In November 2021, CipherHealth partner Inova, Northern Virginia’s largest health system, kicked off its executive rounding program. Inova’s 20,000+ team members provide more than two million patient visits each year through an integrated network of hospitals, primary and specialty care practices, emergency and urgent care centers, outpatient services and destination institutes.
“As Inova continued its transformation journey throughout the pandemic, we recognized the need for a new curriculum to address staff burnout and fatigue across the system,” explained Steve J. Motew, MD, MHA, FACS, Chief, Clinical Enterprise. “We were committed to continuing our transformation but had to acknowledge where we were as a health system. We decided to solely focus on executive rounding to allow our leaders to lean in and connect with frontline staff.”
Here, Motew and the Inova team share their executive rounding story, the impact it has had on frontline teams, and offer advice to other health systems embarking on the journey.
Why Executive Rounding
Inova kicked off its executive rounding program with the goal of supporting its frontline teams – but, most of all, making them feel heard.
While Inova had been doing executive leader rounds previously, it was not systematic and lacked transparency. What’s more, frontline staff (charge nurses, etc.) and mid-level leadership (e.g. clinical directors, nurse managers) had long been asking for more face-time with the executive team. They want executives to see them, to know their suffering as well as their triumphs, and to understand and help with issues that are getting in the way. “Having an executive or C-Suite leader stopping in to say ‘Hi, how are you? What are your barriers and pain points? What do you think about when you drive home?’ provides a sense of empathy and enhanced team support,” said Heather Hunn, BSN, RN, Senior Director of Hospital Services, Performance Advisory (Patient Experience) at Inova Health. “It’s so important to feel heard.”
“You can’t expect excellence from your teams every day without being able to relate to them, building relationships and standing shoulder to shoulder through tough times. That is what this is all about.”
– Steve J. Motew, MD, MHA, FACS, Chief, Clinical Enterprise
Maintaining Transparency
Executive rounds are tracked in a master calendar that is public to everyone in the healthcare system. If a team member wants to see where an executive is going next month, or when a team might be rounded on, that information is readily available. Everything discussed during a round is captured so that when another executive visits, he or she is aware of it. “We like doing it in a little more organized and transparent fashion so that it doesn’t come across as ‘what’s up? I’m having all these leadership people coming to my unit. And that’s a culture switch,” said Hunn.
Reaching Everyone
With more than 100 ambulatory sites, approximately 25 urgent care centers, and multiple freestanding clinics, it was important for Inova to find a way to reach all of their staff members on the frontlines in a meaningful way. Inova added virtual rounds to accommodate remote and hybrid teams. The health system also broke down larger sites, in terms of sheer numbers of team members, into smaller areas. And even then, some areas receive two or three rounds in order to ensure the experience remains personal.
Script Evolution
When the Inova team initially developed the executive rounding script, they received a lot of open-ended responses, but were getting requests to pull out the themes captured. For instance, they received several comments about supply issues and IT-related issues. The team dived into the comments and evolved the script to include checkboxes based on the themes they identified. Now, when executives are rounding, they can easily check the box on what is and isn’t working well. “One of the main benefits of this initiative was to help remove small pebbles or barriers that team members come across, which can range from providing additional communication to fixing IT equipment to supply issues,” expanded Motew.
The evolution to checkboxes enabled the Inova team to take it a step further, creating a ticket-and-alert system to follow up on feedback from the frontline staff – including the aforementioned supply and IT-related issues. If a team member mentions a problem with either, an alert goes to the respective department directly, who handles it immediately.
Executive Rounding and Staffing Needs
Another area the Inova team saw a significant volume of comments on was staffing and the need for additional support, such as “we need another night shift tech.” The Human Resources department receives monthly reports on the executive rounds, and if something is a high-priority, it is flagged for immediate attention. Human Resources uses the direct feedback to guide their recruiting efforts.
Impact on the Frontline
When the Inova leadership team talks to frontline staff, they find that if they mention an executive’s name, they get “Oh yeah, we saw them” or “we know who they are” now. This has been especially important for ambulatory sites who used to never see executives in person. Since executive rounding is scheduled in advance, frontline staff can now prepare for their visit to make sure they ask questions and share important information.
Hunn recalled an early round she did with the CIO. A new system had recently been installed, and there were a few hiccups as they got it up and running. The frontline staff was able to ask him questions face-to-face, and he was able to communicate the fix and timeframe, greatly improving staff engagement. “The beauty and the value to the frontline time is they get answers to something they feel like they’ve been asking for over and over. They finally get to the right person,” said Hunn.
“The executive rounding program gives senior leaders a structured process to build a role-model relationship, check in with an individual, and provide empathy and understanding about what’s going on in their daily work life, which we believe makes a difference,” added Motew.
A Surprising Benefit
One thing the Inova team didn’t expect? For executives to bond during their rounds. The program pairs up leaders who don’t necessarily have something in common; leaders who have met or worked together can find themselves rounding together. And then, when they see the frontline staff, it’s that much more rewarding for them.
“From my perspective, each senior leader is fully engaged in the program and everyone talks about the impact, whether something was solved or a new relationship was made,” said Motew. “As a reasonably large health system, you can feel the energy shift based on how frequently our teams – whether virtual, ambulatory practice or hospital-based – are engaged on a consistent basis.”
Lessons Learned
When asked whether – and why – health systems should implement executive rounding programs, Motew is very clear.
“Your frontline team members are your #1 priority,” he said. Why wouldn’t you do this? You can’t expect excellence from your teams every day without being able to relate to them, building relationships and standing shoulder to shoulder through tough times. That is what this is all about. Your ‘why’ should be aligned with your organizational mission, vision, and values. Ours is, and this gave us a much needed boost through a pandemic. Putting your leaders out to connect with team members is one thing, but equipping them with the structure to close the loop is another – and that’s what we consider excellence.”
