Patient Safety

Leadership
WalkRounds
Dr. Fathi Mohamed Ali
Hospital Leaders Support to
Patient Safety
Action Plan to Improve Hospital
Management Support

 Management and front line staff have different

views of the culture of safety

 Patient Safety Leadership WalkRoundsTM*

 Senior leaders talk with front line staff informally
but regularly to understand their perceptions
 Use the scripted opening statements to get
started
 Follow-up!
 Patient Safety
Leadership WalkRounds
What is WalkRounds?
 Weaves several themes together:
 Learning System

 Leaders and Teams

 Transparency

 Operational Effectiveness

 Rigorous in application and detail

 Well Coordinated.
Agenda

 What is WalkRounds?
 Why is it important to
you?
 How to do them well?
WalkRounds is important to me…

 Patient
•Benefit from decreased risk
•(which usually also leads to
greater efficiency)
 Leaders
•Directly interact
•Learn unfiltered truth
•Directly influence culture
WalkRounds is important to me…(cont)

 Providers
•Opportunity to discuss concerns
•Opportunity to be heard and
respected

 Quality & Safety Experts

•Gather data that lead to action
•Improve how action is taken
Practical WalkRounds:
An Engaging Leadership Activity with Action

Preparation
Scheduling

Debrief

Managing
 Prepare

Preparation

Advance Scheduling
of Walkrounds:
Coordinate calendars
of the Team Members
 Schedule
Preparation

Reminder Confirmations
Scheduling

to team members
regarding Rounds and
recent issues being
addressed.
 Set Content
Preparation

Scheduling

Set Context
Immediately Pre-Rounds,
(for revisits) Review
WalkRounds info
collected from previous
visit to that unit.
 Do WalkRounds
Preparation

Scheduling

Gather for WalkRounds:

Set Context
Utilize scripted opening statement and
questions to foster open discussion.
Sorts concerns.
Do Walkrounds

Record issues.
Keep discussion focused.

Conclude WalkRounds:
Reads back issues, concerns.
Summarize from scripted closing
statement.
 Debrief
Preparation

Scheduling

Set Context

Do Walkrounds
Executive team immediately
Debrief
debriefs onsite.
Assign urgent action items if
needed.
Discuss what went well, what
went poorly, what was learned.
 Begin Feedback
Preparation

Scheduling

Within couple days:

Set Context

Do Walkrounds Send email to participants

Debrief
with list of concerns elicited
during WalkRounds. Also
Begin Feedback
thank for participation and
ensure feedback.
 Track
Preparation

Scheduling

Set Context

Do Walkrounds
Match tasks to applicable
Debrief
resources.
Discuss with appropriate
Begin Feedback
managers and leadership
Tracking
and assign actions when
possible.
 Manage
Preparation

Scheduling

Set Context
Present WalkRounds
Do Walkrounds
issues to Quality
Debrief Management
Begin Feedback Steering Group.
Tracking Assign actions as
Managing
needed.
 Sustain
Preparation

Scheduling Track action items to assure

follow up.
Set Context
Action items are only “closed”
Do Walkrounds
when best resolution is
communicated back to frontline
Debrief individual who raised the
concern.
Begin Feedback

Tracking
Post dashboards of Key Metrics.
Managing Quarterly review by Leadership.

Sustaining
Script for WalkRounds #1

Can you think of any events in

the past day or past few days that
have resulted in prolonged
hospitalization of a patient?
Examples, appointments made
and missed, miscommunication,
delayed or omitted medications.
Script for WalkRounds #2

Have there been any incidents

lately that you can think of
where a patient was harmed?
Examples, infections, surgical
complications, complications
secondary to drugs, side
effects secondary to drugs.
Script for WalkRounds #3

What aspects of the environment

are likely to lead to the next
patient harm? Examples: consider
all aspects of admission, hospital
stay, and discharge, consider
movement within the hospital,
consider communication, consider
informatics and computer issues.
Script for WalkRounds #4

Is there anything we could do to

prevent the next adverse event?
Examples: What information
would be helpful to you? Consider
alterations in the interaction
between clinicians, consider
teamwork, consider environment
and workflow.
Script for WalkRounds #5

What specific intervention from the

leadership would make the work you do
safer for patients.
Examples: Informal conversations in the
hallway instead of organized conversations,
Individual conversations instead of group
discussions, ensure free time to discuss
issues.
Script for WalkRounds #6

How are we actively promoting a

blame free culture and working
on the development of a blame
Free reporting policy?
Example: We do not punish
staff for inadvertent errors.
Closing Comment

We are going to 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.
THANK YOU