Leader Rounding for High Reliability and Improved Patient Safety
Background: Critical to providing safe, effective patient care is ensuring that communication is open and transparent among all members of the health care team. However, current evidence shows that poor communication is commonplace, contributing to medical errors and poor patient outcomes. Implementing leader rounding may improve communication and reliability. The purpose of this initiative was to create an evidence-based process for the implementation of leader rounding for high reliability at the Veterans Affairs Bedford Healthcare System in Massachusetts.
Observations: We conducted a review of medical literature from 2015 to 2022 that found little research specifically related to leader rounding for high reliability. We created a formal and interactive process to improve patient safety by increasing communication among senior leadership, interdisciplinary teams, and frontline staff.
Conclusions: Open, transparent, and bidirectional communication among all staff is critical to improving patient safety and promoting a culture of safety in health care. This initiative may be of value to other health care organizations that are working to improve patient safety. Future efforts will focus on developing a robust evaluation program to explore the impact of leader rounding for high reliability on safety outcomes.
DISCUSSION
This initiative involved the development and implementation of a leader rounding for high reliability process at the VABHS with the overarching goal of ensuring efficient communication exists among members of the health care team for delivering safe, quality patient care. The initiative was well received by staff from senior leadership to frontline personnel and promoted significant interest in efforts to improve safety across the health care system.
The pilot phase permitted us to examine the feasibility and acceptability of the process to leadership as well as frontline staff. The insight gained and lessons learned through the implementation process helped us make revisions where needed and develop the tools to ensure success. In the second phase of implementation, which commenced in December 2023, each executive leadership team member began leader rounding for high reliability with their respective department service chiefs. Throughout this phase, feedback will be sought on the overall process, perceived benefits, and challenges experienced to make improvements or changes as needed. We also will continue to monitor the number of events entered in the patient safety reporting system. Future efforts will focus on developing a robust program of evaluation to explore the impact of the program on patient/family satisfaction as well as safety outcomes.
Limitations
Developing and implementing a process for leader rounding for high reliability was undertaken to support the VABHS and VHA journey to high reliability. Other health care organizations and integrated systems might identify different processes for improving patient safety and to support their journey to becoming an HRO.
CONCLUSIONS
The importance of leader rounding for high reliability to improve patient safety cannot be emphasized enough in a time where health care systems have become increasingly complex. Health care is a complex adaptive system that requires effective, bidirectional communication and collaboration among all disciplines. One of the most useful, evidence-based strategies for promoting this communication and collaboration to improve a culture of safety is leader rounding for high reliability.
