Should patient safety walkrounds take a walk? ("...inadvertently lead to counter-productive attitudes...")

BMJ Qual Saf. 2014 Jan 9. doi: 10.1136/bmjqs-2012-001706. [Epub ahead of print]

'I think we should just listen and get out': a qualitative exploration of views and experiences of Patient Safety Walkrounds.

Rotteau L, Shojania KG, Webster F.

Author information

• University of Toronto Centre for Quality Improvement and Patient Safety, , Toronto, Ontario, Canada.

Abstract

OBJECTIVE:

This article is an exploration of views and experiences of Patient Safety Walkrounds, a widely recommended strategy for identifying patient safety problems and improving safety culture.

DESIGN AND SETTING:

Qualitative analysis of semistructured, in-depth interviews with 11 senior leaders and 33 front-line staff at two major teaching hospitals with mature walkrounds programmes, collected as part of a larger mixed-methods evaluation.

RESULTS:

Despite differences in the structure of the two walkrounds programmes, senior leaders at both institutions reported attitudes and behaviours that contradict the stated goals and principles of walkrounds. Senior leaders tended to regard executive visibility as an end in itself and generally did not engage with staff concerns beyond the walkrounds encounter. Some senior leaders believed they understood patient safety issues better than front-line staff and even characterised staff concerns as 'stupid'. Senior leaders acknowledged that they often controlled the conversations, delimiting what counted as patient safety problems and sometimes even steered the conversations to predetermined topics. Some front-line staff made note of these contradictions in their interviews.

DISCUSSION/CONCLUSIONS:

Our study found that walkrounds may inadvertently lead to counter-productive attitudes by senior leaders at odds with the recommended principles of walkrounds. The results demonstrate similar attitudes from senior leaders at two hospitals with quite different formats for walkrounds, suggesting that this pattern may exist elsewhere. Better preparation of senior leaders prior to the walkrounds may help to avoid the counter-productive attitudes and dynamics that we identified.