Are Patient Safety Leadership WalkRounds™ Worth It?

1. Are Patient Safety Leadership WalkRounds™ Worth It? NNESHRM November 18, 2013 Katie Blackburn, MS Erin Graydon Baker, MS, RRT, CPPS

2. Topics Covered • WalkRounds Concept • Experience at Brigham and Women’s Hospital • Maine Medical Center Process • Successes and Pitfalls • Your Stories

3. WalkRounds Concept • 2001 conversation at the Institute of Healthcare Improvement with Dr. Allan Frankel • Increasing the in-basket of patient safety information • Changing the culture of safety by increasing transparency • Engaging senior leadership with front line staff around patient safety issues

4. Experience at Brigham and Women’s Hospital • Would hospital leadership be willing to openly discuss operational failure, safety and harm with front line staff? • Would frank and open discussion occur in a public setting? • Could the information elicited be collected and aggregated in a useful manner? • Would the information collected affect actions or resource allocation? A. Frankel, et al., Patient Safety Leadership WalkRounds at Partners Healthcare, JC Journal on Quality and Patient Safety, Aug. 2005

5. Preparation for Implementation • Two hour presentation to hospital executives • Promote leadership involvement • Discuss high reliability concepts • Ensure blame –free reporting • Framework and timeline for process • Confirm expectations of senior leadership involvement • Suggest follow up and reporting structure • Comments • Action items

6. BWH Implementation Process • Hospital Executive sponsorship in January 2001 • Participants • CEO, CNO, CMO, COO (one per round) • Patient Safety Manager • Scribe • Pharmacist • Physician leader, unit manager • Scheduling • Weekly • All locations

7. BWH Implementation Process • Facilitation • Send sample questions in advance • Begin with introductions and premise of the rounds • Hear comments with empathy; elicit examples of patients who have been harmed or nearly harmed by our systems • Walk around or not • Synthesize rounds with those actions that the team will take back • Ask participants to share the rounds experience with their colleagues • Thank the participants and invite them to reach out anytime

8. Data Gathering • Comments versus adverse events • Gather all comments for trending; aggregate • Contributing factor • Level of risk ( harm v potential harm) • Location • Use Access or other relational database; Excel or Word format for tracking is not helpful! • Assign actions to appropriate leadership

9. Follow up and Feedback • Most critical element to the success of WalkRounds • Outline a reporting structure with expectations for follow up • Quality Council; Care Improvement Council • Provide bi-directional feedback to staff and leadership • Direct email to participants; Newsletters

10. Continuous Improvement • Add CIO or designee as a regular participant • Add Board members to WalkRounds • Add patients to WalkRounds • Review safety reports and past WalkRounds action items as a starting point for discussion • Take photos when appropriate • Survey staff periodically for suggestions for improving rounds

11. Related Methodology • Comprehensive Unit –Based Safety Program (CUSP) • Leveraging Frontline Expertise ( LFLE) • Management by Walking Around ( MBWA) SJ Singer, et.al., Improving Patient Care Through Leadership Engagement with Front Line staff.., JC Journal on Quality and Patient Safety, Aug, 2012

12. What Makes it Worth It? • Changing Culture • PHS CEO still participates in BWH WalkRounds • Staff satisfaction with WalkRounds • Balance of too many senior leaders participating • Examples • MRI safety zoning completion • Software for assigning care team • Biomedical equipment changes- default settings

13. Maine Medical Center Process Phase I • WalkRounds at MMC commenced in 2005 • Expectation for leadership participation to include unit nursing leadership, key ancillary departments, and chiefs • Visits occurred every other week to an inpatient unit and were coordinated six weeks in advance • Visit summary created and issues were e-mailed to individuals to address • Data stored in an Excel file • No imperative to ensure items were addressed or to track progress

14. Maine Medical Center Process Successes • Many issues were addressed • WalkRounds persisted in this fashion for 7 years • Visits to ancillary units occurred Pitfalls • Scheduling challenges • Interval between visits to a unit • C level participation waned • Items not tracked to resolution • Analysis of issues not easily accomplished • Value to staff

15. Maine Medical Center Process Phase II • 2011 service line structure established with expectation of leadership participation and oversight of issues • Schedule set for the entire year-visits remain every other week • Visits to outpatient locations incorporated • Post visit huddle to discuss high priority issues and assign for resolution • High priority issues are entered in a data base and tracked through to resolution • Low priority issues are not tracked • Minutes are taken and distributed to executives, anyone attending/participating in the visit and the Patient Safety Team • Bi-directional updates on issues provided to staff and leadership

16. Phase II Successes • Size of visits • Engagement of service line leadership • Analysis of issues possible • Inform QI projects • Feedback = staff engagement

17. Phase II Pitfalls • Not always knowing the context and capturing the issue correctly • Determining what units to visit-too many to accomplish in a timely fashion • Epic has been a topic of much discussion-may divert from some of the other safety concerns • Sometimes a challenge to get some of the issues addressed • Sometimes a challenge to close the loop with staff • C level participation is sparse • Size of visits

18. Data

19. Examples of Issues • IS-Epic • Login • Orders • Education and Training • Patient education needs • Use of Epic • Facilities • Installation of overhead mirrors • Timing of automatic doors locking in SCUs • Shower room that leaks out into hall • Pharmacy • Education about who to contact for service • Pyxis availability during certain hours • Pyxis overrides in emergent situations • Communication • Time spent on phone tracking down provider • Equipment • Bed rails

20. Improvement Opportunities • Connecting with night and weekend shifts • Frequency of visits and visits to more units • Track low priority items • Create reports for service line use • Newsletter • Board member/patient participation • Survey staff periodically for suggestions for improving rounds

21. Your Stories • Experience with Other models? • Thoughts about how to improve?

22. Thank You! Erin Graydon Baker EGraydonBa@mmc.org Katie Blackburn blackk3@mmc.org