Hello good afternoon and welcome to today's event. We are covering rounding for high reliability. Uh, this is the final, uh, event for the year.
We appreciate you joining and making it through with us. This 1 is really, uh, a great way to kind of wrap it up for the year as we approach the holidays. I is really talking about, um, making sure that we're looking out for the human aspect, um, you know, our hospital environments in our healthcare environments and really taking care of attending, and recognizing the complexities that exist when humans and systems interact.
Well, if you've been with us before, this is going to be old hat for you when I cover the introduction, uh, slides, just a few housekeeping issues. We want to be sure that you participate as, you know, this is going to be interactive when we look forward to.
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Well, it is my pleasure to introduce.
Our faculty from safe and reliable. I'd 1st, like to introduce Donna novella. Donna is an experienced health care and patient safety expert who spent her clinical career in pediatrics and the emergency department.
She spent the last 15 years dedicated to quality and patient safety and held several operational leadership roles where she designed developed and implemented patient safety programs, using high reliability concepts for both freestanding and academic children's hospitals.
Connecticut in donna's, most recent role as director of patient safety and quality for the kinetic Connecticut hospital association she implemented a large scale, statewide improvement projects in all of acute care hospitals across kinetic Connecticut. She received her bachelors of science in nursing and Sacred Heart University.
In her masters of science and nursing from Yale University currently she lives in beautiful Sandy Hook, Connecticut with her family.
She's joined by Dr. Kennerley. Dr. Kelly is a physician leader who has focused half of his 40 year career and improving the quality and safety of patient care after medical school and residency.
He was a full time faculty member in internal medicine at University of Texas, South, Western medical center where he taught students in residence, did basic science research, and implemented a patient centered disease management program for 20,000 patients with asthma, seeing both the power and failings of health care led to executive work at the bailer health care system where he developed patient safety program across its 10 hospitals and many outpatient clinics, he developed and published methods to measure patient injury. And let other improvements as chief quality officer. After leaving executive work Dr. generally has spent the last 6 years sharing lessons, learned with consulting clients committed to delivering care that we all would want for our own families.
He has published 50 papers or book chapters received a variety of national awards and grants and helped found 2 patients, centered nonprofit organizations. Dr. and Donna. Welcome to today's call. I appreciate you. Both being on.
Dr. Kennelly you may be on mute again. Always happen. Sorry. Uh, Victor, thank you for that. A nice introduction and, and, uh, for your support always and we'll be, uh, we'll be talking today, uh, about really an important technique.
I will talk about rounding and, uh, and it's really a great way for, uh, for all of you, uh, to be able to participate in. Of different ways. Let's go to that next slide, Victor.
Um, I want to emphasize, and that's why, it's in such gigantic letters here that, uh, as you round in the different parts of the organization with different methods that Donna, and I are going to be, uh, sharing with you in a, just a few minutes it's really important that it feel to the people you're talking with, that you are being.
Authentic that they're seeing the real you and that the real you is candid and is a humble and I'm not trying to be too glossy. Uh, we all have our own imperfections. And, you know, really what's important is that we try to help others to improve. But to make sure that we recognize and let others know that we're not perfect.
Either, and, uh, and that authenticity really helps with generating traction with the people that you're talking with during a variety of different kinds of rounding.
And so we've got on the bottom of the slide, uh, a, uh, uh, some things that, I think work very well together. We call it the authenticity equation.
You might have seen it in the previous presentation, but I'll repeat it here which is that. I think we all need. Need to be self-aware and to understand how we're coming across and what our biases are.
We have to be a have skills and use them effectively and we have to behave in ways that are engaging and comfortable with the people to whom we are speaking. We have important activities that oftentimes involve a lot of listening and trying to. To hear and not be trying to solve everyone's problems necessarily, but to listen and understand and to be consistent about these different aspects of the behaviors that we show people and that really together they, uh, they describe authenticity next slide.
So, let's talk now we're going to be covering a series of different kinds of rounding that happened in many of your organizations. Perhaps already. Some might be new to you.
But I think the reason that we're going to be talking about them separately is because I think each of them has a different approach and use may use a slightly different skill set.
So, again, it's not just rounding isn't a 1 size fits all. Again, there are lots of approaches and we'll cover many of them. We won't cover all of them, but we will cover the ones that are commonly used.
So, we're going to be sharing different methods that we hope will be useful to you as you are visiting different kinds of groups in the organization where you find yourselves.
So, now I'm going to turn this over to Donna for a few slides.
Done so I just want to emphasize 1 of the things that Don said in the opening. And that's really what an important tool rounding is for leadership.
And I think that when we find ourselves with a packed calendar and, you know, less time to do, what is, feels the most important to us I would say, calendaring in rounding and making sure.
It's a part of your weekly work is probably 1 of the highest return.
Investments you're going to get for the work you're doing. So we're just going to kind of look at why rounding is so important to leadership and to your units and to your teams. And if we just look at what we have on this slide here, it's really about. As a leader being better informed, and understanding what's happening on your unit, or in your division, or, um, in you’re in your hospital. If you're a leader, that's a, um. You know, an executive leadership person, who's going to be really rounding in all different areas it's a, it is the 1 of the best ways to build relationships with your team members and your staff on your unit as well as folks outside your units.
Um, it's really important in terms of informing people outside of your unit partners that you work with, like, respiratory therapy, physical therapy whomever else is on your unit about, uh, initiatives happening or, uh. You know, up things you want to alert people on, it's a really important way to initiate those conversations. Um. It is a way to promote awareness around things.
So, if you're doing a specific initiative, like, around classy reduction, using your time, when you're rounding to promote those initiatives or the awareness and the attention you want to give a particular topic rounding is the perfect way to do that and really building credibility and trustworthiness of staff, and I think in this day and age where we're really working hard to. Improve burnout and how people feel about being at work, this is rounding is 1 of the ways that I think is a really effective tool in establishing your credibility as a leader with your teams and developing trust. You know, the next slide please.
So, um, you know, as we, as we talked about just a moment ago, uh, the activities that are fostered during rounding or trust between the leadership and the staff, and that's really based in this idea of your team feeling, as though they have a voice and that someone cares, they're being listened to and when I say team, I could mean, you know, a nurse manager speaking with the.
Staff, I could be a director referring to her team of nurse managers, or his team of nurse managers. I can be referring to an executive with their team of directors.
So really think about this sort of, in how you operate operationally cascade information. When I refer to team, it can be in any of those.
So, having that trust with your with your leadership is critical to feeling like.
Your valued at work, um, it's a way to promote very effective communication. Um, and again it's a way to receive and deliver valuable information. That's important in your institution.
It's a very good way to receive feedback as a unit leader to get feedback from patients.
And staff, and again, as you kind of go up that love the levels of leadership, uh, really understanding where your team is in terms of, uh.
How they're doing their work, it is a way certainly 1 of the most effective ways to grow psychological safety and we know from previous webinars that we've discussed psychological safety.
It really? When you're when your staff feels a level of psychological safety, or your team does, that will increase the wellbeing of that group of people because they're going to be feel as though they are cared about. They have a voice in how they do their work. And they can raise.
So, it kind of validates, sort of their importance and their role within, um, within the institution. So, Don, I don't know if you before we start on sort of the specific, different types of rounding.
I wanted to know if you had any reflections or any thoughts that you wanted to add at this point. Sure, you said it very well done it and I'll just emphasize 1 point, which is that.
Many of you have by definition, your position has authority and you have power. And so what you say matters.
But the thing that is really important is the traction you get with that power. And, uh, and I think it's, it's a lot like, I mean, we're coming into the winter season, perhaps not so much nowhere we live. But, uh, uh, you can have a lot of power in your car and it doesn't spin the wheels. Um, and, uh, on the other hand, if you have good traction, but not the right message, you're going nowhere.
So I think there's an important component of rounding really creating traction. So that, in in effect, you help people understand why you think something's important and that so that they can, uh, they can resonate with that or maybe even push back on it. But what happened. Is rounding is a very powerful tool for generating engagement or as is I like to think of as traction.
Thank you John and, um, I, I wholeheartedly agree and I think it's important to keep this in mind as we start to move through the different types of rounding that we're going to present and the way we are framing this is sort of what type of rounding is it how to do that?
Um, you know, in a general sense, obviously, we're, we're going to not get super specific, but how to do that and why that type of rounding is important. So, if we can go to the next slide, we're going to start with, um, patient rounding.
So this would be, uh, you know, self-explanatory rounding on patients themselves.
I think the 1st, bullet point here is critical and that is that this is, uh, you know, it can be very delicate to speak with someone when they're in the hospital. Not feeling.
Well, you really have to sort of time visits to patients appropriately. You want to make sure that it's 1 on 1 if they have a family member with them, you want to ask their permission to speak in front of the family. Remember really always respecting that patient's privacy. 1 of the things that's important about patient rounding is before you walk in a room, you need to check with the care team providing care for that patient.
The nurse that's assigned to that patient to make sure it's okay to speak to that patient. At that time, you can have someone who's had like, the worst night's sleep and was up all night and pain and it's just dozing off and, you know, walk in the room. It's not going to go well, so really making sure.
For that it's appropriate to speak with the patient timing wise, sort of their acuity level wise, and that you're not interrupting something that's going to be time set.
You know, like the care team has an assignment to do with the patient. During the time you're approaching the room, so just check in and make sure that that's the timing is appropriate. Um. A 100% you need to sit down, uh, if you can, uh, I can think of only a few scenarios where that wouldn't be possible, but, uh, for the most part, you want to sit down for obvious reasons. Right?
You don't want to be loading over somebody and asking how their care is, you want to sit next to them and really make this about a conversation. Um, and in that conversation, you want to ask open ended questions, um, often yes.
Or no questions will really give you either a very limited obviously point of view. Or are more likely to give you, maybe the answer you want to hear, versus the answer that you need to hear.
So, as a leader, you need to listen very carefully to the words that are being said, and to the expression on the patient's face and to really hear if they're messaging something without saying, the words patients are vulnerable.
And they may be a little bit concerned about being super upfront. So it's really important to listen very carefully to what they're trying to tell you the other important things to avoid.
Interrupting them and I know, you know, this is obviously you have to use this with, you know, with some common sense. So you, you don't want somebody to go on for 45 minutes necessarily if you have sort of time, limited, limited time with each person. Um, but you don't want to interrupt, um.
To sort of defend a point or to correct. Let them finish what they have to say, and then give feedback to them.
Um, and it's a really important, uh, way to learn what's not working through the patient's eyes. So, I think we, of course, all do our best to give the best patient care possible and to design systems that are efficient, but also work for patients. And I think we can occasionally in a very.
Complex system like health care lose sight of that. So it's important to really get the perspective of the patient. It's also a way that really creates the patient will perceive a genuine sense of caring. And especially if this conversation is done with the authenticity that Don talked about earlier, you don't want to come in rushed you know, they're, they're watching you.
They're going to look at you that you have to go in there really with sort of an open mind with the right tone of voice with the time to sit down and talk and doing this kind of.
Patient rounding where you really get perspective from the patients is a really good way to earn credibility with your staff. Because then you're going to be able to give information back to the staff that they're going to know. You understand what it's like for them to be sort of at the bedside, because you're going to get that, like that feedback you know, real feedback.
Not just about how you're going to, like, talk about how systems are designed, you're going to actually know if it's working or not.
What's really happening, because you're going to get that from the patient um, Don, do you have any, other anything else you want to add if not I'm going to turn it over to you for the, next set of, uh, uh, patient rounding information no, I think a very good point and I think it's really, um, I think what's key. I think, for me, it's I think we're often hoping the patient's going to say something nice and complimentary. Um, but I like what Donna said. Is what you want to hear versus what you need to hear and so I think that's very important and so trying not to shape their response by, you know, don't you, or, you know, you know, you know. Yeah, he's going to restaurants and then saying, you know, how was the food was a great, you know, and I think similarly, here, I think what we want to do is seem very receptive to someone who's disappointed.
Okay, so let's move ahead.
Um, and, uh, the next type of rounding is something that was actually new to me when I, uh, the number of years ago, when I was, uh, uh, sort of an early in my executive career, and it has to do with rounding on just really how, you know about, uh, the, the workplace in particular and the here, uh, the idea is for a leader. And again, it can be a, it can be a unit manager doing this with the head of facilities, oftentimes the executives, or the chief nursing officer, uh, or other executives like the or the or the CEO, or even the CFO. Uh, so a small group.
You don't want a big gaggle of people you walk through 1 or 2 locations every month and I think the idea there is to, uh, again not have this be a big production, it's not you don't want tons of the unit people there.
This is not that trying to do something in front of an audience, but it's to notice what really is not a, it looks like it needs to be fixed and easy things in the environment of care. What do I mean by that?
Uh, in the 1st time, I, I did this, there was a, a doormat, uh, that had a turned up edge and it was just a, it was a trip hazard for sure.
In another place, uh, we asked the people who we did a bump into, you know, whether there was anything that needed to be, uh, fixed, that was part of the environment of care. And they said, well, you know, this store here doesn't lock.
And, and, you know, I, I've been complaining about it for a while so this is a way to generate a little more energy because you've got a leader now, particularly with the facilities person, if they're willing to do this with you.
And that will tell you what's broken and needs to be improved or replaced and I think WH, 1 of the things that's really important is to, uh, is to be sure that if you see something and it's and again, you're with other people, it's important to either explain why you're not going to fix it maybe, because in 2 months, there's to be a general upgrade but, um, following through is incredibly important for the people who see you to note that you're serious about this and you're not doing this just for sort of, for show if you will.
And I think the, the outcome of doing this successfully. And again, you don't, you probably only need to round on a given unit every year or 2, but if you go to different places and you.
You notice, kind of what's going on in units, or in the, uh, in the waiting rooms in some areas, and you'll be able to, to try to create an environment. That really is conducive to excellence.
And what do I mean, by that, that it makes the people who work there feel good because it's in good repair you wouldn't want your home to have certain kinds of things there because it reflects on.
You, uh, is the home owner or renter and, uh, because that's your home I mean, are you really willing to tolerate that? And so, as a result, uh, it shows that you have a high expectation for, um, really taking good care of the environment in which our patients and our staff are working and that you really want to take pride in, uh, in it. And, uh, and that's something that, uh. Not only the staff notice, but certainly the patient's notice as well. Um, and certainly cleanliness. Sometimes some places don't, uh, don't get a floor wax very often, you know, or get a stripping then, uh, you know, on the floor. So they're not shiny.
Um, you know, really take a look at that and see if that's if that's something that could help I think it was also quite helpful for senior executives to be able to be.
Talking about their capital spending and to take a look at things and to see not just these individual small items, but maybe a whole area looks a little run down and need some decorating means a better chairs and a variety of other things.
And I think the, the benefit beyond the environment itself is really, uh, uh, the credibility that you earn with the staff buy, in fact, seeing things that are, uh, don't look good and that you're not proud. And then converting them to things that you are proud of, and that they're proud of too.
And it shows that you really do care about the environment in which patients and staff find themselves when they're in your organization done any thoughts from, you.
Yeah, I mean, I always loved when I was an operational leader, and we had environment of care rounds because when you live in the area that you're working in, you're there every day or just even like, in your own house, you kind of get used to things and you forget how bad they look and, um, my husband just fixed a very small window that's been broken for, like, 2 months.
And, uh, I was like, oh, my God, I forgot how bad that looked because you just get kind of accustomed to it. So, um. It's nice to have outside eyes, I guess, is my basic message there. Um because you kind of can get those things can get lost if you see them every day.
Okay, so, I guess Europe, the next 1, I am next slide please we're going to talk about patient safety rounding so, um, you know, it's pretty obvious why we do patient safety rounding, which is to understand, um, from our team members, what gets in the way of safe care, and, uh, we want to try to, you know, remediate as soon as possible if we can what those issues are. You know, when you're doing patient safety round, and there's a couple of different ways, you can do them. 1 is very small groups. Um, or the other is 1 on 1, but this really needs to be done in a setting in which people feel safe to raise issues.
So, you don't want to be doing this, like, in front of your locator board, or your whiteboard, you want to do this sort of in a semi private way to kind of allow people to speak up and feel like they could be open about speaking up. And, and when. You're doing patient safety rounding and you can really get sort of a.
Like, a garden variety of things that people will bring up from somebody's disruptive behavior to, you know, um, staffing is always a big 1 people like to raise or specific processes or policies, or even sometimes down to sort of the care of a specific patient. So, it's really important to frame your questions appropriately when you're talking patient safety and I know that staffing is a big issue for a lot of us a lot of hospitals now, and I think 1 of the important things you can do is sort of acknowledge that, but frame the rounds to kind of stay away from that conversation because you're not going to be able to solve it in that one conversation and you also don't want it to distract away from other things you may not know about, you know, about staffing you all know painfully well about the needs of your staffing. So, maybe to start your rounds with. I know. Let's just put it on the table, I know that staffing is an issue or working on that from, you know, a hospital perspective. I want to talk specifically about things that are keeping you up at night around patient care, or ways that you think a patient could be harmed here.
And that will sort of steer people away from, you know, frankly a conversation. That is not going to be productive in terms of you being able to really do a whole heck of a lot. Um, it is important to continue to ask questions and get clarity when you are doing patient safety rounding and this is done with again either like a small group like, maybe a few patient care tax or a couple of nurses or a specifically a nurse. You know get, you know, just having somebody who's grabbing someone for a few minutes alone to say, hey, during my patient safety rounds, anything you want to talk about is there anything keeping you up at night but you want to do this in a way. That is feel safe for people to raise issues.
You also want to write things down and the reason it's important to take notes during these rounding is because the, the follow up on this on these issues is critical. So, if somebody, if you are. Conveying to a group or an individual that you are, you want to hear what they have to say about patient safety. You are, you need to follow up and close the loop on what you've done with their concern.
So, you know, it may not be something. You could fix right away. It could be let's say there's an issue with how someone says. Oh, I'm concerned about how our smart pumps, how we're dosing Heparin or smart bumps. I'm making this up. Right? You may not be able to immediately fix that, but you can. Go back to that person who raised that issue and say, hey, I heard what you said, I went to our pharmacy team we're working with biomedical engineering. Do you have any suggestions really keeping that dialogue going, but if you're going to hear from someone and not follow up, you're better off not asking the question at all because it does more harm than good. So take notes make sure you understand. The issue or concern with regards to patient safety and make sure you have, um, you commit to following up, um, you know, patient safety is 1 of those things, it’s a part of everybody's mission vision and values in terms of their hospital. Um, you know, their hospital goals, and, and there's a reality to this that, you know, you have people's lives that's in your hands right? Lives are at stake.
So this is not one of those things that you can take lightly. Um, this is something you have to be.
Specific, you have to be prepared to take action and you have to be prepared for follow up. I also, um, you know, do, like to tell people like, you know, certainly, if there's something that you want to keep confidential if someone says, oh, I had an issue the other day and, um, you know, I tried to raise a concern and there was some, you know somebody a physician who kind of shut me down and when listen to me and I was, you know, I didn't know what to do. Those are the kinds of things that you can.
You could say to folks, I mean, I will keep this in confidence let's put in an event report, so we can get this in the right channels for resolution. So there's, you know, there's different ways to go about this.
Some of these topics are going to be sensitive and people are going to want to keep confidential. Others are things that may prompt conversation at the next staff meeting frankly. So, you're really going to have to kind of sort through sort of the privacy piece of this, depending on the issue. And I think it's really important that it's hard to remember all the details. So it's important that you take notes. So that you understand. What, how you need to do to follow up and what kind of follow up needs to happen? Um. Done anything else on patient safety rounding sure no a good job on that. I think uh, 1 of the things I'll just emphasize is that in in the past, there was sort of this view.
That patient safety rounding was, it was kind of like a big event, and that, you know, somebody would go into a back room and a, and then people would sort of come and go from the back room to kind of talk about patient safety. And, um, and you can do it that way. Um. But it feels a little stiff, uh, and it feels as though it's kind of, uh, choreographed in some respects. Uh, and so, I think 1 of the things, I really think it's, it's a stand up kind of activity that you have with, uh, with people and, um, and I think it's always ask, do you have a couple minutes? You know, because if it isn't the right time, um, you know, you need to move on, uh, it isn't, it isn't to the person, if they're in the middle of doing something important to, uh, to even if you might, it doesn't take a long time to talk to them. Typically just, you know, 4 or 5 maybe 6 minutes at most. But I think it is. Um, but it's much better to say. Well, I'm actually I'm doing if they're saying that they've got something they're doing is to say that's fine. I'll come back. We'll talk another time. Um, so that it feels like it's not a big production. What you're really doing is just trying to sort of talk to some of the people who are there and, uh, and making sure that it is not, uh, felt to be invasive, uh, of the, uh, of the unit. And I think it's, um, I think this notion of, um, you know, what keeps you up at night it goes wrong is, um, is really, uh, tends to work out pretty well. And, uh, but I think it, you know, there are lots of other ways to put it in your own words. You know, if you know, that may sound a little stiff to you. But, um, another thing that is, um, if someone doesn't have anything to say, might be to just ask them. Um, uh, can you tell me about the last close call you've had on your unit? And, um, and that's often helpful because if someone has nothing to say, uh, then that's then that's kind of concerning that that's a finding in and of itself. So right, and thank you John for mentioning and I think this goes for all the rounding that this can't be something that interrupts, you know, important activity. So I appreciate you. Adding that for sure. Thank you. Okay, well, let's, uh, let's move on to the next 1 and I'll talk about a kind of rounding that, uh, really was sort of, the classical rounding that, uh, that many executives had done for many, many years. And it's kind of what I refer to, as kind of a classic kind of light touch, kind of approach where the goal really is to create connection to the individuals, uh, in a unit and to perhaps gather a few. High level issues, but it's not as focused on something like patient safety or the environment of care. And so I think it's important to go to all the units.
And the objective there. I've, I've written down, you know, take the temperature of the unit and the way that you can do that is to be asking, you know, how are things going here? Um, and then, uh, with again, uh, usually a small group, uh, if, uh, or individuals, and certainly not a large group, because I think people get a little more inhibited about telling you things that don't work. So well, once you start having, uh, you know, 3 or 4 people in a group, because I think they're just a little worried that someone might quote them on that. And then, and they may not feel a psychologically safe. Um. And so just asking.
How things are going on the unit and another approach, which is as good as, you know, how things going for you. And so that and there, you know, you might again try to keep it open minded. They might say, hey, you know, I just had a, we just had new baby in our family. And, uh, and so that gives you a chance to be positive about that or just to say, wow, you know, they might be willing to share that they're going through a rough patch. Because 1 of the family members is sick or something like that. And just the act of being interested in them as a person and it doesn't have to be something that's heavy or aggressive, but just hey, how things going for you. You know, uh, really, uh, in a, in an authentic way, creates a connection and over time, uh, you'll get to know, uh, the people who are in the unit, if you don't already and it builds relationships and the long term credibility and, uh, and hopefully you can have these conversations in a way that you can, uh, both gather information, but you can also share a practical. Good news I hate that, you know, we just got this, uh, uh, some approval to be, uh, upgrading the, uh, the parking lot, or we're going to be adding lights to the parking lot.
So, it's safer, or, uh, we're going to be, um, doing something else that's relevant. And it's, it's a nice way to, to, uh, to share good news before it's widely known. Uh, if you've got something to share with the staff and I think 1 of the things is, uh, that I think can be is an option, uh, depending on kind of your how deep you're trying to get into sort of an issue based, uh, exploration is to be, uh, uh, asking. This is a question that I've, I've asked for a number of years and then it says what gets in the way of you having a good day and a, and that then it can also be what gets in the way of patients having a good a day, so, if you're talking about it, from the staff's perspective, you get that information, or if you say gets in the way of, uh, uh, the, you know, patients having a good day and, you know, hey, they may say, well, my gosh, you know, you know, I never know when the dietary is going to bring the lunch trays, you know, and that's, uh, so, uh, you know, that's really an issue because some people are diabetic and they need on a schedule and, you know, it's a, it's an issue. Uh, so, uh, so clearly, um, finding out what are, is 1 of our, uh, sort of founding principles. Uh, Michael Leonard says is what's the Pebble in your shoe, you know, uh, and, uh, and finding out, uh, about those. So that if you ask about them, though, be prepared to be, uh, not only, uh, I guess, uh, thoughtful and sensitive to them, but they're willing to.
Do something about them if you can uh, so, uh, you know, the only thing worse than not asking is asking hearing a problem and then ignoring it. So, it's better not to know. And again, this is just a nice way to create connection with the unit. So that when you have something as a leader that you're hoping to move forward again, it's, it's that thing that gives you traction. Um, uh, in the future, because, in fact, you have credibility, uh, with the team, you're interested, you want to hear their voice, uh, and you have that credibility comes from authentic, uh, situational awareness because you've been there. You've seen people you've seen what's going on and, you know, when, uh, units having, uh, has had a tough day, you may not want to go down, right? And you may hear about it.
You probably don't want to go down right in the middle some, some leaders.
Just dive, right in, you know, into the middle of an issue. Well, if they can really help, that's fine, but don't jump into the middle of something you can't really fix but the next day is a great time to say.
Wow, I heard this was really a tough day yesterday, you know, and I'm sorry about that. Is there anything I need to know about it? Uh, so those are the kinds of things that are pretty motivating for Sam. Donna what can you add to that?
I think just that we are in this time and place and healthcare, that really just asking people how they're doing is critical to making people feel like, you know, cared about at work. And I think this is 1 of the ways, just as rounding for connection. Is 1 of the ways that I think can achieve that, and, you know, if you are a unit leader, or if you're like a quality director and you, you know, are on the units. Often enough, and, you know, people, well, enough to sort of make those personal connections like, hey, how’s you know, your son's soccer team doing things like that? Make people feel like oh, somebody actually knows me and cares about me or if you hear through someone else.
Hey, you know, I heard you guys went on this awesome trip this weekend, you know, tell me about where you went, just those kind of casual conversations, which have seemed to be really hard to have lately because everyone's so busy just that few minutes. Action, I think goes a long way, so I'm, I'm all for this rounding for connection I think it's important it is. And, you know, that actually reminds me of what I what I did when I went to a unit. I mean, I don't have the world's best memory, uh, especially for names, but I do long enough to sort of, uh, when I, I sort of lead the unit is to write down someone's name that I talked to. Uh, and something that I I learned from them, when you go back, you got that to sort of take a look at because, and as Donna says, that makes them really feel like they matter. Okay.
All righty, let's go on to the next slide we're just going to take a little break here to talk about, um, individual and collective situational awareness. And I think on that last slide, you saw where it, it says create situational awareness and this, this is really, you know, pretty self-explanatory this diagram. Um.
Where it's really all about sort of BI, directional communication and understanding team members have situational awareness from what you have to say as a leader and vice versa and, you know, having, uh, everybody sort of rowing in the same direction is really important. And 1 of the ways that you can do, that is like, sort of through sharing situational awareness, like, being out on the unit understanding what's going on or promoting, like. We're working on cloudy reduction and gathering ideas or feedback from other team members to incorporate into your overall message.
This is really 1 of those sort of, um, you know, continual loops that situational awareness is 1 of the foundational things of high reliability. Everybody understands the same thing at the same time and so all of these rounding techniques really promote. Proactive situational awareness. I don't know if you want to add to that. I think you said it. Well um, so let's move on.
Okay, this is this is something that I think is, um, again, wasn't something I knew a great deal about. And, uh, and I think it's a really important technique. And, uh, uh, if you want to sort of read something about this, Jim Reinertsen, um, who's been in healthcare quality for many years, wrote a nice piece.
And, um, that's posted on the website so that if you go to the website, you can just search rounding to influence or and, uh, and re, read about it. This is a little bit of a, a trickier kind of approach because it involves, uh, the potential for you to kind of change directions a little bit, depending on what you're here. And, uh, and so I think it's, uh, for this. The idea is. That you're going to a unit with the idea that you would like to be influencing them to be doing something more or differently. And, uh, and, uh, you'll be gathering information to some degree. But really what you want to do is be influencing those who are on the unit to be doing things that you think are important, um, towards a certain outcomes or processes. So, again, you've got a key. And, uh, and it might be something that has to do with, uh, uh, oh, I don't know, uh, falls for example, and, uh, and you want to go there and not that the unit's got some terrible fall rate or whatever but to, in a sense engage in them so that, uh, what you can do is you better understand what the barriers are and what people are actually doing. And, uh, and so, uh. The idea is, like, some of these others is and it really is good. If it's 1 on 1 this is this is better, not to do with multiple people on the unit. Uh, the only time I ever do it with another person is when I'm teaching somebody how to do this and, uh, and so, uh, again important to have those, you know, not total privacy, but some level of privacy so people aren't listening and it's a relatively short. And the idea is that. You know, you might want to be, uh, uh, talking about fall prevention and just to say, um, hey, listen, you know, I'm sure, uh, you know, uh, you're working on a full prevention.
How are those, uh, uh, new, um, how’s the new those new socks that have? Uh, how’s that going?
Well, um, then because you want to have a different color sock that have a traction on the bottom and people can tell that there are a fall risk. If that's what they're doing, and there are about a 1Million different things you can do for fall prevention. Um, but, um, then then they, they can say, well, you know what, uh, we ran out of those about a, you know 3 weeks ago, or, uh, uh, hey, you know, uh, it's just, it's just that they don't fit very well and patients don't like them. So now, you know, that there's a pushback in terms of how, um, it's working, uh, and the, uh. If you're working on, other kinds of things, you might, uh, you know, hand washing hey, you know, the, the, in the past there were there weren't enough stations to do hand washing, you know, uh, in terms of, to be able to do that effectively. And so, uh, what the idea is, is you, you're trying to say, how is it going, you know, are you doing this thing that we're hoping you're doing? And, uh, and I think, as you do that, it's important to.
Emphasize why this thing that you're, you're asking them about connects to the core values of the information the institution again, this is the, what we tend to call the 4 c's that it connects to a core value. So that you say, well, you know, I'm sure you understand that what we're trying to do is to reduce false injuries because we're committed to patients staying safe. Uh, and, uh, and the can do is the thing that, that you're, uh. You may be asking about it has to do with what they can do in order to, to be, uh, helping, make things work out. Um, and so, as a result of the, excuse me, my computers.
Doing something show up here and I need to get rid of it. Sorry, I was making noise and I've dismissed it. I apologize. Uh, and so what does the can do what's your help what you're hoping they're going to do?
Hey, what gets in the way that the sea of concerns and then, uh, uh, if, uh, perhaps, again, it's something that they've been doing. Incompletely can, uh, the, uh, commitment part is hey, can I count on you to, uh, to be doing this, uh, more regularly? Um, and, uh, and then hopefully they, they'll.
Say, yes, and off, you'll go. So, what you've done is you maybe move someone from sort of cautious willingness to do the thing that you want some time to doing it.
All the time the other thing that is important is that if they're doing what you want is to say, well, how you think it's going for the other members of the team.
And so, uh, you know, and if they say, well, you know, I think it's hard for some of our team members to do it. Um, and 1 of the things you can then do, is to say, well, listen, you know, it would be great.
Would you, would you be willing to be a champion to sort of advocate for this on your unit? And, uh, and then if there are other problems about being able to do it, I'm going to come back in a couple of weeks and, uh, check with you. And see how that's going. Um, and so whenever, uh.
You do make a commitment to check back and again to thank them for being an advocate for something. That's important. Uh, you be sure that you actually wind up doing that.
And I guarantee you that if you come and, you know, instead of sending out an email to throngs of people saying, you know, please do this process that we want you to do.
If you go to the units, talk to a few people, ask what's hard to do about it and if they are doing it. We creates kind of a buzz, hey, you know, the executive came by and did that and sometimes, uh, if you're a unit manager, you can certainly do it on your own unit, but you can go to another unit.
And, uh, be asking what's going on there, because maybe there are things you need to know about.
And, uh, and to create staff awareness that this is a priority of the organization because what you care about matters and, uh, and the goal really is to increase adherence. Uh, to, uh, and to kind of behaviors, uh, that you would really like to do, or, if you've got something where you're doing a bundle and you're trying to get a bunch of things done in a short period of time, or what gets in the way of doing this in the. Timely way, you know, and knowing about that may be able to help you to go back and do some redesigning as far as that's concerned. So, the goal is really to promote desired uh.
Uh, the progress on projects that matter, and, uh, if, uh, if the unit has a learning board, that's a great time to do that, too, is to swing by the union the learning board. See, what's up there?
See, what uh, is being displayed? Is it is it, you know, sort of, uh, sort of important kind of things or or lesson and then that's just a, and if it's more important things to talk about issues.
Then, uh, you know, you can say, hey, can somebody run through this with me and show me what, uh, what's out there uh, love to know how that's going here. And I think it, it just really helps with everything, uh, moving forward and creates energy on the unit and it builds your own credibility and trustworthiness, uh, in terms of follow up.
Uh, so, uh, I think it's, it's very powerful. It's a little tricky because you have to alter your conversation, depending on. Whether somebody says, oh, I never do it. I always do it. I sometimes do it or, you know, I get, them, something gets in the way. Yes. Or no. So you have to be a little flexible Don I'm sure you've used this about a one million times. What? I did, I was just going to say this is 1 of my favorite ways around. Actually, I find it really effective.
I actually would use our where I, when we use this, we have a piece of paper that actually had core value can do concerns commitment and we would jot down just key phrases for ourselves and what our key messaging was, because it is not super easy. It takes a little nuance. It takes a little practice.
It's, you know, when you get good at it, you don't need the little paper to prompt you but I use that in the beginning. And I would always find that the commitment piece when I was teaching rounding to influence to other leaders would be the part.
They would feel most uncomfortable with so sort of just forcing yourself. To be, like, can I count on you? You know, the next time you do address and change to make sure you dot dot, whatever it is whatever or can I count on you to wash in and washed out and promote that with other folks or can I count on you to speak up? You know, about hand washing if you see someone who isn't complying with our handwashing, um, you know, rules, that's the commitment piece. That sort of wraps up your conversation. And I think it's a really important part of it because it doesn't leave things open ended. It kind of gives you sort of the, the whole reason I'm talking to you is because I'm asking you to do this. Can I count on you to do that? So I love this. Um, I think that has a great that you mentioned.
That's a great resource. And if you're going to have to put some time and intensity to any 1 of these rounding techniques if you asked me, I would say using rounding to influence to sort of move the dial on things like or your hand washing compliance numbers. I would use this technique. I think it's really effective. Thank you. All right. Let's go on to the last uh, I think our last type of rounding that we're going to talk about today, which is that? Right? Is it the last 1? Yeah, which is a town hall rounding now? This is sort of many of you may know this type of rounding in terms of what happens hospital wide.
This is usually something done with done organizationally. You know, with a larger group of people, this could be maybe division based or would be something that's done broadly buyer by your folks that are the C suite level. And this is really to give sort of updates on what's happening currently in the organization. What are the future direction? Kind of? Big, big picture more strategic information. It's a great place to share performance data to tell stories to thank staff.
There's a couple different ways that I've seen town halls done some, you submit questions ahead of time. And so the, the answers get the question, and the answer gets hap, happens, sort of, in 1 in 1 fell swoop by whoever's facilitating the town hall, or they have people put cards in and you can pull a card and ask a question from the cards. That's a little more spontaneous 1 of the other suggestions here. Is that staff can write down things that they perceive are low value and what feels like, you know, not needed or wasteful, wasteful activity and those can be sort of addressed and followed up on as done mentioned. And I mentioned previously, don't ask if you're not going to follow up the benefit of these types of meetings, not only to have sort of exposure for your team. To be exposed to, uh, executive leadership um, it's really to just get staff alignment and everybody kind of focused here. The same message. The same way. Um, it brings clarity around the mission vision and values of your hospital. It increases leader credibility. Again. This is really, um, usually done at a very high level.
In terms of the audience is a very broad audience and it's done. A couple times a year or quarterly would be on the on the higher more frequent side. Usually, it's a couple times a year.
People can give sort of end of the year financials, the direction of the organization, the strategy that we're just going to do for the next year, thanking people for their hard work over the year, et cetera. Don, I don't know if you have anything to add. We're getting close to time, so I don't want to really dwell on that any more than I need to.
Okay, no, I think I think that's great. And let's, uh, just go to the next slide and I would, uh, and again, this is the summary. I'm not going to walk you through this uh, because we really have talked about this throughout the course of this presentation.
But I think we do have a few minutes and so I think if anyone has any questions that they want to put into the chat or experiences that they'd like to share or if, uh, um, again. Uh, have. Anything we'd like to us to do know about, or do that. That'd be great. So, yes, I appreciate that. Dr. Kelly is we're waiting for the audience to respond to that. Um, and maybe they're still, uh, digesting some of the information you provided. So, a lot of information in this 1 uh, I know the, the slide count is not high. Content is very dense, and we do appreciate that if we you do not have time to, um, take any questions, we'd be happy to feel those through email, uh, as you disconnect today. I want to remind everybody that you will be asked to, uh, provide a little feedback. You'll be redirected to our online survey. Please take time to do that. Um, be sure that you're connecting with us on TMF networks dot org, and getting all of those resources as be just dropped in that link, uh, to the survey you can click on it. There as well, and of course, you have our email be sure to reach out to us there. I don't think that, uh, I see any questions.
We'll certainly capture those and if we get anything in email and Dr. Kelly and Donna, we'll be sure to share that with you. It has been a tremendous, uh, opportunity to learn and listen from to you and, uh, appreciate you sharing your insight. Unfortunately, that is the, all the time that we have today we want to thank you. Pretty much for attending and participating in the call today. We look forward to hosting you again and on another TMF event that does conclude our call. Thank you again. Dr. and Donna.
Thank you take care everybody. Thank you. You may now all disconnect.