Patient Safety WalkRounds

Content of presentation What do WalkRounds aim to achieve? History and Spread Why are they important? How to do them well

Aim of WalkRounds To demonstrate visible senior leadership in patient safety To combine a top-down and bottom-up approach to safety awareness and management Gain information and act on safety problems and issues

WalkRounds – a history 1999 Concept developed by IHI 2000-2003 piloted in several US hospitals 2003 First published research on Walkrounds 2004 incorporated into the UK Safer Patient’s initiative 2007 identified as a key leadership intervention for the 1000 Lives Campaign

Why are WalkRounds important? Depends on your perspective.. Patient Benefit from decreased risk Leaders Directly interact Learn unfiltered truth Directly influence culture Front line staff Opportunity to discuss concerns Opportunity to be heard and respected Safety Experts Gather data that lead to action Improve how action is taken

WalkRounds: An important additional source of information for the Board Incidents WalkRounds Surveys Complaints Litigation

Who should take part in WalkRounds? Executives Non-Executives/Non-Officers Scribe ..meeting with Front line staff teams

Planning for WalkRounds Plan and scope the programme for the organisation (including frequency and spread of visits). Schedule Board member diaries. Target receptive areas first. Provide notice and advance information to areas that will be visited. Gather other information of particular relevance to the area to be visited to brief the WalkRound team. Ensure that individuals leading WalkRounds are confident with the purpose, style and content of the approach.

During the WalkRound Involve staff at all levels in the discussion Record all issues raised Use scripted opening statements to set the scene and context Use prepared open questions to foster open discussion

Examples of opening statements: “We want to ensure open communication and a blame free environment to make the work environment safer for you and patients” “We are interested in focussing on the system and not individuals” “The discussion we are interested in having with you is confidential to help improve patient safety and improvement”

Some examples of open questions.. Have there been any “near misses” that almost caused patient harm but didn’t? What aspects of the environment are likely to lead to the next patient harm? Is there anything we could do to prevent the next adverse event? What specific intervention from leaders would make the work you do safer for patients?

Concluding the WalkRound Summarise discussions, agree which issues will be taken forward and by whom Explain how feedback will be given and progress on actions will be monitored

Immediately following the WalkRound Undertake WalkRound team debrief. Agree and assign any urgent actions to be taken forward. Discuss what went well, what went poorly and lessons learned.

Communicating and tracking progress following the WalkRound Email participants listing concerns raised, thanking them and assuring them of feedback Record information systematically Assign actions to appropriate staff according to accountability and resources. Track progress on actions Categorise actions as open/closed (Actions should only be categorised as closed when feedback is provided to front line staff)

Framework for tracking actions, monitoring progress and reporting to Boards ISSUES SHOULD BE CATEGORISED INTO THEMES, e.g.: Communication Environment Equipment Staffing Training Team Working Process Incident Reporting ISSUES SHOULD BE CATEGORISED BY LEVEL OF ACTION ALLOCATED, e.g.: Action to be taken by staff Action to be taken by operational/ unit management Action to be taken by Board Executive REPORTS SHOULD INCLUDE, e.g.: Tracking of all actions Timescales for completion Status open/ closed.

Safer Patients Initiative experience of WalkRounds Some comments from Chief Executives… “Walkrounds are simple – but hard to do well” “Of all the interventions we have tried, Walkrounds have probably had the most impact” “A walkround is like a choreographed dance and careful preparation is essential” “Walkrounds do have a resource requirement, but it is small” “A Walkround is the essence of ‘Servant Leadership’”