For the last 10 to 15 years, walkarounds have been widely used in healthcare organisations to improve safety and there is evidence that they lead to a better safety culture and increased understanding of safety risks (Singer and Tucker, 2014).
However, there is also evidence that walkarounds only lead to such results when they are implemented authentically, and with the full commitment of higher management and senior physicians who are actually able to act upon and resolve problems. Half-hearted, insincere or ineffective walkarounds can backfire. I have personally seen situations where walkarounds became a form of surveillance and control, rather than enquiry and support. I have also seen situations where managers controlled or restricted conversations with patients and staff in order to avoid topics they didn’t want to discuss, or where higher mangers said they would address problems but, in the end, did not do so.
So, while there seems no reason why walkarounds cannot have a very positive impact on patient experience, they have to be designed, planned and implemented in the right way.
There are seven things to get right:
(1) Higher Management Support – You must have the full commitment and participation of higher management and the patient experience department must provide the necessary resources in terms of time, staff, budget etc.
(2) Tools – You must design and develop the orientation and training materials with which to prepare higher managers for walkarounds. These should include defining what patient experience is and the staff practices and behaviours on which it depends; the purpose of walkarounds; the aspects of the patient experience that they should be focusing on during a walkaround and guidelines for initiating conversations with patients, families and staff.
(3) Scheduling – You may need to schedule walkarounds many weeks or even months in advance in order to accommodate the schedules of higher managers, senior physicians, department/unit managers, patient experience specialists, and other walkaround participants. You will also need to decide where to conduct the sessions and may choose to pilot walkarounds in just one or two departments to begin with.
(4) Communicating – There needs to be a clear communication strategy for the walkaround programme so that all staff know about walkarounds in general and what their aim is. There also needs to be focused communication immediately before, during and after a visit with information leaflets for patients and families, as well as for staff.
(5) Visiting – The walkaround itself needs to begin with a proper briefing on the department/unit to be visited, including any existing areas of concern or previous complaints received. The team needs to agree on the aspects of the patient experience they will focus on and the questions they will ask. There must be an immediate debriefing, after the walkaround, to agree the issues that must be taken away for action, quick fixes that can be resolved straight away, actions that staff can take immediately if empowered to do so and feedback or praise that should be given where good practices have been identified.
(6) Supervising and Following-Up – You must set-up processes for collecting information during walkarounds, for sharing that information, for assigning action items to the right people and for making sure actions are done and that feedback is given to staff, patients and family members. A follow-up walkaround should be arranged to monitor progress.
(7) Measurement – You must set-up a measurement process to evaluate whether or not walkarounds are delivering the objectives you require. Metrics could include the number of walkaround visits performed, the number actions identified and completed, decreases in patient complaints and/or increases in compliments and satisfaction levels.
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