A Randomized Field Study of a Leadership WalkRoundsTM-Based Intervention

Abstract

Background: Leadership WalkRoundsTM have been widely adopted as a technique for improving patient safety and safety climate. WalkRoundsTM involve senior managers directly observing frontline work and soliciting employees’ ideas about improvement opportunities. However, the hypothesized link between WalkRoundsTM-based programs and performance has not been rigorously examined in a set of randomly selected hospitals. Objective: To fill this research gap, we conducted a randomized field study of a WalkRoundsTM-based program. Research Design: Fifty-six work areas from 19 randomly selected hospitals agreed to implement an 18-month long WalkRoundsTM-based program to improve safety. We compared their results to 138 work areas in 48 randomly selected control hospitals. Participants: We conducted the program in four types of clinical work areas: operating rooms/post-anesthesia care units; emergency departments, intensive care units, and medical/surgical units. We collected survey data from nurses in those work areas. Measures: To measure the program’s impact, we collected pre and post survey data on perceptions of improvement in performance (PIP)—a proxy for quality and an important organizational climate antecedent for positive, discretionary behaviors of frontline staff. We compare change in PIP in the treatment work areas to the same type of work areas in control hospitals. Results: On average, compared to control work areas, our WalkRoundsTM-based program was associated with a statistically significant decrease in PIP of .17 on a 5-point scale (4.5%). Conclusions: Our study calls into question the general effectiveness of WalkRoundsTM on employees' perceptions, which had been assumed in prior literature.