Abstract
Background: This institution is participating in a multi-center quality improvement initiative, Executive Walkrounds (EW), designed to provide hospital staff with a forum to communicate safety concerns to leadership. We developed a method to transform these concerns into actions and facilitate follow-up.
Objective: To use comments elicited during EW to identify themes and actionable items in order to resolve safety concerns.
Design/Methods: The Children's Hospital Executive Walkrounds Team (EWT) visited a different unit in a large pediatric teaching hospital for 1 hour, 3 times per month. Three rotating executives conducted semi-structured interviews with staff including physicians, nurses, and pharmacists, using standardized questions. To identify themes and actionable items, staff comments were recorded verbatim and entered into a database. Comments were coded by 2 observers into thematically distinct categories, and summarized in an Action Plan (AP) - a tool for ensuring follow-up of actionable items. One week later, a Debrief session with unit leaders was convened to discuss items in the AP, determine actionability, and assign responsibility for resolving the item. 12 weeks later, participating staff received feedback and progress-to-date in the form of the updated AP. Each comment was then labeled completed or in progress.
Results: 550 multidisciplinary staff participated in 27 EW. Attendance ranged from 8–47 (mean 12) staff per round. Of 384 items, 14 distinct categories were identified by 2 observers with 90% agreement rate. The top themes were: Workload/Resources (89% of EW), Communication (78%), and Information Systems (63%). Pediatric-specific concerns were present in 15% of the comments. In 12 APs fed back to date, 82% of items were actionable and 32% of these actionable items were completed.
Conclusions: Concerns regarding workload, resources and communication were identified frequently by staff as impacting patient safety. Actionable items were identified and addressed through the AP. One third of the items were resolved comprehensively.
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Horowitz, L., McClay, M., Frankel, A. et al. 175 Identification of Actionable Items for Systems Improvement Through Patient Safety Executive Walkrounds in a Pediatric Hospital (USA). Pediatr Res 58, 384 (2005). https://doi.org/10.1203/00006450-200508000-00204
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DOI: https://doi.org/10.1203/00006450-200508000-00204