High functioning medical teams are essential for providing safe and efficient medical care. To assess team culture on a medical-surgical unit, we conducted an abridged version of the Agency for Healthcare Research and Quality (ARHQ) Hospital Survey on Patient Safety Culture. Two areas of opportunity were identified: management support for a climate that promotes patient safety and need for improved nursing and physician communication. The Institute for Healthcare Improvement’s Patient Safety Leadership Walkrounds provides a model for addressing these issues, however it involves senior leadership rather than unit leadership and is limited to addressing only patient safety concerns, not communication and workflow issues.
To alter team-based attitudes through implementation of ‘Rapid-fire WalkRounds’ on a medical-surgical unit.
Rapid-fire WalkRounds were proposed as a fun and informal forum that would allow unit leaders to initiate a two-way dialog in order to enhance patient safety, teamwork, workflow and communication. WalkRounds were held weekly for 15 minutes at each nursing station to facilitate ease of participation. Each session was run by both a nursing and provider floor ‘leader’ whom would introduce the day’s speaker, hand out ‘tip-sheets’ about the topic and give out candy. Leaders included nurse managers, charge nurses, the medical director, the chief medical resident and members of the unit-based quality improvement (QI) committee. All staff were asked to join if they were in the immediate vicinity. Following each session, attendees provided feedback on how to improve care on the floor. To choose topics, staff submitted ideas via an online survey that were vetted by the QI committee and selected based on timeliness, interest and alignment with WalkRounds goals. Examples of topics included changes in clostridium difficile protocols, diabetic management, role of patient representatives and security issues.
After 4 weeks, a sample of 18 participants were surveyed on their perception of WalkRounds. 100% agreed that WalkRounds made them feel like part of multidisciplinary team, and 94% felt the topics were timely, useful and relevant. 89% felt that Walkrounds established a forum for RN/MD collaboration and 72% felt that they were fun to attend. 83% felt aware of whom to go to with an issue after attending WalkRounds. 78% felt that the Walkrounds were convenient and did not disrupt their workday. Lastly, providers reported improved effectiveness of their working relationship with nurses from 7.2 out of a 10-point scale prior to WalkRounds to 8.69 afterwards. Future steps include re-administration of both the post-survey and the patient safety culture survey to assess long-term effects, as well as dissemination to other floors
Rapid-Fire WalkRounds can be an effective and fun tool for improving camaraderie and leadership presence on the medical floors.