title: Walkrounds in practice: corrupting or enhancing a quality improvement intervention? A qualitative study.
abstract: BACKGROUND
  Walkrounds, introduced as Leadership (or Executive) WalkRounds, are a widely advocated model for increasing leadership engagement in patient safety to improve safety culture, but evidence for their effectiveness is mixed. In the English National Health Service (NHS), hospitals have been strongly encouraged to make use of methods closely based on the walkrounds approach. A study was conducted to explore how walkrounds are used in practice and to identify variations in implementation that might mediate their impact on safety and culture.
  
  
  METHODS
  The data, collected from 82 semistructured interviews in the English NHS, were drawn from two components of a wider study of culture and behavior around quality and safety in the English system. Analysis was based on the constant comparative method.
  
  
  RESULTS
  Our analysis highlights how local, pragmatic adjustments to the walkrounds approach could radically alter its character and the way in which it is received by those at the front line. The modification and expansion of walkrounds to increase the scope of knowledge produced could increase the value that executives draw from them. However, it risks replacing the main objectives of walkrounds--specific, actionable knowledge about safety issues, and a more positive safety culture and relationship between ward and board--with a form of surveillance that could alienate frontline staff and produce fallible insights.
  
  
  CONCLUSIONS
  The studys findings suggest some plausible explanations for the mixed evidence for walkrounds' effectiveness in creating a safety culture. On a practical level, they point to critical questions that executives must ask themselves in practicing interventions of this nature to ensure that adaptations align rather than conflict with the intervention's model of change.
authors.forename: Graham
authors.initials: G
authors.lastname: Martin
authors.forename: Piotr
authors.initials: P
authors.lastname: Ozieranski
authors.forename: Janet
authors.initials: J
authors.lastname: Willars
authors.forename: Kathryn
authors.initials: K
authors.lastname: Charles
authors.forename: Joel
authors.initials: J
authors.lastname: Minion
authors.forename: Lorna
authors.initials: L
authors.lastname: McKee
authors.forename: Mary
authors.initials: M
authors.lastname: Dixon-Woods
mesh_terms: D003142:Communication; D006740:Hospital Administrators / Q000458:organization & administration*; D006801:Humans; D007857:Leadership; D015279:Organizational Culture; D061214:Patient Safety; D036301:Qualitative Research; D011785:Quality Assurance, Health Care / Q000379:methods; D017751:Safety Management / Q000379:methods; D013222:State Medicine / Q000458:organization & administration*; D006113:United Kingdom