How Patient and Employee Rounding Work Together to Drive Patient Loyalty

By Ryan Lebow, VP Solution Consulting, NRC Health  

In our most recent NRC Health nSight, we found a 20-point difference in Likelihood to Recommend (LTR) scores between rounded and non-rounded patients, based on nearly 37,000 patient responses from 11 partners over the past year. 

For leaders who’ve consistently focused on rounding over the years, this data likely serves as a validation of their efforts to improve this critical leadership skill.  

We also found that 40% of that difference could be explained by the increased communication and trust that effective rounding helped produce.  

It’s empowering, especially in today’s healthcare environment, where so much seems out of our control, to know that we can meaningfully influence patient loyalty through the essential practice of patient rounding to improve patient experience. 

While these findings are great, the pessimist in me still focuses on the 60% we’re not explaining with the data.  

Our researchers pointed out the same and offered several factors (e.g., responsiveness, environment) to account for the difference. 

I’d like to offer another relevant factor to explain some of the noise, the enablement and engagement levels of the employees caring for these 37,000 patients.

Before I explain further, let me recap the powerful story shared in the nSight. While on a patient round, a patient shares that she’s not sure what’s happening next in her care and that she’s anxious.  

The leader communicates the next steps clearly to ensure she understands, but then notices that the communication board hasn’t been updated. 

The leader then finds the attending nurse and coaches him on the importance of updating the board with daily plans, and he does so for the remainder of the patient’s stay, alleviating her concerns.  

The Role of Employee Enablement  

This story illustrates why patient rounding is so effective and why we see significant differences in patient loyalty for those rounded upon.  

However, my background in employee experience research makes me question, why did this patient need to feel anxious at all? 

And could this leader have done something different to ensure that updating this communication board didn’t get missed in the first place? 

When we consider the busy healthcare environment, we know that something like that could’ve been missed for several simple reasons, such as:  

• The nurse was new and wasn’t onboarded properly 
• Teamwork on the nurse’s unit was poor, and nobody was giving him feedback 
• Patient experience data—which could’ve helped the nurse understand how critical proactive communications are—wasn’t regularly shared on his unit   
• The nurse’s work area was poorly equipped, putting him in a rush and causing him to forget 

These employee enablement factors matter. Patients notice when their care team isn’t acting like a team; they become uneasy when they hear one thing from a physician and something else from a nurse.  

When staff are scrambling to fulfill requests or when their equipment is unreliable, patients notice. Enablement assesses the ability to do the work.  

When care teams report feeling enabled (i.e., are part of strong teams, have good tools, and are expected to speak up), their patients have better experiences; years of peer-reviewed literature confirm this.  

Let’s look at another hypothetical that’s more troubling.  

The nurse had everything he needed to be successful from a systems, processes, and enablement standpoint. The problem is that he didn’t care enough to update the daily plan before moving on to his next patient.  

Now, we’re talking about employee engagement, or in this case, disengagement. And while he had the ability to proactively communicate, he lacked the motivation to follow through. 

As with enablement, he could’ve been disengaged for many reasons.  

He could be just a bad nurse with a poor work ethic. This is an unfortunate reality at times, but the optimist in me always believes we can influence engagement.  

For example, this nurse could have offered suggestions that were repeatedly ignored. He could’ve felt his organization wasn’t as focused on its mission as it was years ago.  

Maybe it occurred to him that his leader only interacted with him to correct his mistakes. Whatever the reasons or the parties to blame behind it are, disengagement will eventually affect the patient.    

When we enter any business, we can usually tell within 5 minutes if its employees are engaged. Are they greeting me with a smile? Are they listening carefully to me? Do they seem happy I’m here, or would they prefer that I be somewhere else? Did they go the extra mile to help me, or was I left to fend for myself?  

We’re constantly evaluating these things as consumers, and we’ll give our loyalty accordingly. Engaged employees want to treat customers the right way. 

Employee engagement and enablement affect the patient, and thus these constructs should be measured and acted upon frequently.

How then can we consistently follow through on employee feedback?  

Rounding. 

Like patient rounding, employee rounding is nothing new and is just as critical.  

In his 1993 book, Hardwiring Excellence, Quint Studer called rounding “the #1 action he took to drive employee satisfaction.”   

He went on to say, “As a nurse manager, I’m going to first round on the employee and not the patient, and if I’m concentrating on employee satisfaction, employee retention, and physician loyalty, that will lay a strong foundation for higher patient satisfaction.”  

Consistent employee rounding has numerous advantages, namely, the opportunity to address issues like I discussed earlier before they reach the patient.  

Imagine if the leader in the story had rounded on the attending nurse a week or even a day before he saw his patient. The resulting conversation might have prevented the issue. 

Similarly, while rounding with other nurses on the unit who, when asked what we could be doing better, could have pointed out that communication boards weren’t being updated regularly.  

We must remember that leaders won’t be able to catch all issues with patient rounding alone. During regular rounds, employees can be coached to deliver great care more consistently – a huge benefit with employee rounds. 

Does employee rounding guarantee all issues will be caught? No.  

Will it ever replace the need for patient rounding? Of course not.  

But over time, leaders who invest in it create cultures that will be safer and more positive, and patients will notice.

Building Relationships Through Rounding  

Perhaps the most powerful aspect of employee rounding is building relationships.  

Studer notes, “An RN is not going to find another position; he’s going to find another hospital, so in reality, the most important thing you can do to not lose nurses is to build that relationship.”    

Employee rounds should always start with relationship-building or some positive recognition before discussion about the work begins.   

How was your daughter’s soccer game?  

I heard you were great with Jim in 11 B. Can you tell me more about it?  

When leaders intentionally build relationships, their people know they’re valued first, and from there, they’ll make sure patients feel valued.  

Rounding cannot only be performance management and problem resolution. There’s truth in the saying, “people don’t care that you know until they know that you care.”  

Patient rounding is critical, but we don’t have to wait for patients to tell us there’s something we can improve.  

By building stronger relationships and engaging and enabling your employees through rounding, you’ll build the foundation for patient experience.  

Learn more about the power of employee rounding and request a demo.