Using four-phased unit-based patient safety walkrounds to uncover correctable system flaws

Area of Science:

• Healthcare Management
• Patient Safety
• Quality Improvement

Background:

• A unit-based Patient Safety Leadership Walkrounds (PSWR) model was implemented in six medical/surgical units.
• The goal was to identify patient safety issues within the clinical microsystem.

Purpose of the Study:

• Provide a platform for frontline staff to report safety concerns to unit leaders.
• Enhance inter- and intra-unit teamwork and communication.
• Foster a supportive environment for collaborative problem-solving.

Main Methods:

• Developed standardized safety tools and questions based on baseline data and leader/staff discussions.
• Utilized Plan-Do-Study-Act cycles to refine tools and customize the walkrounds process.
• Implemented PSWR across six pilot units.

Main Results:

• Leaders identified previously unrecognized safety concerns, including nurse-physician relations, workflow, equipment, education, and medication safety.
• Engaged 149 individuals across disciplines, including 33 physicians, over 34 walkrounds in the first year.
• Initiated safety changes that extended beyond pilot units, revealing hospital-wide issues.

Conclusions:

• PSWR serves as a situational awareness tool for assessing unit-level vulnerabilities.
• The process identifies microsystem safety concerns and enhances communication across units and to hospital leadership.
• Unit-based PSWR effectively improves safety and care quality at the local level.