1. Patient Safety WalkRounds

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

3. 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

4. WalkRounds – a history 1999 Concept developed by IHI
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

5. 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

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

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

8. 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.

9. 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

10. 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”

11. 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?

12. 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

13. 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.

14. Communicating and tracking progress following the WalkRound
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)

15. 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.

16. 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’”