The evolving literature on safety WalkRounds: emerging themes and practical messages.

To cite: Singer SJ, Tucker AL. BMJ Qual Saf 2014;23: 789–800. THE ROAD TO WALKING AROUND The evidence is clear: a strong culture of safety is necessary to deliver reliably safe care. Safety culture encompasses a group’s shared values, assumptions, attitudes and patterns of behaviour regarding safety. 3 In healthcare organisations with weak safety culture, employees perceive the low priority assigned to safety, and patient safety suffers as a result. Researchers measure safety culture using surveys that include items eliciting perceptions of policies, procedures and practices that reflect the extent to which the organisation prioritises safety relative to competing goals. Numerous studies find that higher safety climate correlates with better performance on a variety of outcomes. 5–17 Research also shows that senior managers play a critical role in creating, changing and sustaining safety culture. 4 Senior managers’ words and deeds receive outsize attention and greatly influence how frontline workers and middle managers perceive what their organisation values and rewards. We know less, though, about specific actions senior managers can take to effectively demonstrate their commitment to safety. Senior managers seeking to create a stronger culture of safety need to know what steps can overcome consistent differences between frontline workers’ and managers’ perceptions of safety climate. Frontline workers typically have more negative views of safety climate compared with senior managers. One approach for strengthening safety culture is for managers to spend time on the frontlines of care, talking with staff and observing work. The Lean literature refers to these types of programmes as Gemba walks. These walks aim to have senior managers observe concrete problems confronted by frontline staff in real time and foster stronger relationships with frontline staff. 24 Gemba walks thus resemble ‘Management by Walking Around,’ popularised by Peters and Waterman’s description of Hewlett–Packard’s use of the programme in the 1980s. A similar approach appeared in healthcare as early as 1990, but did not receive widespread attention until the publication of Frankel and colleagues’ work on Patient Safety Leadership WalkRounds. This programme sought to raise senior managers’ commitment to patient safety. 24 27 Based on its success, safety rounds of this type have been advocated by leading healthcare organisations, including the Institute for Healthcare Improvement, Agency for Healthcare Research and Quality, and Health Research and Educational Trust in the USA; and the National Health System and the Scottish Patient Safety Programme in the UK. We will use the generic term ‘safety rounds’ to refer to all programmes. Safety rounds aim to improve care by providing a systematic approach for engaging senior managers with the work-system challenges faced by frontline staff and ensuring follow-up and accountability for addressing these challenges. Safety rounds encourage senior managers to observe clinical operations, engage with staff to understand their concerns and partner with frontline workers and managers to resolve obstacles. Safety rounds offer opportunities to fix specific problems identified but also to improve safety culture more generally by building trust, understanding and accountability for safety up and down the organisational hierarchy. As of 2014, safety rounds have been implemented by thousands of hospitals worldwide. Drawing on a handful of Editor’s choice Scan to access more free content