Patient Safety Leadership WalkRounds

Tool provided by: Institute for Healthcare Improvement (Boston, MA, USA) in collaboration with Allan Frankel, MD

Senior leaders are encouraged to use weekly Patient Safety Leadership WalkRounds™ to demonstrate their organization’s commitment to building a culture of safety. WalkRounds™ are conducted in patient care departments (such as the emergency department, operating rooms, radiology), the pharmacy, and laboratories. They provide an informal method for leaders to talk with front-line staff about safety issues in the organization and show their support for staff-reported errors.

This tool provides key elements for successful implementation of WalkRounds™ and sample formats and questions to ask staff. Many organizations that have conducted WalkRounds™ in conjunction with Safety Briefings have achieved greater success in changing the culture than organizations that use either tool alone. Leaders who focus solely on safety during these rounds are more successful at creating a culture of safety than those who use them as an opportunity to discuss a variety of topics such as budgets, patient satisfaction, and the like.

Directions

This tool describes the format for WalkRounds™ and includes suggestions about questions for leaders to ask staff, which senior leaders should participate, and where to conduct WalkRounds™ in the organization. Review and modify the instructions as needed for your organization before initiating the WalkRounds™.

• Senior leaders should commit to conducting WalkRounds™ at a minimum of once per week, with no cancellations. (Circumstances may demand postponement from an originally scheduled date, but the WalkRounds™ should still occur within the original week.) 
• Members of the senior executive team can rotate for easier scheduling, but ideally every senior leader should perform WalkRounds™ every week. 
• Organizations should decide whether or not to announce the time and place of WalkRounds™ in advance, and the decision should be agreed to by all parties (senior leaders, managers, physicians, and front-line staff).

Background

In 2000, the Institute for Healthcare Improvement (IHI) convened the Idealized Design of the Medication System (IDMS) Group, a group of patient safety experts to envision and specify the characteristics of an ideal medication system. An important element of such a system was the strong commitment of senior leadership to a culture that encouraged safety. The author conceived of WalkRounds™ during these IHI meetings, as a tool to connect senior leaders with people working on the front line — both as a way to educate senior leadership about safety issues and to signal to frontline workers the senior leaders’ commitment to creating a culture of safety.