An Evaluation of Patient Safety Leadership Walkarounds

Abstract

Patient safety leadership walkarounds (PSLWA) have been identified as an effective tool to improve patient safety culture. At Hamilton Health Sciences, after one year of monthly PSLWA in all clinical and service programs, 1,351 patient safety issues were identified, of which 64-80% have been resolved or have active improvement work in progress. Five hundred staff were invited to complete a process evaluation regarding the effectiveness of the current process of PSLWA. A total of 341 surveys were returned (68%). The overall evaluation demonstrated satisfaction with the process of PSLWA; 93% of those surveyed reported that they felt comfortable openly and honestly discussing patient safety issues and had an enhanced awareness of patient safety. Five areas of opportunity for process improvement were identified: scheduling, scripts, feedback, reporting and resolving issues deferred for an organization approach. PSLWA have offered an effective way to engage leadership and staff in open discussions about patient safety and collaborative approaches for solutions suggesting an enhanced patient safety culture.

‘I think we should just listen and get out’: a qualitative exploration of views and experiences of Patient Safety Walkrounds

“…The mixed-methods evaluation included qualitative interviews and quantitative analysis of the types of patient safety concerns identified and addressed by the walkrounds. The types of problems identified at the two hospitals resembled those reported in the literature, with staff commonly wanting to discuss infrastructure problems (eg, equipment and physical plant issues)1 2 6 11 rather than teamwork, communication and other system problems more explicitly related to patient safety.…”

The evolving literature on safety WalkRounds: emerging themes and practical messages

“…The novel information increases senior managers’ support for patient safety improvement efforts 24. Consequently, safety rounds enable hospitals to identify and eliminate safety hazards27 36–38 40–43 and improve hospital efficiency 39 44 45. They also allow senior managers to demonstrate that safety is a priority 18 37 40 46.…”

“…Most of the studies that report positive results have methodological limitations, such as reporting on a single organisation's implementation of the programme, lack of control groups,36 40 45 lack of objective performance measures to verify the improvement and self-selection for programme implementation. In particular, self-selection limits generalisability of the findings because organisations that voluntarily embark on a programme of safety rounds might differ from other organisations in ways that effect implementation success.…”

“…Thus, to have a beneficial effect, managers must commit to the time-consuming work of visiting with as many frontline staff as possible, which, in practice probably means visiting a given unit more than, say, once a year. However, several papers comment on the difficulty of sustaining a schedule of frequent safety rounds,23 36 even if rounds are conducted by department managers and frontline staff rather than executives 45…”

“…Supportive infrastructure also seems key, including strong project management,23 39 scheduling capability,39 45 availability of tailored scripts to enable a productive discussion with frontline staff during safety rounds,45 maintaining an effective database to monitor action-taking and formal processes to ensure follow-up 27 48 66. Middle managers provide critical support for safety rounds39 55 as well as implementation practices that include application of analytical tools for understanding the problem, small tests of change, and communication, feedback and celebration of results 43 45 48 66–68…”