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The WalkRounds process is designed to accomplish the following goals:
In preparation to implement WalkRounds:
1. Schedule WalkRounds.
2. Conduct WalkRounds with front line staff.
Recommended Opening Statement
“We are moving as an organization to open communication and a blame-free environment because we believe that by doing so we can make your work environment safer for you and your patients. The discussion we are interested in having with you is confidential and purely for patient safety and improvement. We are interested in focusing on the systems you work in each day rather than on blaming specific individuals. The questions we might ask you will tend to be general ones, and you might consider how these questions might apply in your work areas in regards medication errors, communication or teamwork problems, distractions, inefficiencies, problems with protocols etc. We are happy to discuss any issues of concern to you. Our goal is to take what we learn in these conversations and use them to improve your work environment and the overall delivery of care.”
“Can you think of a patient we harmed recently while delivering care?”
“In what way does the system fail you consistently?”
“Can you think of a patient who was saved from harm as a result of your intervention?”
Recommended Closing Statement
“We appreciate the time and effort you put into taking care of patients and making their experience in our organization remarkable. Our job is take the information you have given us, to analyze it carefully, figure out what actions we might take to fix problems, assign those responsibilities to individuals and hold their feet to the fire until the problems are solved. We promise to let you know how we’re doing and we will come back and elicit your opinion. We will work on the information you have given us. In return we would like you to tell two other people you work with about the concepts we have discussed in this conversation.
As you see or think of other adverse events or are concerned about potential harm to a patient please report it by ________________ (Fill in the mechanism to be used in your particular organization). Near misses and adverse events are windows that we can all use to improve the safety of care we deliver. We can only address the issues if we know and talk about them openly.”
3. Collect and analyze data.
4. Assign action items.
Action Items from Pilot Hospitals
Three years into the WalkRounds at Brigham & Women’s Hospital, many changes had been made that could be partly or fully associated with the rounds. (Gandhi 2003). These include:
5. Give feedback to Board, leadership, management, and staff.
6. Measure your progress.
Frankel A, Graydon-Baker E, Neppl C, Simmonds T, Gustafson M, Gandhi TK. "Patient Safety Leadership WalkRounds." Joint Commission Journal of Quality and Safety. 2003, Vol 29(1), 16-26.
Leonard M, Frankel A, Simmonds T, Vega KB. Achieving Safe and Reliable Healthcare: Strategies and Solutions. Chicago: Health Administration Press, 2004.
Gandhi TK, Graydon-Baker E, Barnes JN, Neppl C, Stapinski C, Silverman J, Churchill W, Johnson P, Gustafson M. "Creating an integrated patient safety team." Joint Commission Journal of Quality and Safety. 2003, Vol 29(8), 383-90.
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