If staff members in your facility think their concerns are not being heard or taken seriously by senior leadership, it might be time to implement patient safety rounds or expand your existing program. Not only can patient safety rounds find trouble spots that leaders may not have known existed, they also may improve the culture among staff members.
"The intent of the Patient Safety WalkRounds™ is to bring senior leadership out to the front line to talk about what concerns the frontline staff about taking care of their patients safely," says Erin Graydon-Baker, MS, RRT, director of patient safety at Brigham and Women's Hospital in Boston. "If the program contains vigilance around feedback, I think it improves culture."
BWH has been using the IHI's Patient Safety WalkRounds model since 2001. Allan Frankel, MD, then-director of patient safety for Partners Healthcare and affiliate of the IHI, thought BWH would be a great place to test the WalkRounds, and the hospital has had success with them ever since, says Graydon-Baker.
Frankel and some of his colleagues recently published a study in Health Services Research that showed implementing WalkRounds helped increase perceptions of patient safety with frontline caregivers. The study, partially funded by the AHRQ, followed 21 care areas at seven hospitals that had implemented WalkRounds for 18 months.
Prior to the study, one-third of care areas had patient safety climate scores below 60%; after the study, only 7% were below this number. Additionally, researchers saw significant improvement in how often staff members' discuss patient safety issues and report concerns.
How BWH's WalkRounds work
BWH requires that one member of senior leadership take part in the WalkRounds. This member can be any of the following:
- Chief medical officer
- President or CEO
- Chief nursing officer
- Chief operating officer
BWH feels so strongly about having a member of this senior leadership team in attendance that if, for some reason, the leader scheduled to take part in the WalkRounds cannot attend, Graydon-Baker reschedules the safety round.
Additionally, the vice presidents of each area are invited. The chief information officer often attends because BWH is a technology-driven hospital, Graydon-Baker says. Other staff members who usually attend include a pharmacist, the medication safety officer, a physician leader, and the nurse manager of the area in which the patient safety rounds are taking place.
Each week, a senior leader will visit one area of the hospital. An area could be a patient care floor, a service department, or an outpatient clinic.
The weekly WalkRounds take 45–50 minutes to complete, says Graydon-Baker. Because the hospital is so big, it takes about 18 months to do rounds throughout the entire facility.
Most importantly, in attendance are the staff members from the area of the hospital in which the patient safety rounds are taking place. Graydon-Baker begins informally by describing the purpose of the rounds and introducing everyone in attendance to staff members.
Additionally, because BWH has been doing the rounds since 2001, she recaps the issues brought up the previous time that area had its patient safety round and whether those issues were addressed. Providing this feedback shows staff members that their concerns are being taken seriously.
She then starts off the questioning and lets the senior executives take over.
"There's always going to be that little bit of reluctance initially, but once [staff members] get talking, it doesn't matter, and the playing field is leveled. They're very forthcoming about their issues," says Graydon-Baker.
Questions senior leaders might ask include:
- How will the next patient be harmed in your area?
- How does the environment fail you?
- What happened the last time a patient was hurt as a result of how we delivered care?
- What keeps you up at night?
Keys to successful patient safety rounds
There are three main requirements for ensuring that your patient safety rounds will be a success:
- The full participation of senior leadership is a must. Unless senior leaders are engaged and believe that hosting the WalkRounds is essential to patient safety, staff members will not be convinced that leadership really cares.
- A robust database or infrastructure is necessary for compiling and analyzing the data that come out of the WalkRounds.
- A mechanism for follow-up with the staff members involved with the WalkRounds is necessary.
Graydon-Baker says about one month after the WalkRounds take place, she sends out questionnaires to those staff members who were included to gauge whether they thought the leaders were listening to their concerns.
"There are questions like, ‘Do you think we take you seriously?' and ‘Have you seen improvements?' on the survey," says Graydon-Baker. "But that's solely dependent on the feedback you give them—even if it's negative feedback, even if it's, 'I can't do this right now; we heard you, and we're going to track this.'"