By Renee Jensen

If you are part of your hospital’s front-line staff, think about the last time a member of the executive team rounded in your department.  Did the staff scatter, hide behind the computer, and hope to not be noticed, or pretend to be too busy to be interrupted?  Did you take one for the team and entertain the executive until they finally left?

As a CEO performing my rounds, this is sure how it felt to me.  

A little secret about me: I am a total introvert.  When I tell people this, most laugh and insist that I am joking.  But naturally, I am shy and not very outgoing in social settings. I know as an executive it is important to be visible, accessible, and present across the organization. Even though making rounds is hard for me, I have learned over the years of my professional career how to better relate to others and how to engage staff in a meaningful way. 

Although my introverted tendencies make rounding somewhat uncomfortable for me, I have learned to love rounding and very much believe in the value it brings to being a successful CEO.  Rounding affords me the opportunity to get out of my office and see the work happening in real time.  I hopefully can get a few minutes with several staff members and have a meaningful conversation about their work. On a really good day, I will stumble upon a problem or need that I can actually help with in the moment.  

I use rounding as a learning opportunity.  I learn more about our staff, the work environment, what is working, definitely what isn’t working (those people are never shy), and hopefully take away new knowledge that leaves me knowing more about the organization than I did before.  

On one of my most memorable days of rounding, I met Nurse Jackie.  She taught me one of the most valuable lessons in my career: simply knowing is much different than truly understanding.

Nurse Jackie noticed me rounding and spending a few minutes in each department around the hospital.  She also noticed that occasionally I would spend a concentrated few hours in a department trying to get to know the staff and become more familiar with their day to day work.  Jackie also heard through the grapevine that employees dreaded the extended visits because the only thing worse than your boss hovering, was your boss’s boss hovering and asking a lot of questions.  

But Nurse Jackie was smart. She wanted things for her department, and she had a vision of how we could provide better patient care.  She was a skilled professional, and she wanted her department to reflect her level of professionalism and talent.  The problem was the hospital was on shaky financial ground; when I started there were only 4 days of cash available and basically nothing for capital.  With such a limited budget and competing priorities, the things Jackie wanted never rose to the top of the list.

Undeterred, Nurse Jackie made an appointment to see me in my office.  She had the courage to meet me in a space that was unfamiliar to her, but comfortable to me.  In my world it is almost never a good thing when a front-line staff member wants a personal meeting with you, but this day was different.  Nurse Jackie asked me to do an extended rounding in her department for a few hours.  I was happy to do it, but was surprised. Every time I visited her department, nobody wanted to talk with me, and I always felt like I was an interruption.  She assured me this time would be different.

At her request, I showed up in her department on our agreed upon day and time with my walking shoes.  She gave me some scrubs and escorted me to this tiny space—barely bigger than a closet—so I could change my clothes.  “This is where we all change,” she said matter-of-factly.  

In the following hours, I worked beside Nurse Jackie emptying urinals, hunting and gathering supplies, talking with patients and families, and observing first-hand the everyday challenges Nurse Jackie encountered on her shift while she cared for patients and on this particular day, saved a life.  No matter how busy or stressful the situation was, she took the time to not just show me, but explain to me each and every challenge we encountered and how it impacted her ability to provide the very best care.  

In between patients Jackie gathered other nurses and staff and engaged them to tell their stories and share openly with me what worked, what didn’t, and their ideas for improvement.  I didn’t know it at the time, but Jackie actually arranged the schedule with staff that were willing to participate and host me, so I would feel more comfortable and get more out of the experience.

I built a special relationship with Nurse Jackie that day, one of trust and mutual respect.  I became a human to the nurses in that department and I was able to see how their requests for things like new TVs would improve workflow, patient satisfaction, throughput, and productivity.

How does the story end?  Truthfully, I couldn’t give Nurse Jackie everything she needed.  I couldn’t fix the small changing and break space, but she did get new TVs, IV poles, paint, and a few other requests moved to the top of the priority list, and she didn’t have to wait until the next budget cycle to have her needs addressed.

As a CEO I always took pride in knowing what was on the “request list.”  I knew these items had been requested and I knew we didn’t have enough money to fund the requests.  But what was missing was that I didn’t fully understand the true meaning behind the requests.  

During my time with the nurses they shared their ideas on how they could be more efficient, see more patients, have faster turnaround times, improve volume in their department, and—the holy grail—improve patient satisfaction.  It’s not uncommon to get a well-prepared request from a manager that promises all of these things if we fund their wish list.  But what was uncommon on my day with Nurse Jackie, was to have the opportunity to build trust and a relationship that helped me understand the heart behind the requests and have confidence that they would make good on their promises.

I would encourage my fellow hospital executives to stop learning on rounds, and start understanding.  Instead of trying to increase your knowledge about everything, slow down and deep dive until you understand the why behind the requests.  And, of course, this story wouldn’t have such a positive ending if it weren’t for the nurses who took a chance to get to know me and allow me to get to know them.  I felt like I gained partners and teammates that day.  The nurses were willing to help me and be a proactive part of the solution, and I honestly needed all the help I could get.  

I hope you have the opportunity to have a Nurse Jackie in your career.  Someone who is willing to take a risk to help patients get better care, erase the lines between staff and administration, and at the end of the day realize that sometimes even the CEO is human and needs help to understand.