Patient Safety

WalkRounds
Ammal F. Farahat, CPHQ
QM Specialist- KAMC
HQMN-KKESH 10/02/08
What are Patient Safety
WalkRounds?
 Why Patient Safety WalkRounds?
Effective reduction of medical/health care errors
and other factors that contribute to unintended
adverse patient outcomes in a health care
organization requires an environment in which
patients, their families, organization staff and
leaders can identify and manage actual and
potential risk to patient safety."
American Association, Health Research & Educational Trust, 2002
Why Patient Safety WalkRounds?

When leaders begin to change their responses

to mistakes and failure, asking what happened
instead of who made the error, the culture within
their health care institutions will begin to
change. Institute for Healthcare Improvement (IHI) 2005
What are Patient Safety
WalkRounds?
In January 2001, Brigham and Womens Hospital
(BWH) introduced Patient Safety Executive Walk-
rounds so as to:
make patient safety a high priority for BWH senior
leadership
educate and increase clinicians awareness regarding
patient safety issues
obtain information affecting patient safety and using
it to make system improvements
Why Patient Safety WalkRounds?
Executives to get a feel for the daily work environment of
staff dealing directly with patients
Executives to get a better understanding for patient safety
issues, how they arise, why and how they can be dealt with
Executives to show frontline staff their commitment towards
patient safety by listening and acting upon their concerns
Open communication between executives and frontline staff
directly
Promote fair and just culture

Foster an environment in which staff are mindful

Mindfulness?
Defined by Roberts, Weick, and Sutcliffe (2001) as:
1. a constant concern about possibility of failure even
in the most successful endeavors
2. respect expertise regardless of rank or status
3. an ability to adapt when the unexpected occurs
4. an ability to both concentrate on a specific task
while having a sense of the bigger picture
5. an ability to alter and flatten hierarchy as best fits
the situation
Goal of Patient Safety
WalkRounds
To improve the culture of safety and
systems that support the practice of safe
and high quality care of patient by
bridging the separate practice cultures of
the administrator, physician, nurse, and
pharmacist.
 Design of WalkRounds
I. At least one team consisting of Patient Safety
Champions/ Volunteers :

Team leader = Senior leader/ EXECUTIVE

Team members: Safety Manager
Senior QM staff
Area Pharmacist
 Design of WalkRounds
II. Before the Visit:
Every visit is scheduled and the team goes to
an area within the hospital. All hospital areas
are visited with priority given to direct patient
care areas.
24 hours before the visit the nurse manager of
the area is contacted and asked to discuss in a
non-threatening manner with their staffs the
questions to be asked.
Design of WalkRounds
Sample questions to be asked:
1. Were you able to care for your patients this week as safely as possible?
If not, why not?
2. Can you describe how communication between caregivers either
enhances or inhibits safe care on your unit?
3. Can you describe the unit's ability to work as a team?
4. Is there anything we could do to prevent the next adverse event?
5. What do you think this unit could do on a regular basis to improve
safety? For example, would it be feasible to discuss safety concerns,
eg, patients with same name, near misses that happened, etc, during
report?
6. When you make an error, do you always report it?
 Design of WalkRounds
III. The Visit:
Physician leaders are also asked to join the
rounds.
The nurse manager is encouraged to observe
the process and participate to learn the
concepts however main focus is given to the
frontline staff.
Comments are recorded on a worksheet and
later transferred to the database.
 Design of WalkRounds
IV. After the Visit:
The team discusses the issues raised, prioritize
them choose and agree on the issues to be
tackled and who will be accountable.
Share the information with the Nurse Manager
and Senior Physician of the area before acting
upon them to confirm their priority and the
planned outcome.
Take care of the issues as soon as possible.
Give feedback.
 Design of WalkRounds
VI. Feedback:
- Frontline Staff who participated in the WR
- Senior Leaders of the area visited
- Directors
- Top Executives and Hospital Wide Committees
(the governing body)
- WR team leaders and members
- Annual reports and reviews.
 Design of WalkRounds
V. The Database:
1. Know what is needed from the database.
2. Each issue picked up, including those resolved
or with a positive impact.
3. If issue requires action, by whom, what is the
action, and deadline.
4. Maintained by 1-2 people
 KAMC Walkrounds
1. June 2007 after the Patient Safety Culture
Assessment was done however before the
information was disseminated.
2. Teams: 6, each consisted of a team leader, facilitator,
2 Senior staff (physician, administrator, &/or nurse)
3. Visits: 6/month, questions sent one week in advance,
pre-briefing and post-briefing
4. Reports: each issue was given a Category and sub-
category coding with action to be taken (usually a
memo drafted by QM & sent by Executive Directors
Office, no follow-up
Tips for Patient Safety WalkRounds
Get a commitment from senior executives for an hour every week. The
WalkRounds may be rescheduled but never canceled.
Keep discussions focused on safety - dont dilute the safety message by
trying to cover other topics.
Involve all the senior executives in the organization, not just the chief
executive officer.
Communicate with managers so they understand why senior executives are
visiting their departments.
Make sure that senior executives follow up and provide feedback to staff
about issues raised during the WalkRounds.
Institute regular safety briefings. Pass along issues raised in the briefings
(with names of the contributing staff members withheld) to the executives to
talk about on their WalkRounds.
Take a digital camera. It has been wonderful for PowerPoint presentations to
staff and quality council meetings. Pictures are worth a thousand words.
[Submitted by Marie Zappia Kuzmack, San Clemente Hospital]

http://www.ihi.org/IHI/Topics/PatientSafety/MedicationSystems/Changes/IndividualChanges/Conduct+Patient+Safety+Leade
rship+WalkRounds.htm
Tips for Patient Safety WalkRounds
Not a WISH LIST session!
Long standing issues brought up during the WalkRounds such
as shortage of staff, space or salary increase and so on are noted
in the worksheet, the team leader thanks the staff for their
honesty and contribution however these issues will be
forwarded and addressed in their proper venue such as the
strategic management committee. Also, remind other rounds
participants of the limitations facing the system, seek out ideas
for improvement, and discuss efforts that are under way to
address them.

Bad news: cant fix everything. Good news: they dont have to.
Tips for Patient Safety WalkRounds
Before starting the WalkRounds have everything
prepared from training all the facilitators and teams,
the database, pilot the project by having the teams
practice amongst each other or with one of the areas
and using the database and producing reports.
Then launch the project with a