The boardroom is a long way from the bedside, and there is often a large gap between what senior executives think is happening, and what is actually going on at the front lines. In safety, for instance, the senior executive team might believe that key safety practices such as pre-procedural timeouts, infection control bundles, and safety briefings are in place, simply because they’ve held a number of educational sessions on these matters, and are now receiving reports that say the practices have been implemented. But it takes far more than some “inservices” to eliminate the numerous operational and cultural obstacles to these new safety practices, and to embed them deeply into daily work. One key way to close the gap between the boardroom and the bedside is to make a regular practice of “reality rounds” by leaders. For a major new process such as the implementation of surgical checklists, I recommend that the CEO spend one hour a month doing scripted observations in the operating room. (The CMO might do this an hour a week, and the VP of Surgery an hour a day.) The executive team would quickly learn whether the new practices are simply another “tick the box” exercise, or whether they’re really changing the culture. Most importantly, the team would have many opportunities to say “attaboy” and “attagirl,” and would learn about all the operational obstacles that stand in the way of your frontline staff when they try to implement these practices. If you want to learn more about this sort of scripted rounding, take a look at this paper that I wrote with Kerry Johnson of Healthcare Performance Improvement.

Rounding to Influence Reinertsen Johnson