Nurturing a Patient Safety Culture Changing a Culture with Patient Safety Walkarounds

BACKGROUND It is evident within Canada and abroad that healthcare is a high-risk industry not unlike aviation, nuclear energy and offshore oil drilling. The results from the Canadian Adverse Events Study (Baker et al. 2004) found an adjusted adverse event rate of 7.5% in Canadian hospitals. The consequences of these adverse events include prolonged length of stay, varying degrees of injury, and in some instances death. These injuries and deaths are not attributable to the patients’ diagnoses but are, in fact, a result of the care provided to them by healthcare practitioners. This study is a part of a growing body of literature that has provided the momentum in many healthcare organizations, including Sunnybrook & Women’s College Health Science Centre (S&W), to ensure patient safety is a priority. S&W is dedicated to becoming the safest hospital in Canada. In order to achieve this goal, we must create a culture of safety, which requires significant organizational change. We have implemented several initiatives which have created the impetus for this culture change. One of the most influential initiatives is a patient safety walkarounds program. This well-tested concept has been used in many other healthcare organizations in the United States and in other nonhealthcare-related industries. We have created a model that is an adaptation of the original WalkRoundsTM framework created by Dr. Allan Frankel, (2003) Director of Patient Safety for Partners HealthCare System in Boston, Massachusetts. Representatives from the Patient Safety Service at the Partners HealthCare System in Boston were instrumental in our understanding the effectiveness of the walkarounds model. By sharing their experiences and openly discussing the merits and development of WalkRoundsTM, we were able to construct a similar model that was applicable to a Canadian healthcare delivery system. Some of the adaptations that we made included: a revision of the documentation and communication tools; a modified list of questions to guide the dialogue; inviting managers and directors to hear the walkaround session; and the creation of a handbook to orient the senior leadership team. Patient safety walkarounds provide any healthcare organization a unique opportunity to facilitate the foundation of a safe culture. Walkarounds in their very essence connect frontline staff with senior leaders in an open dialogue concerning patient safety. This interaction allows frontline staff to share their safety concerns with senior leaders, as well as creating a forum to promote the awareness of patient safety. Conversely, it is an opportunity for senior leaders to demonstrate their commitment by hearing concerns and removing the barriers to safe care.