Patient Safety Leadership WalkRounds – Aims of WalkRound and Information for Leadership Team (Jan 2008)
(Dr GJ Shortland AMD Clinical Governance and Patient Safety)
The establishment of a Patient Safety Leadership WalkRound, over the last 8 months, has been an important opportunity to demonstrate Cardiff and Vale Trust’s commitment to build a safety culture. Review of this experience has led to a greater understanding of those WalkRounds which appear to have a positive outcome with Patient Safety issues identified and are summarised in this document.
Information for WalkRounds
Organisation
WalkRounds are organised in advance with the local clinical team. This may be organised by and requested by the Executive/Leadership team or at the request of the local team. As of April 2008 it is anticipated that completion of the first years WalkRounds will allow return visits to review the actions identified at the first visit.
WalkRounds are scheduled on a weekly basis and will comprise an Executive Director, Clinical Leader and scribe/recorder. Non-executives will be provided with details of the visits and opportunity to attend. Prior to the visit a detailed leaflet of the purpose of the WalkRound is provided to the local clinical team.
Venue
Clinical areas, operating rooms, radiology department, emergency department, pharmacy, laboratories and service areas have all been used. It is recognised that more protected areas, e.g ward side-rooms, teaching rooms, have allowed more conversation with less interruption.
Format
Conversation has been structured in different ways. This can occur as hallway conversations, a number of individual conversations or group conversations.
Opening Introductions and Statements
A general introduction of the visiting Leadership team and introduction of the local team is important. It is also important to note that the local team have received the WalkRound information leaflet with an opportunity to pass this to the local team and frontline staff.
To set the context of the WalkRound an opening statement is important
“We are interested in focussing on the system and not individuals”
“The discussion we are interested in having with you is confidential to help improve patient safety and improvement”
“We are working to as an organisation to ensure open communication and a blame free environment to make the work environment safer for you and patients”
In addition it is important early in the visit to emphasis that the Leadership team wish to hear from all members of the local team and frontline staff about their Patient Safety concerns.
Questions to Ask
Examples of questions to identify Patient Safety issues include
“Can you think of any events in the past day or few days that have resulted in prolonged hospitalisation?”
e.g. medication delays, communication problems
“Have there been any near misses that almost caused patient harm but didn’t?”
e.g. medication errors, pump errors
“Have there been any incidents lately that you think of where a patient was harmed?”
e.g. infection, surgical complications, drug complications
“Is there anything we could do to prevent the next adverse event?”
e.g communication and interaction between clinical staff, environmental problems, lack of information
“What specific intervention from leadership would make the work you do safer for patients?”
e.g. improve interdisciplinary working, changing attitudes of staff groups, facilitate interaction between different groups.
“Are you confident that you can report your patient safety concerns through appropriate channels in your clinical area”
e.g. education about incident reporting, knowledge of clinical governance structure
“Is there anyway we could improve the WalkRound and make it more effective?”
Areas to Avoid
· Avoid general managerial issues
There are already identified procedures and methods of solving or resolving general management issues which may not be related to patient safety
· Avoid global issues
Be realistic in highlighting that the visit does not pretend to solve all the problems that may affect the clinical area and that the visit is not an opportunity for a shopping list for new resources.
· Avoid managerial hi-jack.
Ensure all staff are given the opportunity to discuss patient safety issues identifying frontline staff and the issues that affect them
· Avoid overload of issues
It is important to avoid taking away too many issues. Local ownership of problems identified should be encouraged and the WalkRound used as an opportunity to put wards and departments with similar issues in touch with each other to solve problems.
Themes Identified
During the previous WalkRounds a number of common themes have been identified which can be included and adapted in questions relevant to the local clinical area as necessary to prompt patient safety concerns
· Delayed transfers of care
· Clinical Outliers
· Storage space
· Timely access and communication with clinical staff
· Access to I.T. facilities
· Wheelchairs and seating arrangements
· Quality of patient identification
· Engagement of clinical and other departments e.g. planning, in strategic developments
· Increasing frailty and obesity of patients
Closing Comments
The local team should be thanked for giving their time. It may also be useful to ask about 1 or 2 examples of changes that have been made that have improved patient safety and could be passed to others in future WalkRounds, ending the WalkRound on a positive note. The WalkRound team will feed back a summary, in 72 hours, and ask the clinical area to identify their own solutions to issues identified and highlight two specific issues requiring Executive support.