Safety rounds as a strategy for continuous quality and safety improvement in healthcare processes

Safety rounds (SR) emerged as a tool to engage healthcare leaders in patient safety, inspired by the LEAN 'Gemba' visits. While SRs have shown potential to improve safety culture and clinical practices, their effectiveness varies. Success depends on engaged leadership, regular implementation, and a focus on continuous improvement, involving staff in identifying and addressing safety issues. However, evidence on SRs effectiveness remains fragmented. This study aims to design, implement, and evaluate a strategy for using SRs to improve quality and safety in healthcare processes within an integrated health area, contributing to the global understanding of SR adaptation across different healthcare settings.

A five-year quasi-experimental pre-post study was conducted (2018-2023) in a Spanish integrated healthcare area. A multidisciplinary group designed and deployed SRs in five key care settings: Primary Care, Outpatient Consultation, Emergency Services, Hospitalization, and Surgery. SRs were structured in four stages: team formation, indicator assessment, improvement proposal, and dissemination of results. A total of 41 SRs were conducted, assessing 122 indicators. Measurements included the Hospital Survey on Patient Safety Culture (HSOPS) and patient safety incident reports.

41 SRs were conducted across 5 clinical settings, with an average compliance rate of 71% for assessed indicators. Of the 122 indicators assessed, 87 (71%) met the standard compliance threshold. The number of safety incident reports increased by 27% from 2017 to 2023. Significant improvements were noted in 'Management Support for Patient Safety' and 'Feedback and Communication', while decreases occurred in dimensions such as 'Perception of Safety'.

SR, when systematically designed, can improve safety culture and healthcare quality, particularly in communication and leadership. Declines in some dimensions indicate a need for continuous refinement of SR strategies. Further research is needed to optimize SR impact across diverse contexts.