C-suite leaders and members of the senior executive team at health care institutions have been increasingly encouraged to use weekly Safety Leadership Rounds or WalkRounds as an opportunity to learn first-hand about what is happening within their hospitals and to proactively address any problems or safety concerns. Safety Leadership Rounds not only demonstrate a commitment to patient safety, but also establish trusting relationships and open lines of communication regarding patient safety.*
Although some surgeons in leadership positions may have the opportunity to participate in Safety Leadership Rounds, other surgeons also can actively contribute, as rounds are often conducted on surgical floors and in operating rooms. During Safety Leadership Rounds, informal conversations occur between leadership and staff about safety issues within the institution. Surgeons can use Safety Leadership Rounds to demonstrate a commitment to safety and teamwork and to identify opportunities to improve the lines of communication across all levels of the organization.
In Patient Safety Initiative: Hospital Executive and Physician Leadership Strategies, Joint Commission Resources and the Institute for Healthcare Improvement recommend seven steps to conduct Safety Leadership Rounds, which are as follows:†
- Prepare. Garner commitment and regular participation from leadership and secure dedicated resources.
- Schedule. Set schedules months in advance to accommodate the time demands of leadership.
- Conduct. Determine where to conduct Safety Leadership Rounds, including possible sites where safety culture may need improvement.
- Track. Establish a system for tracking and ranking collected data obtained from the rounds.
- Report. Share data with a multidisciplinary committee so that action items may be assigned to management personnel.
- Get feedback. Use formal methods to provide feedback to frontline providers to ensure the appropriate buy-in from all levels of the organization.
- Measure. Evaluate whether rounds are effective in improving the organization’s culture.
When participating in Safety Leadership Rounds, surgeons may want to consider asking or being prepared to answer the following questions:
- Have there been any near-misses that almost caused patient harm?
- Is there anything we can do to prevent the next adverse event?
- What specific intervention from leadership can make the work you do safer for patients?
- How are you engaging patients and families in their care?
Once Safety Leadership Rounds are established and implemented, it is important to assess their impact on the safety culture. An article in the July 2014 issue of The Joint Commission Journal on Quality and Patient Safety details how England’s National Health Service found variations in the implementation of WalkRounds, potentially mediating their impact on safety culture.
In the study, safety stakeholders revealed modification and expansion of WalkRounds, and the authors contend that such deviations risk replacing the main objectives of rounds as a form of surveillance that could alienate frontline staff and produce fallible insights. They also suggest that leadership should attempt to ensure that WalkRounds adaptations align, rather than conflict, with the intervention’s model of change.*‡
As Safety Leadership Rounds continue to evolve, surgeons can work with leadership to ensure that rounds continue to promote an institution-wide safety culture and improve patient safety and quality of care.
For more information on Safety Leadership Rounds, access Patient Safety Initiative: Hospital Executive and Physician Leadership Strategies, a complimentary guide from the Joint Commission Resources’ Hospital Engagement Network is available.
*Joint Commission Resources Hospital Engagement Network, Patient Safety Initiative: Hospital Executive and Physician Leadership Strategies. Oakbrook, IL: Joint Commission Resources; 2014; 9.
†Leonard M, Frankel A, Federico F, et al. Systematic Flow of Information: The Evolution of WalkRounds. The Essential Guide for Patient Safety Officers, 2nd ed. Oakbrook Terrace, IL: Joint Commission Resources; 2013; 43-52.
‡Martin G, Ozieranski P, Willars J, et al. Walkrounds in practice: corrupting or enhancing a quality improvement intervention? A qualitative study. Jt Comm J Qual Patient Saf. 2014;40(7):303-310.