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HRET Mission

Transforming health care through research and education.

HRET Vision

Leveraging research and education to create a society of healthy communities, where all individuals reach their highest potential for health.

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Implementing Patient Safety Leadership WalkRoundsTM

The WalkRounds process is designed to accomplish the following goals:

  • Increase awareness of safety issues among all clinicians and leaders.
  • Make safety a high priority for senior leadership.
  • Educate staff about patient safety concepts such as a “just culture.”
  • Obtain information collected from staff about barriers to safety.
  • Act, after careful analysis, on information collected from staff.
  • Consistently give feedback to frontline providers and leadership on processes.

In preparation to implement WalkRounds:

  1. Identify the core WalkRounds team.  This group should consist of at least one senior executive, a patient safety officer/manager, a scribe (usually a member of patient safety or administrative staff), and the manager or director of each unit to be visited on the rounds.
  2. Establish formal methods for reporting feedback from the rounds to senior executives, physician leaders, patient safety/quality committees, and the Board.
  3. Measure your safety culture, using a validated instrument, such as the Safety Attitudes Questionnaire (SAQ).

1. Schedule WalkRounds.

  • Schedule WalkRounds up to one year in advance
  • Base dates and times on staff availability rather than executive availability.  Take into consideration nursing shifts, lulls in activity and physician rounds.
  • Schedule WalkRounds weekly.  Frequency of WalkRounds will vary based on the size of the organization, but one round per week is a good “rule of thumb.”
  • Rounds should occur at any site where employees and clinicians are involved in patient care.

2. Conduct WalkRounds with front line staff.

  • Notify the department manager several days in advance of a WalkRound.  The department manager will then notify the front line staff who will participate in the scheduled round, allowing time for staff to reflect on safety concerns to discuss during the round.
  • When the WalkRounds core team arrives on the unit, either the visiting senior executive or the patient safety manager should make a formal, initial statement to set the stage for open discussion.

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.”

  • Elicit episodes of harm and concerns about risk

“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?”

  • The scribe records specific comments heard during the WalkRounds
  • At the end of each WalkRound, either the executive or patient safety manager should explain to participants what will be done with the information obtained.

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.

  • In the WalkRounds Database, track all individuals who participated in the rounds; the date, time, and location of the rounds; and all comments heard.
  • Classify each stated hazard or event by its contributing factors.  Record the frequency with which each hazard is likely to occur, and the severity of its potential or actual impact on patients.
  • For each comment in the database, calculate a priority score, based on measures of impact and frequency.
  • The priority scores will inform the best course of action for senior leadership in addressing hazards.

4. Assign action items.

  • Produce reports of categorized and prioritized WalkRounds comments, and distribute the reports to senior executives, patient safety committees, and the hospital Board.
  • Determine action items using comments, priority scores, and contributing factors recorded in the WalkRounds database.
  • On a monthly basis, convene a committee of clinical leaders, administrative directors and executives to review monthly reports of both open and closed action items.
  • The patient safety manager should establish communication mechanisms for transferring information from those responsible for actions being taken.

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:

  • Communication of the web-based on call system for reliable and easily accessible attending physician on call contacts.
  • Completion of the MRI safety zones within Radiology/MRI
  • Addition of MRI compatible IV pumps
  • Review and reduction of delays in patient transport to diagnostics
  • Initiation of the E-Z lift program for lifting heavy patients.
  • Addition of a PACS radiology viewing station on the Hem/Onc Service.
  • Review and reduction of infant travel from a neonatology unit.
  • Increased central monitoring for a neurology unit.
  • Improved discharge education for cardiac surgical patients.
  • Improvements in the OmniCell medication dispensing system.

5. Give feedback to Board, leadership, management, and staff.

  • Develop a plan for feeding information back to rounds participants, senior leaders, committees, and the Board.
  • Leverage hospital marketing resources to develop a communication plan for actions taken as a result of WalkRounds.

6. Measure your progress.

  • Refer to actions taken as the result of WalkRounds during later visits to each unit.
  • Measure safety climate changes periodically, using the Safety Attitudes Questionnaire.
  • Continually track follow-up comments, time to complete action items, frequency scores, and other indicators recorded in the WalkRounds database.

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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