22 Aug 2012Working Paper Summaries

A Randomized Field Study of a Leadership WalkRounds™-Based Intervention

by Anita L. Tucker and Sara J. Singer
Hospitals face an imperative to improve quality, increase efficiency, and improve customer experience. Many hospitals utilize process improvement techniques to achieve these goals. One technique to involve senior managers, known in hospitals most commonly as Leadership WalkRounds™, is a program of visiting the organization's frontlines to observe and talk with employees while they do their work. The intention is that managers and frontline staff will work together to identify and resolve obstacles to efficiency, quality, or safety. (For brevity, the authors refer to it in this paper as WalkRounds™.) Rigorous testing of the effectiveness of process improvement interventions generally, and WalkRounds™ particularly, however, has been rare. This paper presents results from a field study that tested the effectiveness of a safety improvement program inspired by WalkRounds™. The authors compare pre-program and post-program measures of perceived improvement in performance (PIP) from work areas in hospitals that were randomly selected to implement the program, with pre- and post- measures from the same types of work areas in control hospitals. Findings show that, contrary to expectations, the WalkRounds™-based program was associated with decreased PIP. This study calls into question the general effectiveness of WalkRounds™ on employees' perceptions, which had been assumed in prior literature. Key concepts include:
  • This study shows that participating in this particular program actually decreased perceived improvement in performance (PIP), on average. Compared to control work areas, the WalkRounds™-based program was associated with a statistically significant decrease in PIP.
  • This is an important result because, despite the limited evidence base, many hospitals throughout the U.S. and U.K. have implemented similar programs under the assumption that WalkRounds™ will improve organizational climate.
  • The study provides a cautionary tale that visits by senior managers to the frontlines of the organization will not necessarily increase staff perceptions of performance improvement.
  • Failure to meet expectations, once raised, can negatively impact organizational climate. Unless such programs are implemented with authentic motivation to identify and resolve issues, they may yield a negative return on the money invested.

Background: Leadership WalkRounds™ have been widely adopted as a technique for improving patient safety and safety climate. WalkRounds™ involve senior managers directly observing frontline work and soliciting employees' ideas about improvement opportunities. However, the hypothesized link between WalkRounds™-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 WalkRounds™-based program.

Research Design: Fifty-six work areas from 19 randomly selected hospitals agreed to implement an 18-month long WalkRounds™-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 WalkRounds™-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 WalkRounds™ on employees' perceptions, which had been assumed in prior literature.

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