Creating a culture of safety within a health care institution requires leadership involvement and commitment. The Patient Safety Team sought to improve the safety culture at BWH by implementing leadership safety WalkRounds in January 2001. Since that time, more than 50 Patient Safety Executive WalkRounds have taken place and the Patient Safety Team has cataloged nearly 700 comments looking for common themes.
The top five most cited themes include:
- Equipment functionality and maintenance;
- Facilities- space issues;
- Work overload;
- Supply availability; and
- Polices/Procedures/Protocols-communication
Each week, participants visit different areas of the hospital, including the medical/surgical/ obstetrical pods, ED, Pharmacy, and the OR.
The goals of these rounds are to:
- ensure safety is a high priority for senior leadership;
- increase staff awareness of safety issues;
- educate staff about patient safety concepts such as non-punitive reporting; and
- obtain information from staff about safety issues.
During the WalkRounds, specific questions are asked of the staff nurses, residents, and staff pharmacists, such as “ Were you able to care for your patients this week as safely as possible? If not, why not?” and “What could this unit do on a regular basis to improve safety?” At the end of the rounds, participants are educated about patient safety concepts such as reporting, near misses, and human factors. Soon after the rounds are conducted, the comments are emailed to the nurse manager, department manager, vice president and anyone who may have an impact on the event. Events that are captured in these rounds are put into a database and classified according to factors that contributed to the event. Each event is assigned a score based on the severity or the potential for patient harm.
The Patient Safety Team brings the list of actionable items prioritized by severity to the vice presidents to enlist their leadership in addressing the identified issues. Each quarter, the vice presidents report on their progress in addressing such issues. The action taken to resolve the issues is then communicated back to the front-line staff who initially brought it to light.
Using feedback from the WalkRounds, as well as the 2001 BWH Staff Survey, a “Spring Cleaning Team” has been formed and is actively meeting to address and track issues such as equipment repair and maintenance. Additionally, Materials Management has standardized product stocking and maintenance with an eye toward improved customer
service.
The WalkRounds also initiated progress on communication issues between nurses and attending physicians, as well as Nursing and the Pharmacy. A revised protocol to improve the timely evaluation of spinal injuries is another example where Walk-Rounds comments have raised the awareness forimprovement processes. Oncology physicians can now view radiolgy images on the computer ( PACS) on the unit. Physical improvements involving electric doors for the Cardiac Surgery ICU, increased space for families and a redesigned MRI facility to enhance safety have also been generated by this feedback.
As the program continues to evolve, your feedback is important. For more information on Patient Safety Executive WalkRounds, contact Erin Graydon-Baker via email (egraydonbaker@partners.org).