Exposure to Leadership WalkRounds in neonatal intensive care units is associated with a better patient safety culture and less caregiver burnout

doi:10.1136/bmjqs-2013-002042

. 2014 Oct;23(10):814-22.

doi: 10.1136/bmjqs-2013-002042. Epub 2014 May 13.

Exposure to Leadership WalkRounds in neonatal intensive care units is associated with a better patient safety culture and less caregiver burnout

J Bryan Sexton¹, Paul J Sharek², Eric J Thomas³, Jeffrey B Gould⁴, Courtney C Nisbet⁵, Amber B Amspoker⁶, Mark A Kowalkowski⁶, René Schwendimann⁷, Jochen Profit⁴

Affiliations

¹ Department of Psychiatry, Duke University School of Medicine, Duke University Health System, Durham, North Carolina, USA Patient Safety Training and Research Center, Duke University Health System, Durham, North Carolina, USA.
² Division of General Pediatrics, Department of Pediatrics, Stanford University, Palo Alto, California, USA California Perinatal Quality Care Collaborative, Palo Alto, California, USA Center for Quality and Clinical Effectiveness, Lucile Packard Cahildren's Hospital, Palo Alto, California, USA.
³ University of Texas at Houston- Memorial Hermann Center for Healthcare Quality and Safety, University of Texas Medical School, Houston, Texas, USA.
⁴ Division of General Pediatrics, Department of Pediatrics, Stanford University, Palo Alto, California, USA California Perinatal Quality Care Collaborative, Palo Alto, California, USA Perinatal Epidemiology and Health Outcomes Research Unit, Division of Neonatal and Developmental Medicine, Stanford University School of Medicine and Lucile Packard Children's Hospital, Palo Alto, California, USA.
⁵ Division of General Pediatrics, Department of Pediatrics, Stanford University, Palo Alto, California, USA California Perinatal Quality Care Collaborative, Palo Alto, California, USA.
⁶ Levine Cancer Institute, Carolinas Health Care System, Charlotte, North Carolina, USA Duke University School of Nursing, Durham, North Carolina, USA.
⁷ Patient Safety Training and Research Center, Duke University Health System, Durham, North Carolina, USA Institute of Nursing Science, University of Basel, Basel, Switzerland.

PMID: 24825895
PMCID: PMC4167964
DOI: 10.1136/bmjqs-2013-002042

Exposure to Leadership WalkRounds in neonatal intensive care units is associated with a better patient safety culture and less caregiver burnout

J Bryan Sexton et al. BMJ Qual Saf. 2014 Oct.

. 2014 Oct;23(10):814-22.

doi: 10.1136/bmjqs-2013-002042. Epub 2014 May 13.

Authors

J Bryan Sexton¹, Paul J Sharek², Eric J Thomas³, Jeffrey B Gould⁴, Courtney C Nisbet⁵, Amber B Amspoker⁶, Mark A Kowalkowski⁶, René Schwendimann⁷, Jochen Profit⁴

Affiliations

¹ Department of Psychiatry, Duke University School of Medicine, Duke University Health System, Durham, North Carolina, USA Patient Safety Training and Research Center, Duke University Health System, Durham, North Carolina, USA.
² Division of General Pediatrics, Department of Pediatrics, Stanford University, Palo Alto, California, USA California Perinatal Quality Care Collaborative, Palo Alto, California, USA Center for Quality and Clinical Effectiveness, Lucile Packard Cahildren's Hospital, Palo Alto, California, USA.
³ University of Texas at Houston- Memorial Hermann Center for Healthcare Quality and Safety, University of Texas Medical School, Houston, Texas, USA.
⁴ Division of General Pediatrics, Department of Pediatrics, Stanford University, Palo Alto, California, USA California Perinatal Quality Care Collaborative, Palo Alto, California, USA Perinatal Epidemiology and Health Outcomes Research Unit, Division of Neonatal and Developmental Medicine, Stanford University School of Medicine and Lucile Packard Children's Hospital, Palo Alto, California, USA.
⁵ Division of General Pediatrics, Department of Pediatrics, Stanford University, Palo Alto, California, USA California Perinatal Quality Care Collaborative, Palo Alto, California, USA.
⁶ Levine Cancer Institute, Carolinas Health Care System, Charlotte, North Carolina, USA Duke University School of Nursing, Durham, North Carolina, USA.
⁷ Patient Safety Training and Research Center, Duke University Health System, Durham, North Carolina, USA Institute of Nursing Science, University of Basel, Basel, Switzerland.

PMID: 24825895
PMCID: PMC4167964
DOI: 10.1136/bmjqs-2013-002042

Abstract

Background: Leadership WalkRounds (WR) are widely used in healthcare organisations to improve patient safety. The relationship between WR and caregiver assessments of patient safety culture, and healthcare worker burnout is unknown.

Methods: This cross-sectional survey study evaluated the association between receiving feedback about actions taken as a result of WR and healthcare worker assessments of patient safety culture and burnout across 44 neonatal intensive care units (NICUs) actively participating in a structured delivery room management quality improvement initiative.

Results: Of 3294 administered surveys, 2073 were returned for an overall response rate of 62.9%. More WR feedback was associated with better safety culture results and lower burnout rates in the NICUs. Participation in WR and receiving feedback about WR were less common in NICUs than in a benchmarking comparison of adult clinical areas.

Conclusions: WR are linked to patient safety and burnout. In NICUs, where they occurred more often, the workplace appears to be a better place to deliver and to receive care.

Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

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Figures

**Figure 1**
Three panels of WalkRounds exposure and one for safety climate. Each bar=1 clinical area, hash marks indicate a neonatal intensive care unit (NICU). There are 44 NICUs and 706 adult clinical areas from: Schwendimann R, Milne J, Frush K, Ausserhofer D, Frankel A, and Sexton JB. American Journal Of Medical Quality: 28 January 2013. The mean (SD) number of respondents per adult clinical area was 27.0, 46% of which were RNs (by comparison, the NICU mean was 47.1, 71% of which were RNs). RN, registered nurse.

**Figure 2**
Burnout and safety culture domains displayed by WR feedback quartiles. Comparison of the first and fourth WR feedback quartiles with domains of safety culture and burnout. SAQ, Safety Attitudes Questionnaire; AHRQ HSOPSC, Agency for Healthcare Research and Quality Hospital Survey on Patient Safety Culture; Safe Clim, safety climate; TW Clim, teamwork climate; OPS, overall perceptions of safety; TW w/in units, teamwork within units; Comm Open, communication openness; Error FB/Comm, error feedback and communication; WR, WalkRounds.

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References

1. Sharek PJ, Horbar JD, Mason W, et al. Adverse events in the neonatal intensive care unit: development, testing, and findings of an NICU-focused trigger tool to identify harm in North American NICUs. Pediatrics. 2006;118:1332–40. - PubMed
1. Simpson KR. Measuring perinatal patient safety: review of current methods. J Obstet Gynecol Neonatal Nurs. 2006;35:432–42. - PubMed
1. Frankel A, Graydon-Baker E, Neppl C, et al. Patient safety leadership WalkRounds. Jt Comm J Qual Saf. 2003;29:16–26. - PubMed
1. Frankel A, Gandhi TK, Bates DW. Improving patient safety across a large integrated health care delivery system. Int J Qual Health Care. 2003;15(Suppl 1):i31–40. - PubMed
1. Zimmerman R, Ip I, Daniels C, et al. An evaluation of patient safety leadership walkarounds. Healthcare Q. 2008;11(3 Spec No):16–20. - PubMed

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[1] Sharek PJ, Horbar JD, Mason W, et al. Adverse events in the neonatal intensive care unit: development, testing, and findings of an NICU-focused trigger tool to identify harm in North American NICUs. Pediatrics. 2006;118:1332–40. - PubMed

[2] Sharek PJ, Horbar JD, Mason W, et al. Adverse events in the neonatal intensive care unit: development, testing, and findings of an NICU-focused trigger tool to identify harm in North American NICUs. Pediatrics. 2006;118:1332–40. - PubMed

[3] Simpson KR. Measuring perinatal patient safety: review of current methods. J Obstet Gynecol Neonatal Nurs. 2006;35:432–42. - PubMed

[4] Simpson KR. Measuring perinatal patient safety: review of current methods. J Obstet Gynecol Neonatal Nurs. 2006;35:432–42. - PubMed

[5] Frankel A, Graydon-Baker E, Neppl C, et al. Patient safety leadership WalkRounds. Jt Comm J Qual Saf. 2003;29:16–26. - PubMed

[6] Frankel A, Graydon-Baker E, Neppl C, et al. Patient safety leadership WalkRounds. Jt Comm J Qual Saf. 2003;29:16–26. - PubMed

[7] Frankel A, Gandhi TK, Bates DW. Improving patient safety across a large integrated health care delivery system. Int J Qual Health Care. 2003;15(Suppl 1):i31–40. - PubMed

[8] Frankel A, Gandhi TK, Bates DW. Improving patient safety across a large integrated health care delivery system. Int J Qual Health Care. 2003;15(Suppl 1):i31–40. - PubMed

[9] Zimmerman R, Ip I, Daniels C, et al. An evaluation of patient safety leadership walkarounds. Healthcare Q. 2008;11(3 Spec No):16–20. - PubMed

[10] Zimmerman R, Ip I, Daniels C, et al. An evaluation of patient safety leadership walkarounds. Healthcare Q. 2008;11(3 Spec No):16–20. - PubMed

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Exposure to Leadership WalkRounds in neonatal intensive care units is associated with a better patient safety culture and less caregiver burnout

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Exposure to Leadership WalkRounds in neonatal intensive care units is associated with a better patient safety culture and less caregiver burnout

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