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Revealing and Resolving Patient Safety Defects: The Impact of Leadership WalkRounds on Frontline Caregiver Assessments of Patient Safety

Authors

  • Allan Frankel,

    1. 15 Whitetail Lane, Sudbury, M.A. 01776,
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    • Address correspondence to Allan Frankel, M.D., 15 Whitetail Lane, Sudbury, M.A. 01776; e-mail: allan.frankel@lotusforum.com. Dr. Frankel is a member of the Division of General Medicine, Brigham and Women's Hospital, Boston, Massachusetts, and is an instructor at Harvard Medical School. Sarah Pratt Grillo, M.H.A., is from Alexandria, VA. Mary A. Pittman, Dr.P.H., President and CEO, is with the Public Health Institute, Oakland, CA. Eric J. Thomas, M.D., M.P.H., Griff T. Ross Professor in Humanities, and Technology Director, is with the UT Houston-Memorial Hermann Center for Healthcare Quality and Safety, and is Associate Professor of Medicine, University of Texas Medical School at Houston, Houston, TX. Lisa M. Horowitz, Ph.D., M.P.H., Office of the Clinical Director, is with the National Institute of Mental Health, NIH, Bethesda, M.D. Martha B. Page, M.S.N., R.N., C.P.H.Q. is Director of Patient Safety with North Shore Medical Center, Salem, MA. J. Bryan Sexton, Ph.D., Assistant Professor, is with the Johns Hopkins Quality and Safety Research Group, Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD.

  • Sarah Pratt Grillo,

    1. Alexandria, VA,
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  • Mary Pittman,

    1. Public Health Institute, Oakland, CA,
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  • Eric J. Thomas,

    1. UT Houston-Memorial Hermann Center for Healthcare Quality and Safety, and is Associate Professor of Medicine, University of Texas Medical School at Houston, Houston, TX,
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  • Lisa Horowitz,

    1. Office of the Clinical Director, is with the National Institute of Mental Health, NIH, Bethesda, M.D.,
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  • Martha Page,

    1. North Shore Medical Center, Salem, MA,
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  • Bryan Sexton

    1. Johns Hopkins Quality and Safety Research Group, Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD
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Abstract

Objective. To evaluate the impact of rigorous WalkRounds on frontline caregiver assessments of safety climate, and to clarify the steps and implementation of rigorous WalkRounds.

Data Sources/Study Setting. Primary outcome variables were baseline and post WalkRounds safety climate scores from the Safety Attitudes Questionnaire (SAQ). Secondary outcomes were safety issues elicited through WalkRounds. Study period was August 2002 to April 2005; seven hospitals in Massachusetts agreed to participate; and the project was implemented in all patient care areas.

Study Design. Prospective study of the impact of rigorously applied WalkRounds on frontline caregivers assessments of safety climate in their patient care area. WalkRounds were conducted weekly and according to the seven-step WalkRounds Guide. The SAQ was administered at baseline and approximately 18 months post-WalkRounds implementation to all caregivers in patient care areas.

Results. Two of seven hospitals complied with the rigorous WalkRounds approach; hospital A was an academic teaching center and hospital B a community teaching hospital. Of 21 patient care areas, SAQ surveys were received from 62 percent of respondents at baseline and 60 percent post WalkRounds. At baseline, 10 of 21 care areas (48 percent) had safety climate scores below 60 percent, whereas post-WalkRounds three care areas (14 percent) had safety climate scores below 60 percent without improving by 10 points or more. Safety climate scale scores in hospital A were 62 percent at baseline and 77 percent post-WalkRounds (t=2.67, p=.03), and in hospital B were 46 percent at baseline and 56 percent post WalkRounds (t=2.06, p=.06). Main safety issues by category were equipment/facility (A [26 percent] and B [33 percent]) and communication (A [24 percent] and B [18 percent]).

Conclusions. WalkRounds implementation requires significant organizational will; sustainability requires outstanding project management and leadership engagement. In the patient care areas that rigorously implemented WalkRounds, frontline caregiver assessments of patient safety increased. SAQ results such as safety climate scores facilitate the triage of quality improvement efforts, and provide consensus assessments of frontline caregivers that identify themes for improvement.

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