RESUMEN
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.
Asunto(s)
Liderazgo , Cultura Organizacional , Garantía de la Calidad de Atención de Salud/métodos , Administración de la Seguridad , Adulto , Femenino , Encuestas de Atención de la Salud , Humanos , Masculino , Massachusetts , Persona de Mediana Edad , Estudios Prospectivos , Administración de la Seguridad/normasRESUMEN
BACKGROUND: Brigham and Women's Hospital (BWH) began Patient Safety Leadership WalkRounds in January 2001; its experience, along with that of three other Partner Healthcare hospitals, is reported. COLLECTING DATA ON WALKROUNDS: Data were obtained from interviews with patient safety personnel, WalkRounds scribes, and senior leaders. FINDINGS: A total of 233 one-hour WalkRounds during 28 months yielded 1,433 comments--30% related to equipment, 13% to communications, 7% to pharmacy, and 6% to workforce. Actions occurred quickly in small hospitals. Formal processes for managing larger issues were necessary in large organizations. Implementation feasibility featured more prominently than severity in determining actions. DISCUSSION: The study generated essential guidelines for success--for example, the supporting resources must include the maintenance of effective information databases that identify actions taken, and the discussions during WalkRounds are influenced by who in leadership is participating, their ability to quietly listen, and whether they have clinical or nonclinical backgrounds. CONCLUSIONS: WalkRounds appears to be an effective tool for engaging leadership, identifying safety issues, and supporting a culture of safety.