JOINT BASE SAN ANTONIO-FORT SAM HOUSTON, Texas (Jan. 5, 2016) -- Brooke Army Medical Center, or BAMC, leaders are adjusting their schedules to ensure they're connecting with staff and patients from dusk till dawn.

The process, called reverse cycle leadership rounding, entails visiting units throughout the hospital during night and weekend shifts.

"As leaders, we have a very real responsibility for knowing how medicine is practiced within our walls, for knowing if and how we are meeting the needs of our patients at all times of the day and night," said BAMC Commander Army Col. Evan Renz, who also serves as an active surgeon. "Active, engaged leadership at all levels is vital to continued success and medical readiness throughout BAMC. "

The commander and his most senior leaders embarked on another reverse cycle rounding shift from 8 p.m. to nearly dawn, Dec. 11. Friday nights make sense, Renz explained, noting that with a 24/7 trauma and specialty care mission, the weekends are oftentimes when the staff kicks into high gear.

For their reverse cycle schedule, "the goal was to visit the areas of the facility that operate 24/7, observe operations and speak with staff about patient care and support services," said Army Col. Mark Swofford, BAMC deputy commanding officer and deputy commander for administration.

"The hospital runs continuously and processes that work during normal weekday operations may not work as well at night or on the weekends," he added. "By doing the reverse cycle and weekend rounding, we can get a better understanding of how our decisions will impact the organization over the entire range of operations."

The teams visited nearly every floor of the hospital, speaking with staff in medical, neonatal, pediatric and surgical intensive care units throughout the facility.

Karen Rideout, a neonatal intensive care unit, or ICU, staff nurse, said she was honored by the late night visit. "I was able to share stories about our NICU [neonatal intensive care unit] Family, which includes parents, grandparents and, of course, the babies," she said. "We create very close bonds with many of our NICU patient Families; these bonds continue for years.

"We were not in need of any particular assistance at the time, but the offer to assist with our needs was welcomed, appreciated and helpful," she added.

Glinda Rangel-Garcia, a nurse in the 5E antepartum unit, said seeing the command team made her feel more connected to leadership. "I was very impressed when the commander asked if our unit had any gynecology [GYN] patients on the boards," she said. "Our unit is primarily an antepartum unit, and the fact that he knew we extend our services to serve GYN patients made me feel he took an active part in knowing each unit he commands."

As he walked throughout the units, Swofford said he gained valuable feedback on staff challenges, "but one of the most important things that occurred was that we had a chance to speak with the staff in various areas and thank them for what they are doing for our patients."

The discussions were mutually beneficial, added Army Col. (Dr.) Douglas Soderdahl, deputy commander for surgical services.

"The command team was able to directly discuss issues with staff, and employees had the opportunity to provide candid and direct feedback and suggestions to the leadership of the hospital," said Soderdahl, who also serves as a urologist.

The reverse cycle rounding program is an addition to leaders' already robust daytime rounding routine. Additionally, last year the hospital implemented the "Suits to Scrubs" program in which nurse leaders trade their uniforms for scrubs to join their staff on the front lines.

It's all about keeping their finger on the pulse of this organization, Renz said, which includes the Defense Department's only Level I trauma center, more than 8,500 staff, 425 inpatient beds, and more than 2 million square feet of clinical facilities.

Renz said he looks forward to the future reverse cycle rounding schedule. "The process of establishing a high-reliability organization demands that those responsible for day-to-day operations have an accurate grasp of all activities that occur within a major military medical center," he said. "We have an enormous responsibility to optimize the valuable resources we have been given to ensure safe, high-quality care."

"At the end of the day, our patients are at the center of everything we do."