title: Revealing and resolving patient safety defects: the impact of leadership WalkRounds on frontline caregiver assessments of patient safety.
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.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
authors.affiliation: Division of General Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA. allan.frankel@lotusforum.com
authors.forename: Allan
authors.initials: A
authors.lastname: Frankel
authors.forename: Sarah Pratt
authors.initials: SP
authors.lastname: Grillo
authors.forename: Mary
authors.initials: M
authors.lastname: Pittman
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Thomas
authors.forename: Lisa
authors.initials: L
authors.lastname: Horowitz
authors.forename: Martha
authors.initials: M
authors.lastname: Page
authors.forename: Bryan
authors.initials: B
authors.lastname: Sexton
mesh_terms: D000328:Adult; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D007857:Leadership; D008297:Male; D008404:Massachusetts; D008875:Middle Aged; D015279:Organizational Culture; D011446:Prospective Studies; D011785:Quality Assurance, Health Care / Q000379:methods*; D017751:Safety Management / Q000592:standards