Measures walk-round

Various safety culture tools and approaches have been adapted from other industries and tailored to measure safety culture in healthcare organisations. These include safety culture measurement tools, safety walk rounds and checklists which aim to standardise patient care and improve reliability. So how have safety culture tools been adapted and implemented in healthcare organisations What lessons have we leamt so far that could inform future work in this area ... 

Some important lessons can be learnt about how safety walk rounds have been implemented in healthcare. Most notable are the measurement paradox and the purpose paradox ... 

The measurement paradox The measurement paradox relates to how safety walk-round performance is measured. The walk-roimd measures used in the National Patient Safety First Campaign in 2009 involved using run charts to measure ... 

A thematic analysis of the issues identified on walk-rounds is routinely carried out to measure the completion rate. Trust data showed that the clear-up rate of high priority issues has improved year on year, in 2011, 50 percent of actions were resolved and 26 percent were partly resolved. 

Hospital B s experience is not unique. The net effect of the completion rate measure has been that it produces data which show that many actions are not completed within a specified time frame. This has, in some hospitals led senior managers to call into question the value of the walk rounds or to drive behaviour to focus on problems that can be fixed easily. Thus the lack of integration of human factors into hospital and medical device design and the allocation of staffing and resources gets put into an unresolvable box and remain latent conditions that continue to create error traps, inefficiencies and poor patient experience. 

The description of how safety climate tools, walk-rounds and the WHO Surgical Safety Checklist have been implemented in healthcare has identhied some of the challenges to measuring and improving culture in healthcare teams and organisations. Other important barriers to improving safety culture exist ... 

The difficulty in assessing the effectiveness of patient safety interventions is the same as that for all programme evaluations it is difficult to find rigorous studies that measure programme effectiveness quantitatively. There have been a number of recent reviews of patient safety initiatives and their effectiveness. Morello et al. (2012) reviewed over 2,000 articles and found only 21 studies meeting their inclusion criteria for study rigour. They concluded that there is some evidence to support the theory that leadership walk rounds and multi-faceted unit-based programmes may have a positive impact on patient safety chmate. 

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