Counties Manukau Health is keeping its leaders in touch with frontline care and improving patient safety with the Leadership Walk Rounds.
The Leadership Walk Rounds were introduced in 2014 after the publication of the Francis Report in 2013 highlighted the dangers of leaders becoming distanced from the reality of frontline care.
“The Francis Report showed that a healthcare organisation can perform well against quantitative targets while actually delivering appalling standards of care. That can happen when leaders focus on the numbers at the expense of listening to what patients and their families, and frontline staff, say about their experience of care. Our leaders need to see and hear first-hand what’s happening on our wards to get a complete picture of whether we’re providing safe care,” says Jacqui Wynne-Jones, Clinical Nurse Director.
Ms Wynne-Jones led a collaborative team, which included the directors of nursing, patient safety and innovation, an improvement advisor and a consumer advisor, to develop the Leadership Walk Rounds.
The Leadership Walk Rounds are held every fortnight. In each one, a team of six CM Health staff visit a ward or unit. Teams are typically made up of: members of the Executive Leadership Team; clinical leaders; heads of departments; representatives from Health & Safety, Quality Assurance and Human Resources; patient and whānau care advisors; clinical directors and senior medical officers. A wide variety of other staff, as well as visitors from other healthcare organisations, have also participated. A staff member with expertise in patient experience accompanies the team.
During the Leadership Walk Round, the team use three qualitative tools to perform an assessment of how safe the ward is and capture the experience of staff and patients on that ward: the First 15 Steps, a patient experience questionnaire, and a staff experience questionnaire. The First 15 Steps is an assessment of how safe a ward is based on first impressions of the ward environment. The patient and staff questionnaires each comprise ten questions about experiences on the ward. The team aim to speak to patients of different ages and ethnicities and staff in a variety of roles to get a representative perspective.
Following the visit, team members agree on the key themes they found. The ward’s charge nurse and service manager participate in the discussion to ensure transparency and are encouraged to take ownership of outcomes. A summary celebrating the positive aspects and identifying areas for improvement is supplied to the charge nurse, head of department, service manager and clinical nurse director within 24 hours. Ms Wynne-Jones’s team maintain communication with wards to follow up on actions taken and provide any assistance needed.
“So far, we’ve visited 40 areas, and spoken to more than 250 patients and 300 staff. What’s interesting is that we’ve been back to 20 of the areas since our first visit and we’re seeing encouraging results,” says Ms Wynne-Jones.
“One of the big improvements we’ve noticed is in communication. In the initial Leadership Walk Rounds, many patients said that they didn’t feel involved in their care or didn’t understand medical terminology. And staff described a different culture operating on the ward when the charge nurse wasn’t around. This point was reinforced by some patients commenting that they felt uncomfortable because nurses were speaking in their own languages after-hours.”
“In response, wards have started initiatives known to improve communication, such as huddles and bedside handovers. One ward has also started including nurses in the doctors’ rounds, so they can explain any medical terminology that patients don’t understand.”
Duty managers and the Patient at Risk (PAR) team have reported improved communication and behaviour after-hours.
In addition, wards have de-cluttered, and charge nurses report that the Leadership Walk Rounds are helping them to strengthen their leadership, build teamwork and highlight staff and rostering issues.
“Staff tell us that when strong leadership is visible, they feel valued and love coming to work. They enjoy celebrating the positive points about their wards through the Leadership Walk Rounds and value the feedback on areas for improvement as a platform for change.”
1. Francis R. (Chair). The Mid Staffordshire NHS Foundation Trust Public Inquiry: Report of the Mid Staffordshire Foundation Trust Public Inquiry. London: The Stationery Office; 2013.
2. NHS Institute for Innovation and Improvement. The Fifteen Steps Challenge. 2006-2013. Accessed 22 April 2015 from http://www.institute.nhs.uk/productives/15stepschallenge/15stepschallenge.html