Feasibility and Added Value of Executive WalkRounds in Long Term Care Organizations in the Netherlands.
Currently available tools for the management of safety in health care are largely based on quantitative management information. Executive WalkRounds (WalkRounds [WR]) seems useful as a leadership tool to detect "soft signals"-alerts of unsafe situations or practices-and to enhance the mutual trust between frontline staff and the board of directors. The majority of the research on WR has been performed in hospitals. Therefore, a study was conducted to assess how the boards of directors of long term care organizations value WR as a leadership tool to perceive soft signals, and whether soft signals are of added value to enhance patient safety.



WRs were introduced in a convenience sample of six organizations-two mental health care institutions, two nursing homes and home care organizations, and two institutions for the physically and intellectually disabled-between July 2012 and December 2013. Data were gathered from observation and reporting forms. Feasibility was evaluated by open-group interviews. A mixed-method analysis was performed using descriptive statistics and content analysis.



WRs were considered feasible, and the added value for the boards of directors consisted of an increased sense of urgency and safety awareness. The dialogue between the board of directors and frontline staff in each organization was essential for a collective patient safety culture. In total, WRs were used 68 times, and 298 soft signals were identified; most addressed care delivery and communication. Overall, 245 improvement activities were reported, of which 109 related to work environment.



WRs were considered useful and feasible for detecting soft signals in long term care organizations. These signals are valuable for enhancing patient safety and can be used by the board of directors in addition to the current quality management systems.
PhD Student, IQ healthcare, Scientific Center for Quality of Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands; Nurse Scientist, Atlant Care Group, Apeldoorn, the Netherlands. Electronic address: Loes.vanDusseldorp@radboudumc.nl.
Loes
L
van Dusseldorp
IQ healthcare.
Getty
G
Huisman-de Waal
Faculty of Health and Social Studies, University of Applied Sciences, Nijmegen.
Hub
H
Hamers
Professor, Quality of Healthcare; Head, IQ healthcare.
Gert
G
Westert
Formerly Senior Research Fellow Nursing Science, IQ healthcare; Professor of Nursing, Faculty of Health Sciences, University of Southampton, United Kingdom.
Lisette
L
Schoonhoven
D005240:Feasibility Studies; D006740:Hospital Administrators; D006801:Humans; D007407:Interviews as Topic; D007857:Leadership; D008134:Long-Term Care; D009426:Netherlands; D015279:Organizational Culture; D061214:Patient Safety; D011785:Quality Assurance, Health Care; D040242:Risk Reduction Behavior; D017751:Safety Management / Q000458:organization & administration*