Leadership Taking the Lead: Identifying and addressing system issues through the implementation of patient safety-focused Executive WalkRounds

Background: In August 2007, MHC implemented Patient Safety Executive WalkRounds (EWR) to achieve its two-fold goal of taking the first steps in achieving the National Quality Forum's number one Safe Practice of Creating a Cultural of Safety and to provide frontline staff with the opportunity to speak directly with hospital's new executive leadership team about issues that they face on their unit. Methods: The hospital's executive leadership was divided into two Executive Leadership teams that visit at least two units each month. During the initial visit to the unit, the frontline staff is asked about their key patient safety concerns, areas for improvement, teamwork on the unit, communication and hand-offs, incident reporting and what the EWR team can do to assist them. All issues raised are recorded, and then discussed further by the EWR team and the unit's leadership in a debriefing session, during which solutions are formulated. Within a few weeks, the EWR team returns to the unit to report back to the frontline staff what actions have been taken to address the issues raised. Results: EWR have been vital in indentifying important system issues that must be addressed, while improving staff satisfaction by showing the senior leadership's interest in hearing from the frontline staff. The most common five issues that have been raised during EWR are communication between units/RNs/MDs; need for additional, experienced nursing staff; slow response times from housekeeping/HIS; need for resident education & training on policies; and perceived lack of staff safety. Conclusions: Bringing the hospital's executive leadership to the frontline staff has resulted in an increased focus on patient safety, while opening lines of communication at all levels. The EWR teams are now working closely with the units' leadership to address the system issues identified, and the program is being expanded to cover off-tours.