In the complex, dynamic environment of healthcare, maintaining a culture of safety is of paramount importance. Hospital administrators play a crucial role in fostering this culture, and one effective strategy for doing so is executive rounding. This practice involves administrators regularly touring the facility, engaging with frontline staff and addressing safety concerns in real time. To understand the importance of executive rounding, it is essential to explore why front-line employees may not always recognize or address issues in their workspaces. Drawing insights from the concept of “collective mind” in high-reliability organizations like aircraft carriers, we can better understand the dynamics in hospital settings.
Normalization of the Environment
Over time, employees can become accustomed to their surroundings, even if these conditions are suboptimal. This phenomenon, known as normalization, occurs when frequent exposure to an environment makes irregularities seem normal. For instance, a cluttered medication room or a poorly maintained piece of equipment might become part of the routine landscape. Just as a person may overlook clutter in their home because it feels normal, a healthcare worker might not see certain safety risks because they have become part of the daily routine.
Perceptual Blindness
Perceptual blindness, a psychological phenomenon where individuals fail to notice stimuli that are in plain sight, can significantly affect workplace safety. Healthcare workers are often focused on immediate tasks and thus overlook safety hazards. Just as someone might not notice a mess in their home because they are used to filtering out clutter, hospital staff might miss unsafe conditions because their attention is diverted by more pressing concerns.
Avoidance Behavior
When facing a stressful situation, such as a chaotic work environment, employees may subconsciously avoid acknowledging the problem. This avoidance behavior can result in unaddressed safety hazards, just as someone might ignore a messy home to avoid the stress of cleaning it. By regularly engaging with staff, hospital administrators can help reduce the anxiety associated with these issues and encourage a proactive approach to safety.
Shame and Embarrassment
Feelings of shame or embarrassment can discourage employees from speaking up about safety concerns. Just as someone might feel embarrassed by the state of their home and avoid confronting it, healthcare workers might feel embarrassed about the condition of their work environment and hesitate to report issues. Executive rounding provides a platform for open communication, where administrators can create a nonjudgmental space for staff to voice their concerns and suggest improvements.
Effects of Physical and Mental Health
Employees’ physical and mental health can affect their ability to perceive and address safety issues. Burnout, stress, or mental health disorders can impair judgment and reduce awareness of the surrounding environment. Just as certain health conditions can lead to a neglected home, these issues can lead to neglected workplace safety. Through executive rounding, administrators can identify signs of staff burnout or stress and can implement supportive measures to enhance overall well-being and safety awareness.
Time Constraints
Healthcare workers often face demanding schedules and multiple responsibilities, which can lead to time constraints that prioritize patient care over environmental safety. This is similar to how busy individuals might neglect tidying their homes because of other commitments. Executive rounding allows administrators to recognize and address these time constraints, providing additional resources or adjusting workflows to ensure that safety does not fall by the wayside.
Lack of Organizational Skills
Some employees may lack the organizational skills to maintain a safe and efficient work environment. Without effective strategies for managing their workspace, they might struggle to keep track of safety protocols and equipment maintenance. This lack of organization can lead to safety risks. Through executive rounding, administrators can identify training needs and provide staff with the tools and knowledge required to maintain a safe workplace.
Collective Mind in High-Reliability Organizations
Weick and Roberts’s study on “collective mind” in organizations, particularly on flight decks of aircraft carriers, offers valuable insights into safety and performance in high-stakes environments. The authors develop the concept of collective mind to explain organizational performance in situations that require nearly continuous operational reliability. The concept describes a pattern of heedful interrelations of actions in a social system, in which people take action with the understanding that the system consists of connected actions by themselves and others.
In healthcare, fostering a collective mind through executive rounding can enhance safety by promoting mindful attention and heedful interrelating among staff. By regularly engaging with front-line employees, administrators can ensure that individual contributions are interrelated with the overall system, leading to better comprehension of unfolding events and a reduction in errors.
The Benefits of Executive Rounding
Implementing executive rounding has five benefits that contribute to a culture of safety:
- Enhanced communication. Regular interactions between administrators and frontline staff foster open communication, allowing for real-time feedback and immediate resolution of safety concerns.
- Increased visibility. Administrators gain a firsthand understanding of the daily challenges faced by staff, leading to targeted interventions and more informed decision-making.
- Proactive problem-solving. By identifying and addressing issues early, executive rounding helps prevent small problems from escalating into major safety hazards.
- Staff engagement. Engaging with staff shows that administrators value their input and are committed to their well-being, which can boost morale and job satisfaction.
- Continuous improvement. Executive rounding promotes a culture of continuous improvement, in which safety is constantly monitored and enhanced through regular feedback and action.
Eric W. Ford, PhD, is editor, Journal of Healthcare Management.
Editor’s Note: This content has been excerpted from “The Vital Role of Executive Rounding in Promoting a Culture of Safety in Hospitals,” Journal of Healthcare Management, vol. 69, no. 4.