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Problem Statement

Patient safety leadership walk rounds (walk rounds) have been occurring at CMH regularly since 2014.

The walk rounds involve senior leaders within the organisation participating in organised ward rounds, to interview patients and staff around their experiences and how safe they feel in the area where they are being cared for, including whether they understand and are partners in their plan of care, and feel culturally safe and that all their needs are being met.

The walk rounds aim to provide greater visibility for senior leaders into the front line level of care, to explore the experiences of staff and patients in these areas, and to improve the safety culture. The view is that providing this greater contact with the wards will help identify variations in ward safety practices.

The walk rounds also include an environmental observational audit, which reviewers also have the opportunity to participate in.

Many organisational leaders have joined the walk rounds over the years and their feedback has reflected their enjoyment of the process. However. Although there have been several attempts to evaluate the programme in the past, until this year the level of support required for a proper evaluation was not available.

What are we trying to achieve?

The evaluation project aims to identify and evaluate the impact of the patient safety leadership walk rounds. The evaluation will focus on the following five questions:

  1. Do the walk rounds contribute to improved patient and staff experiences of care?
  2. Do the walk rounds contribute to an increased sense of ownership among charge nurse managers for processes around safety and culture?
  3. To what extent do the walk rounds support reduced variation in ward quality processes among participating wards?
  4. How have the walk rounds contributed to an acceptance of a culture of monitoring and evaluation?
  5. Do the walk rounds support increased visibility of care and ward management/operations for executive management?

Answering these questions will provide insight into the value of the walk rounds and highlight opportunities for improvement. It is expected that the evaluation will take 15 months, with the final report available in March 2020.

The outcomes of the evaluation will be used to inform long-term decision-making about the walk rounds at CM Health, and potentially, lend credibility to the walk round programme, to support dissemination of the evaluation findings to other health care providers.

What have we done?

The evaluation is being led by the Ko Awatea Research and Evaluation Office within CM Health, and will take place at Middlemore Hospital.

A dedicated project manager has been appointed to support the clinical lead. TUPU funding and ethics approval for the evaluation was obtained in 2019, and a business analyst and data researcher have been sourced. This has enabled evaluation of the programme to get underway and good progress is being made.

All patients and staff interviewed as part of the walk rounds between 1 January 2019 and 31 December 2019 will be included in the evaluation, along with historical interview data from when the walk rounds were initiated in 2014.

Information collected during the walk rounds is recorded on the patient experience and staff experience walk round templates. This includes data on patient ethnicity, which will help the evaluation identify persistent disparities and inequities in the delivery of care.

The 15-step ward environment walk round assessment template data will also be collected during the evaluation and, along with historical data, included in the analysis.

Where to from here?

An evaluation report will be produced, which will include a list of recommendations for the Patient Safety Leadership Walk Round Programme to implement. The recommendations will help to shape and improve the programme, so it best achieves its goals, and to improve the safety culture and leadership visibility at CM Health.

The findings will be shared with charge nurse managers at Frontline Focus Friday and during Research Week 2019 (preliminary findings) and Research Week 2020 (final findings). Findings will also be shared with the Ko Awatea Senior Leadership Team and the CM Health Executive Leadership Team.

A journal article will be published about the project to help disseminate the findings about using patient safety leadership walk rounds in a New Zealand context to the wider New Zealand and global health sector.

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