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. 2018 Apr;27(4):261-270.
doi: 10.1136/bmjqs-2016-006399. Epub 2017 Oct 9.

Providing feedback following Leadership WalkRounds is associated with better patient safety culture, higher employee engagement and lower burnout

J Bryan Sexton  1   2 , Kathryn C Adair  3 , Michael W Leonard  4   5 , Terri Christensen Frankel  4 , Joshua Proulx  4 , Sam R Watson  6 , Brooke Magnus  7 , Brittany Bogan  8 , Maleek Jamal  9 , Rene Schwendimann  10 , Allan S Frankel  4
Affiliations

Providing feedback following Leadership WalkRounds is associated with better patient safety culture, higher employee engagement and lower burnout

J Bryan Sexton et al. BMJ Qual Saf. 2018 Apr.

Abstract

Background: There is a poorly understood relationship between Leadership WalkRounds (WR) and domains such as safety culture, employee engagement, burnout and work-life balance.

Methods: This cross-sectional survey study evaluated associations between receiving feedback about actions taken as a result of WR and healthcare worker assessments of patient safety culture, employee engagement, burnout and work-life balance, across 829 work settings.

Results: 16 797 of 23 853 administered surveys were returned (70.4%). 5497 (32.7% of total) reported that they had participated in WR, and 4074 (24.3%) reported that they participated in WR with feedback. Work settings reporting more WR with feedback had substantially higher safety culture domain scores (first vs fourth quartile Cohen's d range: 0.34-0.84; % increase range: 15-27) and significantly higher engagement scores for four of its six domains (first vs fourth quartile Cohen's d range: 0.02-0.76; % increase range: 0.48-0.70).

Conclusion: This WR study of patient safety and organisational outcomes tested relationships with a comprehensive set of safety culture and engagement metrics in the largest sample of hospitals and respondents to date. Beyond measuring simply whether WRs occur, we examine WR with feedback, as WR being done well. We suggest that when WRs are conducted, acted on, and the results are fed back to those involved, the work setting is a better place to deliver and receive care as assessed across a broad range of metrics, including teamwork, safety, leadership, growth opportunities, participation in decision-making and the emotional exhaustion component of burnout. Whether WR with feedback is a manifestation of better norms, or a cause of these norms, is unknown, but the link is demonstrably potent.

Keywords: burnout; engagement; feedback; resilience; safety culture; score; walkrounds.

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Conflict of interest statement

Competing interests: JBS has an NIH Grant: R01 HD084679-01; MWL, TCF, JP and ASF each works at Safe and Reliable Healthcare, where they administer, analyse and debrief survey data to healthcare organisations. SCORE is available at no cost for research and quality improvement purposes. Safe and Reliable Healthcare offers SCORE and several other surveys through their online platform. The SCORE survey is a synthesis of validated instruments from safety culture and employee engagement research already published in the peer-reviewed literature. We added items and domains that cover psychological safety and quality improvement readiness in ways that were not already published, but the rest of SCORE involved selecting the best available items and domains. All authors stand by the validity of this instrument and the data set used here.

Figures

Figure 1
Figure 1
WalkRounds (WR) exposure and WR feedback across work settings
Figure 2
Figure 2
SCORE (Safety, Communication, Operational Reliability, and Engagement) domains displayed by WalkRounds feedback quartiles.
See this image and copyright information in PMC

Comment in

References

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