We're excited you could be with us today for Rounding that Resonates: How Better Communication Drives Loyalty and Trust. Before we begin, just a quick reminder that we will send out the slides within two business days. On the left side of your screen, you'll find a lot of great information about rounding and our new ambient listening announcement. Be sure to check those out. I would love to hear from you in the attendee chat in the Q&A box. Feel free to put the questions in that Q&A box throughout the presentation, and we'll answer what we can get to at the end. To start with, why don't you share where you're joining us from today in that attendee chat? We would love to hear your thoughts and reactions as this goes on. Presenting with us today are Dr. William England. He is a researcher here at NRC Health. We have Katie Haifley, the Director of Product for Rounding at NRC Health. You can read both of their bios in the bio section of your screen. We're going to try and keep it to a tight 30 minutes, so I won't delay any longer. I'll let you get right to the content. Dr. England, will you take us away? Yeah. Thank you, Matthew. Good afternoon, everyone. Or morning, I suppose, depending on where you're located. Appreciate you taking the time to join us today. I know everyone's very busy, but it's really great that we had such a good turnout for this webinar. Want to make sure I get that thanks in. I want to begin my remarks by acknowledging that most of the healthcare leaders that we work with already believe that rounding matters. Actually, for many of our partners, it's become a cornerstone or foundational practice tied to patient experience improvement. Sort of off the bat, claiming that rounding works is not particularly groundbreaking. We wanted to understand how this works, something slightly different. Not whether rounding works, but sort of how it works. What Katie and I are going to walk through today is what we found when we looked beneath the surface of the relationship between rounding and patient loyalty outcomes. A review of the research about why rounding works typically falls along one of several lines. Rounding helps surface environmental issues. It creates opportunities to resolve concerns in real time. It can reduce discomfort, strengthen communication between patients and care teams. I think if I were to summarize the literature in a sentence or two, I think it gives organizations basically visibility into the patient experience while care is still happening, not days or weeks later in a retrospective survey. Again, this study was never meant to prove that rounding works, but really figure out how it works and then quantify some of the pathways behind it. The idea there being that once we understand the mechanisms behind the improvement we see for patients who are rounded on, we can start to make smarter recommendations about where to focus energy operationally and what behaviors to reinforce and how to make essentially rounding just more efficacious over time. We started the analysis by looking at 11 organizations representing roughly 37,000 patients who were asked yes or no, whether they recalled being rounded on. At the highest level, the pattern was extremely consistent across these organizations. Patients who reported being rounded on were substantially more likely to give a top box likelihood to recommend score. Across the organizations, the gap varied. There was a wide range, a few outliers, but typically the gap was around 15 to 20 percentage points, and on average it was 20. Like I said, in some cases, it was much larger. When we started looking at other kinds of differences besides likelihood to recommend scores, things got kind of interesting, where we started to see really large gaps, even larger than 20 points in operational and environmental domains. Think quietness, responsiveness, cleanliness, even food quality emerged. Not all these organizations asked the same set of questions, it kind of makes cross-partner analyses a little bit tricky. Suffice to say, at the same time, we also saw meaningful improvements in common questions across all 11 partners as well in interpersonal domains like trust, listening, explaining things clearly, and courtesy, respect. The first insight that we uncovered is that rounding appears to have a sort of holistic impact on experience, meaning that we can see meaningful differences across both environmental and interpersonal factors. We thought this was an encouraging finding, but we also know that while environmental domains are important, what really drives likelihood to recommend scores are interpersonal factors like trust and communication in particular. This next slide is really sort of a look at that. This is the result of the logistic regression model. What you're seeing visualized are basically the relationship, the association between that kind of question, whether it's trust or explaining things or courtesy, respect, and the relationship to likelihood to recommend scores giving a nine or a 10 to that question. What we see here is basically a key driver analysis, and one of the things that we wanted to understand was not just which factors are the most predictive of likelihood to recommend outcomes, but where does rounding fall on the list? You'll see at the very bottom, rounding emerges as statistically significant as a predictor. Ranked in this way, the least predictive of 9s and 10s for this group of factors. That got us thinking, well, we see a profound impact on likelihood to recommend scores, and yet this model is suggesting that rounding is relatively low on the list. We started wondering if rounding was actually indirectly affecting those types of behaviors, listening, explaining things, courtesy, respect, and trust, and maybe it was functioning through that pathway as an influencer of giving 9s and 10s on the likelihood to recommend question. In other words, we hypothesized that rounding appears to create the conditions where these higher value or high-value behaviors are more likely to occur. That's where we went next, is trying as best we can to separate correlation from causation and explain this 20-point gap in likelihood to recommend scores that we were seeing. What we did is we performed what's called a decomposition analysis of the rounding effect. I know that's a lot of statistical jargon, but I'll try to explain that as best I can. As I mentioned, the baseline was that 20-point gap. That's what we're trying to explain. What we want to understand is how much of that effect can be explained by communication factors and trust, since those were the ones that are highest on the list in terms of predicting nines and tens to likelihood to recommend. To do this, we created a series of logistic regression models and started with just rounding, so just rounding as a predictor of LTR scores. One by one, added in the trust and communication factors to the model to measure how much the rounding effect is decreased when we added those other variables. That reduction of the rounding effect provides an estimate of how much the observed effect may be operating through those other experience pathways. What we found is that trust and communication explain about 40% of the effect that rounding has on likelihood to recommend. It's a good start. It's clearly not the end of the story. There are still more than half of the effect to it that our data was unable to explain. The key takeaway for us is that rounding obviously works through multiple pathways. Communication and trust is an important one. There are other candidates that fell beyond the ambit of our data set. We were unable to capture that. Thinking through this, your responsiveness, quality and safety, issue resolution, we can speculate, or we can hypothesize about some other issues that we just weren't able to measure. From the data that we had, we were able to explain about 40% of the story here. It led us to this proposal of a conceptual framework that we thought was insightful and worth sharing. Before I explain that, I should mention that from previous research, we know that trust behaves less like an isolated construct and more like the emergent outcome of a bunch of other behaviors. When we model trust as a dependent variable, we find patients tend to report higher trust when care providers listen, explanations are clear, and interactions feel respectful. Back to the slide here with the proposed pathway. We think the analysis supports that rounding offers more opportunities to engage with patients. It creates better communication. Communication is strongly correlated with trust, and trust is by far the best predictor of positive likelihood to recommend scores. The framework for rounding here that we're proposing shifts our thinking from being simply a box to check or a task to complete into something maybe a little bit deeper, like basically a mechanism for creating better experiences. Ultimately, this led us to reframing the question of rounding from if organizations should do it, which the answer is yes, to how organizations should use rounding to create more meaningful interactions. Here to discuss that part of the story is our senior director of our rounding product and the former founder of Nobl, the rounding platform that NRC Health acquired two years ago. Katie? Yeah. Oh, thank you so much, William. Hi, everyone. Honored to be on this webinar today to present with Dr. William England. Really, I think that this research is just so fascinating to see unfold. It really validates what we all know, right? Rounding works and helps us better understand why. Where I want to take this today is talk about it from a practice perspective. What can we take home from this webinar to start to refine our practice of leader rounding? I think to start, it's a mindset shift. This is something that you talked about, William, is we need to, as leaders, start to shift our mindset about rounding from a task to an experience. For years, I think rounding has been operationalized as a checklist. Did it happen? Are we doing it to a certain high frequency? Was the script followed? What this research points to and suggests is that the quality of that interaction matters much more than the rounding itself, right? The quality of that interaction. It's not just a task to complete, and it really creates the conditions of trust, connection, reassurance, and confidence. When patients feel heard and understood, respected, loyalty is much more likely to follow. The goal isn't more rounds. The goal is better interactions within those rounds. I'd like us to think and rethink about measurement and accountability. Instead of asking, "Are we rounding?" Could we be asking, "What is rounding producing?" Are patients feeling heard? Do they understand what's happening? Are we building trust and confidence? While this research suggests us rethinking how we measure leader rounding activities, I would say, just from a personal note, I feel like I've seen this trend quite a bit in the last five years, that many organizations are recognizing that rounding on every patient every day is simply not realistic given leader capacity and competing operational demands. I've seen personally that there's just this renewed focus on the quality of time spent with patients and the depth of that interaction, the ability to be fully present during those moments. That's why I think this is really interesting with emerging technologies like ambient listening and becoming especially important, right? Just last week, I know Matthew mentioned this at the beginning, we announced some new results from our partners using our ambient listening feature built into the NRC rounding platform. What we found was really compelling, not just from an efficiency standpoint, but I think from a human interaction standpoint as well. What's interesting about our findings with ambient listening and how it connects directly back to this research is I think if communication and trust are among the strongest drivers of loyalty, then anything that improves the leader's ability to listen, to explain clearly, to remain present during that rounding interaction should strengthen the impact of those interactions. That's where ambient listening comes in and why it's so interesting right now. Not simply because it saves time or improves documentation, but because it may improve the quality of the human interaction itself. I think that one of the biggest challenges during rounding is that cognitive burden. Leaders are trying to listen carefully, observe the environment, capture concerns, document accurately, and remain emotionally present throughout the whole thing, right? That's difficult, right? If you've been on any webinars with me, for many years, I've talked about this concept of rounding is a art and a science for that reason, right? I think that ambient listening really has the potential to reduce some of that friction by allowing leaders to really focus on that patient interaction instead of splitting their attention between conversation and documentation. If behaviors like listening, explaining things clearly, emotional presence are some of the strongest drivers of trust, then improving those moments may actually ultimately improve loyalty outcomes as well. What's really encouraging, too, is we're already starting to see measurable signals that really support this idea. In early results, after partners using ambient listening, we reduced perceived device distraction by 15 points on a qualitative survey that we gave out to users. This matters because one of the biggest barriers to connection during rounding is that divided attention, right? We also saw increased confidence in using AI during patient interactions, and even maybe more importantly, users reported greater confidence in capturing what matters most during that interaction. Taken together, I think these findings suggest that ambient listening may help leaders stay more focused on the patient, still while capturing meaningful insights. Ultimately, I think this supports the broader idea that we've been discussing throughout this presentation. Better communication leads to stronger trust. Stronger trust leads to greater loyalty. Just some more kind of interesting results, too, that we're seeing after using ambient listening with select partners. We've seen a meaningful shift in the quality of the interaction as well. Teams are moving from short, transactional notes to more context-driven narratives. More rounds are adding in comments. They're adding in storytelling. Patient concerns that may not have otherwise been captured are now being added to the platform for later review and process improvement. This is all to say it's happening without extra workload, right? That's really important. In many cases, leaders are shifting their time from trying to recall that rounding activity and document conversations to simply reviewing and approving that content generated from ambient listening. This matters because what we've talked about is cognitive burden. It really changes behavior. When leaders are less distracted by documentation tasks, they're better able to stay present, to listen actively, to observe emotional cues, to engage more naturally with the patient. Really allows them to focus on a high-quality round, right? Really the key takeaway here is that documentation improved, but ambient listening may help us create better conditions for better communication and stronger human connection during rounding. When we take a step back and kind of look at organizations that consistently perform well, that's exactly what we see, right? Those high performers are not necessarily dramatically doing more rounding than everyone else. They're consistently executing the behaviors that matter most to patients. Listening well, explaining clearly, building confidence, creating trust. The question becomes: What does an effective round actually look like when we focus on behaviors that drive loyalty? I think that we can kind of think of this from a practical framework lens. We can look at effective rounding through the lens of those high-performing organizations, and we see kind of three common things. Typically, we're resolving something, we're connecting with the patient, we're building trust. Listening is probably the strongest driver of trust, which means if we ask open-ended questions and reflect back on what the patient shares to show that we're listening. Explaining is also really critical because patients are going to be more confident when they understand what's happening next and what to expect. I think of our partners that are doing rounding in the emergency department with patient ambassadors, patient advocates, helping inform our patients of what's next, what to expect, answering those questions. When I think about courtesy and respect, that can help reduce, I call it, the power distance between us and make patients feel seen as individuals, not just cases or room numbers, right? Trust building really comes down to consistency and follow-through. Doing what you say you're going to do and ultimately doing it. I really see that technology can help reduce that friction so our leaders can focus more on that connection. Really, our goal is to not automate empathy, but to create more capacity for it, right? Focus on building those interpersonal skills of your rounders to build confidence in these areas, is one key takeaway there. Let's bring it all together. Bottom line, rounding works, right? That's not what we set out to do with this research. We set out to understand why. NRC Health data supports that conclusion, that the experiences of many organizations also reinforce it. The mechanisms appear to be much more nuanced than often described. A substantial share of rounding's impact operate through known drivers of patient experience, communication, listening, explaining clearly, respect, trust. There's even more happening beneath the surface that we're still trying to understand. Right? I think what's becoming increasingly clear, too, is that if loyalty is shaped by trust, and trust is shaped by communication, then technologies that improve the quality of communication may be important loyalty strategies even, not just operational tools to understand if we did rounding or not. Right? So the opportunity for us, I think, for on this webinar is to not just to ensure rounding's happening, to ensure that rounding produces the experiences that matter most. I think that ultimately the future of rounding may depend less on increasing the number of interactions and more on improving quality and consistency of those human moments within them. With that, I will pass it over to Matthew to wrap us up, and we will look at the attendee questions to see if there are any questions that we want to answer. Yeah, that's great. Thank you so much. This research is so interesting. We already have a couple of questions that we'll get to. Before that, let me encourage everybody here to check out HUB26. This is our flagship patient experience event. It gets bigger and better every year. If this has interested you, if you are interested in learning more about how to connect with patients, new technologies, if you just want to be inspired to go and do your work, get back to the heart of why you got healthcare in the first place, HUB26 is the place to be. It's in Nashville this year. I believe the Country Music Hall of Fame is where some of the events will be. It's going to be really excellent. Click the link, see what it's about, and be on the lookout for some emails and promotions from us to tell you about who's joining, who's coming up. Again, like I said, put your questions in that Q&A box, and we will answer them as we go. If we don't have time to answer them all at the end of the webcast, we will follow up with you directly via email. Our first question, do you have any suggestions on how we can equip our rounders so they are set up to be high performers? Yeah, I think I can take that one. Oh my gosh, I could probably talk for hours about that particular one. Gosh, it's a good one. High performers. Two thoughts on this. One, I would try to find those that you feel like are high performers in the organization, that they have this process down. You go in, they're doing it with high quality. They have those interpersonal skills. Think about building a buddy system. Pairing them with someone that maybe has an opportunity to improve their own skill sets. I feel like we learn so well when we can learn from a colleague, from a person that we respect, from a fellow patient experience champion, right? I think that doing co-rounding is such a rich opportunity, that we don't take advantage of often enough. Then I'd also say one of the things that we often do with Rounding is we implement a solution. We build the perfect plan. Maybe we even have a fantastic playbook. Right? Then we just say, "Go and do it," and do it in front of a patient, where that can be really nerve-wracking, right? We might not have a chance to really practice our skill sets as a rounder. So I love making skills labs, make use of your medical skills labs for leader Rounding and just practice those interpersonal skills. Obviously, you have to ask the right questions. You have to engage it to a certain degree with what our expectations are, but so much of Rounding is just what did the patient say and how did I react to it, right? Am I asking deeper questions after they give me an answer? Am I paying attention, right? Am I emotionally present for that round? Those nuances, some people just have that on day one, and others have to grow that skill set, right? I think skills labs is a great opportunity to use that. Oftentimes you already have those sort of environments already within your organization that you can rent out and use for this sort of application. Great question. Yeah. Awesome. Thank you. We have another one here. You suggested organizations should stop asking, "Are we rounding?" Instead ask, "What is rounding producing?" What are some better metrics or signals we should start paying attention to? Oh, man. There's so many signals, right, of, first off, high quality rounds, also outcomes of your rounds. I look for two things from a signal perspective. First off, I want to look for high quality rounds, right? I do look at how often are we asking the questions, right? Are we going off script where we're just, "Hey, how's everything going?" Leaving, right? Oftentimes in your rounding documentation, you'll be able to tell that. It's been interesting to see that our ambient listening partners too, that are using that feature, we actually give a key takeaway summary of that interaction, we also have a coaching summary as well. We really understand the quality of those rounds that are going on. When I think about the signals that you look at in the data, if we feel like we have really high quality rounds going, we have high quality documentation, the signals in the data would be looking at are things not being answered 100% of the time? Are there certain questions that are showing up to be, in our software they're red, right? They highlight that, "Hey, you need to pay attention to this." They have a majority of the time they're negative or they're neutral answers. Those are the things that I look at for process improvement. I also think about asking questions that give us indication that a patient maybe is having an okay or a fine experience, and can we move them to a great experience. We know moving from good to great is much easier than moving from a detractor to a promoter, right? Still a worthwhile cause, right? I also like to look at that and are we asking questions, are we engaging patients? Are we looking at our data to see where are those patients that we feel like we can just wow them and resolve a few things to really move them into someone that's going to be a promoter, that's going to have a 9 or 10 experience with our organization. Awesome. Thank you. I bet we have time for one more. We probably have two minutes, Let's see if you can get through it. We've been asked, you said that you found communication and trust explain about 40% of the rounding effect. What do you believe is happening in the remaining 60%? I can take this one, then Katie Haifley, if you have any thoughts or comments, I'd love to hear those. I'm sure everyone would. You mentioned that we uncovered part of the story, less than half of the story. That's a limitation of our data set, things like quality and safety, issue resolution, call light responsiveness, or the lack thereof because maybe there's fewer call lights being answered because people are rounding more often. All those kinds of things just fell outside of the data set that we were working with. Not surprisingly, we couldn't capture the complete story. For what we had, I thought we did a fair job of illuminating some important aspects of rounding, that rounding affects loyalty by. I don't know, Katie Haifley, would you add anything besides those bullets that I mentioned? No, I think that's fair. I think that's fair. It's something that we'll continue to research and understand more. I think it's fascinating to be able to pinpoint exactly what we can with the data, right? Explaining why. Yeah. On that topic, we are future research oriented here. We're actually convening a panel, a consortium of rounding partners to do a more qualitative deep dive into how rounding functions within these organizations. If you're interested, by all means reach out and we can see if we can form a partnership and work on that research too. Great. Thank you so much, both of you. Thank you for all of our attendees for coming out today. As a reminder, we will send out a link to this recording within two business days. Be sure to check out those resources on the left side hand of your screen, and make sure to fill out that survey after the webcast so we can know what we did well, what topics you might be interested in in the future. Thanks for joining us, everybody, and we will see you next time.