How do you square with rounding?

By Steve MacArthur, Hospital Safety Consultant

It is entirely possible (if not likely) that I’ve covered this before, but for some reason or another, it’s been circling around in my head lately and it seemed like it might be time for a re-visit.

I think we all know that rounding as it might have once been required in the past (from a regulatory perspective) is a way to monitor conditions in the environment. Is it a good way? Is it the only way? I think we can also establish that if there is any follow-up monitoring as the result of a survey finding, it’s usually through the rounding process that that performance data will be obtained/retrieved, so it does have its uses. But could it be more?

Lately I am less sure about the value of the process as it seems to have devolved into a quasi-social experience with different people having different checklists (or different parts of one checklist), maybe some catching up with colleagues, etc. There may be some interactions with line staff, but I keep getting hung up on the “why” of it all—to my mind (what’s left of it, at any rate), purposeful rounding is the goal. But first you have to agree on the purpose of rounding… (and this is not something that requires my agreement, but rather among those with whom you round).

While I suppose it can exist as a means of identifying deficiencies in the environment—as it often does (finding expired stuff; observing obstructed access to fire extinguishers, pull stations and the like; making sure logs are properly filled out—no gaps, out-of-range values responded to, etc.)—it just seems like such a waste to work this as an exercise in “gotcha” oversight. And it seems like some of those gotcha checklists go on for days (weeks?) and, to be honest, I have a hard time thinking of that as a useful or effective process.

There will always be stuff to find in the physical environment—this has always been the case, but it’s only fairly recently that the regulators are operating with that fact in mind. But if you think about the stuff that can get you into the most survey trouble (management of behavioral health patients, management of procedural environments, including sterile storage, or pretty much anything that impacts infection control and prevention), there’s a pretty clear path upon which to focus one’s energies. But still we get hung up on drinks in the nurses’ station, cardboard boxes on the floor, segregation of compressed gas cylinders. Yet we never make these things go away (so to speak).

My challenge to those of you who do rounding is this: when you do your next annual evaluation of your EC program, look carefully at all the data you have relative to rounding and try to figure out if what you’re doing is truly effective (in a measurable way). Instead of focusing on a thousand item checklist, pick five of the most important considerations for which improvement would have a meaningful impact—not just your program, but on the quality of “life” in your organization.

We’ve been rounding for years and now that we don’t “have” to, let’s make this process an engine for organizational change. Let’s empower the folks in the environment to help manage that environment—I only see that as an improvement for all concerned.

About the Author: Steve MacArthur is a safety consultant with Chartis Clinical Quality Solutions (formerly known as The Greeley Company) in Danvers, Mass. He brings more than 30 years of healthcare management and consulting experience to his work with hospitals, physician offices, and ambulatory care facilities across the country. He is the author of HCPro's Hospital Safety Director's Handbook and is contributing editor for Healthcare Safety Leader. Contact Steve at