage scripts across the platform, and there were no single point person for access or accountability.”

On top of this, more than 500 unique reports were being sent across the organization, adding complexity without providing clear insights. As the team put it, they knew they needed structure, ownership and strategy.

To address these issues, the team at Carilion sought to:

• Ensure consistency in the rounding process and increase the number of patients receiving round
• Make rounding fill a part of the day-to-day, not an extra task to complete
• Create a mindset shift from a transactional round to a purposeful visit
• Align workflows with achieving experiential quality and safety goals

Redesigning scripts and reporting workflows

Rounding redesign began in June 2023. The first step was to separate overloaded scripts into two clean, purpose-built types: patient rounding for experience and device-specific rounds for safety measures like CLABSI, CAUTI, VAP and HAPI. 

Next, they put script owners in place and formed a steering committee to manage updates, ensuring the process would remain consistent and sustainable.

Custom report packages were then created for each rounding type, giving leaders a simpler way to track what mattered most.

By the following year, teams across the system began requesting their own workflows. Pediatric leaders asked for kid-specific scripts, while the emergency department requested a workflow with a trauma survey. 

Psych and imaging departments followed with their own needs and the resource pool added a staff engagement script. Scripts became specific, actionable and tied directly to goals.

The phases of a leader visit 

Carilion wanted to build more trust and consistency into every patient interaction. They broke the leader visit into three distinct phases to make sure each step had a clear purpose:

• Admission was designed to set expectations. Leaders asked about prior experiences and established what care would look like on the current unit.
• Treatment was designed to verify expectations. Any leader on the unit could check in to ensure promises were being met and celebrate or address issues in real time.
• Discharge was designed to close out the experience. The unit leader confirmed that patients felt safe to go home and addressed any “last chance” questions.

The structure shifted the focus from checklists to connection and made it easier for leaders to catch and resolve issues before discharge.

Turning data into real-time insights 

This shift also changed how committees could use the data. 

Starting in March 2025, quality teams began pulling reports by script usage, patient count and flagged opportunities. They were able to identify specific care gaps, such as missed device protocols or recurring safety concerns. They could then use this information to collaborate with nursing leaders on targeted action plans.

In addition, quality committees were no longer chasing static reports. They could pull dashboards showing script usage, patient counts, and flagged opportunities. They could use those insights to spot missed device protocols or recurring safety issues and work with unit leaders on targeted fixes.

The result? Improvements in both device safety and patient safety.

A culture shift toward purposeful “visits”

Alongside these operational changes came a broader cultural shift. Carilion intentionally moved away from the term “rounds” to “visits,” placing emphasis on purpose and connection. 

Scripts became “guides,” with the flexibility to adapt conversations to patient needs. 

Leaders also began structuring visits around phases of the patient journey: admission, treatment and discharge. This meant interactions were designed to set expectations, verify them and then close the experience.

As Jones explained, the change in language was deliberate, as it helped staff move away from checklists and toward authentic conversations that patients remembered.

Preparing leaders through simulation and training

A key part of Carilion’s redesign was recognizing that being a leader doesn’t automatically prepare someone to connect with patients.

To meet that need, Carilion introduced simulation-based education for nurse leaders. Leaders were shown realistic scenarios pulled from their own units, including “tough scenarios” like an emergency department patient upset about privacy. 

Jones described the program as “a simulation-based educational program to teach our leaders, yes, how to use the tool, yes, how to document, but more importantly, how to communicate and how to make connections with our patients and families.”

Measurable impact on patients and staff

Carilion’s shift from transactional rounds to purposeful visits has made a big difference for patients and staff. As Jones said, “When a leadership visit happens, we see improved safety, improved quality, and improved patient experience.”

Survey scores showed more patients felt seen by leaders, while complaint volume dropped dramatically. Leaders were addressing concerns in the moment instead of after discharge.

Some of the most notable outcomes included: 

• Daily leader visits rose to nearly 80%. More patients reported seeing a leader every day, a significant improvement from the previous rate in the high 60% range.
• Complaint volume dropped by nearly 70%. Leaders were addressing concerns in the moment, preventing issues from escalating after discharge.
• Better trust and experience scores. Patients who reported daily leader visits were much more likely to recommend Carilion, with likelihood-to-recommend scores in the 80th–90th percentile compared to much lower scores when no leader visit was reported.

“We get to share the story,” Jones said, “but this is because of the hard work and dedication of those nursing leaders who are, right now, out having some amazing conversations with patients who are doing this work every single day.”

Ultimately, the team at Carilion was able to transform leader rounding from the ground up, simplifying scripts, creating actionable reports, and shifting the culture toward purposeful visits. 

You can access the full webinar here and if you are interested in learning more about how CipherHealth supports purposeful rounding and nurse visit programs, click here to get in touch with us.