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Quality and Safety

Walk-rounds
Toolkit

We are all responsible…and together
we are creating a safer healthcare system

An initiative of the Quality and Patient Safety Directorate, Health Service Executive, May 2013 ©

THERAPY PROFESSIONS COMMITTEE

An initiative of the Quality and Patient Safety Directorate

Clinical Governance: we are all responsible…
This forms part of a series of supports developed by the HSE Quality and Patient Safety Directorate:
■ Quality and Patient Safety Clinical Governance Information Leaflet (2012);

The Safety Pause (2013): Information Sheet;

Quality and Safety Committee(s): Guidance and Sample Terms of Reference;

Quality and Patient Safety Clinical Governance Development Assurance Check
for Health Service Providers (2012);

Quality and Safety Prompts for Multidisciplinary Teams (2012);

Clinical Governance:
we are all responsible…

Achieving Excellence in Clinical Governance: Towards a Culture of Accountability (2010); and

Integrated Framework for Quality Safety and Risk Management (2009).

Copies of the documents can be located at www.hse.ie/go/clinicalgovernance
All of the above will assist organisations in demonstrating their commitment to staff engagement, building
relationships, trust and patient service quality and safety. Along with working to meet the National Standards for
Safer Better Healthcare (2012), the Quality Framework for Mental Health Services in Ireland (2007) and preparing for the
new governance arrangements within the health system.

© Health Service Executive
Quality and Patient Safety Directorate
May 2013
ISBN 978-1-906218-60-7
Quality and Patient Safety Directorate
Health Service Executive
Dr Steevens’ Hospital
Dublin 8
Ireland
Telephone: +353 1 6352344
Email : clinical.governance@hse.ie
Web : http://www.hse.ie
Adapted from: Institute for Healthcare Improvement (2004), Patient Safety First UK (2009), Great Ormond
Street Hospital for Children, NHS Trust (2011) and The Scottish Patient Safety Programme (2011).

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An initiative of the Quality and Patient Safety Directorate

Clinical Governance: we are all responsible…

Foreword
The Quality and Patient Safety Directorate in the HSE is constantly seeking ways to support health service
providers to improve the way they work and thus deliver a safer high quality experience to patients and people
who access our services. To that end we are seeking to promote leadership for high quality compassionate
care. Ultimately we are seeking to nurture a culture where problems in care are openly discussed and solutions
identified, where hierarchies are flattened and all staff feel that they can speak up and contribute to improving
the services we provide.

Clinical Governance: we are all responsible…

In a systematic review leadership walk-rounds and multi-faceted unit-based strategies are the two strategies
with some stronger evidence to support a positive impact on patient safety culture in hospitals1. The purpose
of this Quality and Safety Walk-round Toolkit is to provide a structured process to bring senior managers and
front line staff together to have conversations about quality and safety with the intention to prevent, detect and
mitigate patient/staff harm.
The guidance document is one of a series with the tag line ‘we are all responsible … and together we are creating
a safer healthcare system’. While the health system is under significant pressure we would intend this to not be
an additional burden but a practical toolkit. The walk-round can be focused on any location or service that may
affect patient care and safety of the organisation.
I would like to thank the quality and safety clinical governance development steering group, working group,
international reference panel, colleges and associations for preparing and endorsing our approach.
I would like to strongly recommend that our senior leaders and managers would embrace the style of leadership
embedded in the concept of quality and safety walk-round many already do. This will form a key element in our
model for service delivery where we really listen to front line staff and ensure that quality and safety is at the top
of all our agendas.
I would welcome feedback and learning from the system from the practical application of this approach and we
will develop the document further based on your experience.

Dr. Philip Crowley
National Director
Quality and Patient Safety Directorate

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Morello, R., Lowthian, J., Barker, A., McGinnes, R., Dunt, D., and Brand, C. (2012), ‘Strategies for improving patient safety culture in hospitals: a systematic review.’
British Medical Journal Quality and Safety, on line published on 21st July 2012 as 10.1136/bmjqs-2011-000582.

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An initiative of the Quality and Patient Safety Directorate Clinical Governance: we are all responsible… Clinical Governance: we are all responsible… 2 .

4 When 7 2. 7.1 At the start 9 3.6 How 7 2.7 Tracking Mechanism 8 3.1 Aims 2.5 Where 7 2.3 Who 6 2.2 Before the Walk-round 9 3. Approach to: Quality and Safety Walk-rounds 2. Communication 4. 5. 6.2 Setting the Scene Clinical Governance: we are all responsible… 6 6 2. Introduction 2.3 Follow up after the Walk-round 9 3. 1 4 5 9 3.An initiative of the Quality and Patient Safety Directorate Clinical Governance: we are all responsible… Table of Contents Foreword 1.4 On-going 9 Sample Guide for Discussion with Patients Sample Guide for Discussion with Staff Impact of Quality and Safety Walk-rounds Summary Toolkit: Quality and Safety Walk-rounds Appendix 1: Sample Quality and Safety Walk-rounds Contact Information Appendix 2: Sample Executive/Senior Management Team: Quality and Safety the Walk-round Members Appendix 3: Sample Communication Prior to the Walk-round Appendix 4: Sample Quality and Safety Walk-round Notice Appendix 5: Sample Walk-round Leaflet Appendix 6: Sample Preparation for the Senior Managers Leading the Quality and Safety Walk-round Team Appendix 7: Sample Communication after the Quality and Safety Walk-round Appendix 8: Sample Final Communication after the Quality and Safety Walk-round Appendix 9: Sample Quality and Safety Walk-round Action Plan Template Appendix 10: Sample Quality and Safety Walk-round Schedule 10 11 13 13 14 15 16 17 18 19 20 21 22 23 25 3 .

.. Safety walk-rounds have helped many organisations make a significant impact on their safety culture. on line published on 21st July 2012 as 10. A. The walk-round can be focused on any location or service that may affect patient care and safety of the organisation. Senior managers have a lead role in: Creating a culture where quality and safety is everybody’s primary goal Patient safety walk-rounds are a way of ensuring that senior managers can build relationships and trust so they are informed and can exchange views. A.3 Governments4 5 and hospitals6 as a tool to engage senior managers and frontline staff in a meaningful discussion of patient safety concerns with agreed actions7. but are not limited to these. They provide an opportunity for frontline staff to identify and discuss their safety concerns.. MD2. Quality and safety walk-rounds can be conducted in any setting such as wards. As a more formalised framework. M. as evidence suggests.. Simmonds.. TK. Institute for Healthcare Improvement (2004).. D.. 'Looking for Harm in Healthcare: Can Patient Safety Leadership Walk Rounds Help to detect and prevent harm in NHS hospitals? A Case Study of NHS Tayside'.. Gustafson. 1 2 3 4 5 4 6 7 Morello. Edinburgh: Scottish Patient Safety Programme Patient Safety First (2009).. Central to the success walk-rounds is a collaborative open approach. J. S. R. C. general practice and community settings. Graydon-Baker. and Brand. Introduction This document provides a short guide and toolkit aimed at helping organisations start out on this important initiative. They are also a way of demonstrating visible commitment by listening to and supporting staff when issues of safety are raised. They are also useful in services such as pathology and portering or other areas that may affect patient care or the safety of the organisation such as information communication technology (ICT) and finance. detect and mitigate patient/staff harm. (2003). Boston: Institute for Healthcare Improvement Healthcare Improvement Scotland (2011). Walk-rounds can be instrumental in developing an open culture where the safety of patients is seen as the priority of the organisation. Visits are intended to be helpful Clinical Governance: we areof all responsible… opportunities to share ideas and provide immediate feedback without taking responsibility away from line managers. ‘Patient Safety Ledrship Walk-rounds ’. T. departments.' The Permante Journal 10(2). regarding the safety concerns of units/teams. (2006). Neppl. Joint Commission Journal on Quality and Safety 29(1): 16-26.’ British Medical Journal Quality and Safety. that without this. Dunt. Gandhi. Leadership Walk-rounds Fact Sheet. P. They provide a formal process for members of the executive/senior management team/members of the board to talk with staff about safety issues in their unit or team and show their support of staff for reporting errors/near misses.. Leadership for Safety Patient Safety Walk-rounds . Barker. McGinnes. .1 Quality and safety walk-rounds allow executive/senior management team members to have a structured conversation around safety with frontline staff and patients. Patient Safety Leadership Walk-rounds . E. London: Patient Safety First Feitelberg. C. (2011). ‘Strategies for improving patient safety culture in hospitals: a systematic review. 'Patient Safety Executive Walkarounds.1136/bmjqs-2011-000582. R. 29-36 O'Connor.. operating theatres. Strong effective leadership is essential to build a safety-orientated organisational culture. (2012). patient safety walk-rounds were initially introduced by Allan Frankel. many other interventions are likely to fail. Lowthian. have since been developed by the Institute for Healthcare Improvement. Quality and safety walk-round Structured process to bring senior managers and front line staff together to have quality and safety conversations with a purpose to prevent. PhD Thesis: University of St. Scotland. Frankel. Andrews. clinics.An initiative of the Quality and Patient Safety Directorate Clinical Governance: we are all responsible… 1.

acknowledge and share good practice Support a proactive approach to minimising risk. one of the following will be designated lead: ■ CEO/GM /Service Manager ■ Lead/Executive/Clinical Director/Director of Quality and Safety ■ Health and Social Care Professional Lead ■ Director of Nursing/Midwifery ■ Head of Finance or Human Resources or ICT Accompanied by (where possible): ■ Patient representative/advocate or patient liaison officer ■ A member of the board ■ A note taker WHEN The Walk-rounds occur at an agreed frequency Dates and times are arranged.what is working well.An initiative of the Quality and Patient Safety Directorate Clinical Governance: we are all responsible… 2. For example. how this was managed by the team and how the senior management team can help COMMUNICATION A clear communication plan for the Quality and Safety Walk-round initiative All staff are briefed about the initiative and the aims General staff briefings. Consideration of the context and culture will inform the decision on the best approach and level of organisation. seminar room) is used for the discussion HOW The team in the area being visited are asked to think of a recent example of a patient safety incident they have experienced and share this at the meeting so that discussion can take place on . in consultation with area. timely reporting and feedback Strengthen commitment and accountability for quality and safety Clinical Governance: we are all responsible… SETTING THE SCENE Agreed and confirmed at the start of the walk-round The walk-round is an opportunity for an open discussion on quality and safety and is not an assessment or inspection All information discussed in a walk-round is confidential WHO Led by CEO/General Manager/Service Manager To ensure continuity a named person for all Quality and Safety Walk-rounds is identified by the CEO/GM/Service Manager Representatives nominated by the Senior Management Team and the Unit/Team participate in the walk-round WARD/DEPARTMENT/UNIT TEAM – – – SENIOR MANAGEMENT WALK-ROUND TEAM Ward/Department/Unit manager (identified lead) Medical Leads On the day there may be a number of other staff present For example: ■ Junior doctors ■ Consultants ■ Health and Social Care Professionals ■ Clerical Staff ■ Catering Staff ■ Nurses/Midwives ■ Health Care Assistants and other Support Staff – – Senior management team lead. who. Algorithm: Quality and Safety Walk-rounds AIMS Demonstrate senior manager’s commitment to quality and safety for patients. when. who will schedule all dates and areas to be visited for the year WHERE Walk-rounds start with a tour of the unit and meeting with patients and staff A meeting venue close to the patient /service area (office. newsletters and intranet communication should be used to promote the initiative Providing feedback and follow up with the unit/team within agreed time frames 5 . where and how is central to the success of quality and safety walk-rounds. Approach to: Quality and Safety Walk-rounds Being clear on the why. and communicated by the named person coordinating the Quality and Safety Walk-round. staff and the public Increase staff engagement and a culture of open communication Identify.

It is not an assessment or inspection and can provide the opportunity for staff to express concerns on behalf of patients.2 Setting the Scene It is helpful to clarify ground rules in advance and re confirm this at the start of the walk-round. health and social care professionals. nurses/midwives and health care assistants. Some suggestions for successful walk-rounds are: ■ Understanding that the walk-round is an opportunity for an open discussion on quality and safety. staff and the public. ■ Identify. acknowledge and share good practice. and ■ Prompt feedback from the senior management team with follow up. catering. ■ Increase staff engagement and develop a culture of open communication. ■ Support a proactive approach to minimising risk. ■ Sharing key learning from walk-rounds with other units/teams. Clinical Governance: we are allandresponsible… 2. 2. it is advised that a named person be identified by the CEO/General Manager/Service Manager to coordinate all Quality and Safety walk-rounds. The unit/team manager and medical leads are each invited to attend. usually the senior accountable person responsible for the area visited. and ■ Strengthen commitment accountability for quality and safety. ■ Agreeing times and location of walk-rounds an agreed period in advance. 6 . ■ Actively listening and a proactive approach to identifying and minimising risk. The priority is to have an opportunity to talk to both patients and staff. clerical. there may be a number of other staff present such as junior doctors.1 Aims The aims in introducing Quality and Safety Walk-rounds are: ■ Demonstrate senior managers’ commitment to quality and safety for patients. To assist with planning. it is advised that a list of contacts for each participating executive/senior management team member and the relevant unit/team be maintained (see Toolkit). consultants. Unit team For each walk-round a lead is identified from the unit/team being visited. ■ Confidentiality of information discussed in a walk-round and patient safety disclosure requirements. resources and time to effectively manage the process. On the day.An initiative of the Quality and Patient Safety Directorate Clinical Governance: we are all responsible… 2. It is important for the individual to have appropriate authority. timely reporting and feedback.3 Who To ensure continuity.

2. ■ A nominated note taker (normally from the executive/senior management teams administrative staff ). Dates and times (most suitable for staff and the service) are arranged and communicated by the named Quality and Safety Walk-round person. The quality improvement plan or any challenges can be shared with the executive/senior managment team. as being prepared to provide further development and support to other team members. healthcare records manager. ■ Director of Nursing/Midwifery. health and safety. It is better to focus the walk-round rather than a formal meeting. or technical services/estates/facilities staff prior to. 8 and ■ Non-Executive Director (member of the Board) – on occasions arranged through the CEO/General Manager/ Service Manager’s office. A meeting area as close to the patient/service area (as possible) such as an office or seminar room can be used for the discussion. and ■ Head of ICT. It is best to agree a time limit (for example maximum one hour). 2. The maximum number visiting an area should be agreed. for example: ■ Lead/Executive/Clinical Director/Director Quality and Safety.6 How The team in the area being visited is asked to describe what is working well or a change that was brought in at local level that might also work in other locations.5 Where It is useful for the walk-rounds to start with a tour of the unit/team and meeting with patients (where possible). They may also be asked to think of a recent example of a risk or patient safety incident they have experienced.An initiative of the Quality and Patient Safety Directorate Clinical Governance: we are all responsible… Senior Management Walk-round team The senior most accountable person (CEO/General Manager/Service Manager) leads each walk-round. based on their experience and personal strengths. The walk-round lead may be accompanied by (where possible): ■ A patient representative/advocate or patient liaison officer. or following on from. Members of the walk-round team may be identified. Clinical Governance: we are all responsible… ■ Head of Finance. Advice may be sought from quality improvement. To support dialogue and positive relationships it is important that the Quality and Safety Walk-round numbers are kept small and never outnumber the front line team. who will schedule all dates and areas to be visited for the year. Some members of the executive/ senior management team may feel apprehensive about leading quality and safety oriented discussions and a shadowing system among the executive/senior management team may be useful at the initial stages. ■ Chief Operating Officer. Other members of the executive/senior management team may be involved.4 When The Walk-rounds occur at an agreed frequency (at least monthly or as designated by the executive/senior management team). ■ Head of Human Resources. ■ Health and Social Care Professional Lead. 2. the visit. risk management. 7 8 The note taker should not be a member of the walk-round team as this impedes active participation in the discussion .

actioned. This will also provide evidence.g. and ■ Leadership e. medication reconciliation. how the team operates. the experience of the team in reporting incidents or near misses. ■ Continuing Professional Development e. By exception they may be circulated also to the executive/senior management team. At the end of the walk-round. The aim is for the safety issues to be dealt with at a local level with the support of the executive/senior management team. The aim is to complete these actions within an agreed timeframe.g. A number of issues that might be considered are: ■ Identifying and acknowledging good practice. new safety devices or maintenance and access to equipment.g. this is an opportunity to discuss progress with other improvement initiatives and update the 'visit pyramid'. A tracking mechanism (electronic) can then be used to monitor progress while at the same time providing reports on issues identified. changes to the physical environment. The nominated Quality and Safety Walkround person will be responsible for maintaining the record. standard of cleaning and compliance with hand-washing.g.g. The findings of the walk-round can be circulated and discussed at the appropriate line management forum. the executive/senior management team normally commits to maintaining a record of the process. everyone agrees the safety issues identified. 8 . where appropriate. clinical audits. if any. ■ Teamwork e. for assurance.g. ■ Communication e. ■ Equipment e. safety education and training specific to the area. If the ward/area is a 'productive ward' site. Responsibility is delegated to address issues arising. This does not prevent all staff from addressing the risks identified and recording these on the unit/team risk register. within teams and with patients. drug errors or delays in prescribing medication. ■ Prevention and control of HCAI e.g. ■ Risk management e.7 Tracking Mechanism For effective use and follow up. escalated and resolved.An initiative of the Quality and Patient Safety Directorate Clinical Governance: we are all responsible… It can be helpful to ask probing questions and all members of staff are actively encouraged to participate. 2. missing or incomplete healthcare records. key quality improvements plans to address National Standards.g. Clinical Governance: we are all responsible… ■ Environment e. ■ Process e.g.

newsletters.An initiative of the Quality and Patient Safety Directorate Clinical Governance: we are all responsible… 3. ❙ Health and safety issues. and ■ Preparing reports as required. and intranet communication may be used to promote the initiative (see suggested leaflet in the toolkit). team meetings.3 Follow up after the Walk-round ■ Updating the Quality and Safety Walk-round Database. Communication A strong communication plan is essential to the success of any Quality and Safety Walk-round initiative.1Governance: At the start we are all responsible… ■ Creating the schedule for Quality and Safety Walk-rounds for the year.4 On-going ■ Creating the schedule for Quality and Safety Walk-rounds for each subsequent year. These may include (but are not limited to): ❙ Relevant quality and performance indicators. ❙ Staffing complements/absenteeism. General staff briefings. 3.2 Before the Walk-round ■ Issuing email reminder to the unit/team (the week before the scheduled visit). ■ Circulating the final action plan (within an agreed timeframe). Briefing staff so they know about the initiative and understand the aims is really important. 3. It can be useful to include prompts of the information to be reviewed in preparation for the visit. ❙ Incidents/near misses. heads of departments. ❙ Quality improvements. ❙ Unit/team risk register. ❙ Copy of the outstanding actions from the previous Walk-round visit. The nominated Quality and Safety Walk-round person arranges all communication and follow up as follows by: Clinical 3. notice boards. 9 . ❙ Infection prevention and control issues. and ■ Following up progress on the issues being actioned by the executive/senior management team. This is informed by the approach adopted by the organisation. ■ Updating the Quality and Safety Walk-round Database on an on-going basis. and ❙ Preparing material for the note taker to take on the walk-round. 3. and ■ Distributing the schedule to all executive/senior management team members. ❙ Patient feedback about their experience (compliments/complaints). ■ Preparing and circulating to all those present at the walk-round the draft action plan for comment and approval (within an agreed timeframe of the visit where possible). relevant others and unit/team being visited with requests for the dates to be confirmed in relevant diaries. ■ Issuing email reminder to walk-round team (four days before the visit).

there may be a chance to highlight some of the opportunities for patients to provide further feedback.your feedback’. These are: access. 10 . If you were in-charge here. Sample Guide for Discussion with Patients The prompts below are examples that may be used in the walk-round conversation with patients. Is there anything that we could do better? 3.ie/eng/services/ysys/ National_Healthcare_Charter The questions arewe designed promote constructive feedback.An initiative of the Quality and Patient Safety Directorate Clinical Governance: we are all responsible… 4. How are you today? 2. therefore. People often feel concerned about making a Clinical Governance: are alltoresponsible… complaint. for example using the leaflet ‘You and your health service: tell us…. participation. See further information at http://www. communication and information.hse. what would you do to make things work better? During the discussion. privacy. SUGGESTED QUESTIONS 1. safe and effective service. if we invite them to make a positive statement it is easier to suggest improvements. improving health and accountability. The principles of the National Healthcare Charter (2012) 'You and your health service' may be of assistance in preparing for the discussion. dignity and respect.

commodes.g. etc.An initiative of the Quality and Patient Safety Directorate Clinical Governance: we are all responsible… 5.g. ■ What patient or staff safety issues keep you awake at night? ■ Is there anything we could do to help you or your staff to further minimise risk? ■ Can you describe how communication among staff either enhances or inhibits safe care on your unit/team? ❙ shift handovers ❙ between teams e. do you report it? What makes you do that? ■ If you prevent/intercept a mistake. are you concerned about personal consequences? ■ Do you know what happens to the information that you report? ■ What were your last hand hygiene audit results? Were there areas to be improved and what are you doing to improve them? ■ What is the standard of cleaning of clinical equipment . doctors. decontamination of clinical equipment policy and cleaning services policy)? ■ What percentage of patients on antibiotics have a review date documented in their medication record? ■ What percentage of your patients with peripheral intravenous lines or urinary catheters have the care bundle components recorded today? 11 . drip stands. health and social care professionals ❙ support staff (clerical.. The aim is to take a discursive rather than a formulaic approach. Sample Guide for Discussion with Staff The topics below are examples that may be used to guide the discussion. portering) ■ Have you discussed patient safety issues with patients or their families? ■ Do patients and families raise any safety concerns? ■ How legible are the patient’s healthcare records? ■ Have you any problems accessing patients healthcare records? ■ Can you tell us how your team works? ■ Can you tell us how the team works with other teams? ■ What is staff morale like? ■ Tell us about the last time a patient was harmed here/about the most recent near miss? What happened? (good starting question to get the discussion going). It is helpful for the walk-round members to meet in advance to prepare for the specific walk-round. Not all areas can be covered at each visit. trolley’s. The walk-round leader in consultation with the group makes a decision based on engagement with the unit/team on which areas to focus on.pumps. cleaning. Are they cleaned regularly? ■ Do you know how often different items should be cleaned? If not do you know how to find out (e. catering. ■ When you make a mistake. TOPIC SUGGESTED QUESTIONS ■ What do you do well – what are you most proud of here? Could this practice Introductionwe are all Clinical1 Governance: responsible… be of benefit elsewhere? 2 3 4 5 Communication Teamwork Risk Management Prevention and Control of Health Care Associated Infection ■ Can you tell us one thing you are happy with and one that might cause you concern? ■ Would you be happy for yourself or a member of your family to be treated in this area? (good starting question which can be profoundly indicative of a serious problem). do you report it? ■ If you make or report an error. nurses.

Moving and Handling. building works affecting care) Do you have regular maintenance of your equipment? Do you have service notices on your equipment? ■ Do you have access to all the equipment you need to care for your Clinical Governance: we are all responsible… patients safely? 8 9 10 12 Process Continuing professional development Leadership ■ What audits (both clinical and non clinical) does your area undertake or lead? ■ Today. are you able to care for your patients as safely as possible? If not.g. quality improvement and clinical governance training have you had? ■ What infection prevention and control and medication management training have you had? ■ Are your team up to date with mandatory training. scales. Fire Training. why not? ■ Have there been any near misses that nearly caused patient harm but didn’t? Examples: ❙ Taking a drug to give to a patient and then realising it is incorrect ❙ Mis-programming a pump. but having an alert that warns you ❙ Incorrect prescriptions/orders caught by nurses/midwives or other staff ■ What incident. risk management. for example. ligature points. Hand Hygiene? ■ Do you feel supported when you make a mistake or things go wrong? ■ Who leads your team? ■ What specific intervention from senior management would make the work you do safer for patients and staff? Examples: ❙ Organise multi-disciplinary groups to evaluate a specific problem ❙ Facilitate in changing the attitude of a particular group ❙ Facilitating interaction between two specific groups ■ What would make these Quality and Safety Walk-rounds more effective? ■ Have you found participation in these Quality and Safety Walk-rounds beneficial? . etc ❙ Not enough information available (e.An initiative of the Quality and Patient Safety Directorate Clinical Governance: we are all responsible… TOPIC 6 Environment 7 Equipment SUGGESTED QUESTIONS ■ ■ What aspects of the environment are likely to lead to the next patient harm? Examples: ❙ Broken sinks. bedpan washers. taps. Basic Life Support.

■ Promote a culture for change pertaining to patient safety. infection rates). ■ Number of safety-based changes made by staff by units/teams per year. Impact of Quality and Safety Walk-rounds It is important to build a process to demonstrate the impact of the Quality and Safety Walk-rounds. Summary In summary.An initiative of the Quality and Patient Safety Directorate Clinical Governance: we are all responsible… 6. ■ Provide opportunities for staff to raise concerns and suggest improvements. ■ Identify opportunities with staff concerned for improving safety. 13 . and Clinical Governance: we are all responsible… ■ Response to patient safety culture survey (process measure). ■ Establish lines of communication about patient safety among frontline staff and managers throughout all departments within the organisation. 7. ■ Number of compliments/complaints received per month (outcome measure). Some examples are: ■ Number of problems identified by staff which are addressed within a certain time period. walk-rounds can: ■ Demonstrate top level commitment to improving safety and quality of care. ■ Percent changes in overall surveillance data (for example. ■ Provide opportunity for direct engagement and communication with patients about safety and their experience. and ■ Demonstrate accountability. errors. One targeted measure might be considered. ■ Establish local solutions to minimise risk. ■ Encourage reporting of issues. and near misses.

An initiative of the Quality and Patient Safety Directorate Clinical Governance: we are all responsible… Toolkit: Quality and Safety Walk-rounds Clinical Governance: we are all responsible… Continuous quality improvement Patient first Safety Open culture Personal responsibility Supporting performance Defined authority Clear accountability Multidisciplinary working Leadership 14 .

12 11 10 9 8 7 6 5 4 3 2 1 UNIT/TEAM DIRECTORATE/ DIVISION NURSE/MIDWIFE LEAD MEDICAL LEAD PHONE Appendix 1: Sample Quality and Safety Walk-rounds Contact information – as of XX (month/year) Clinical Governance: we are all responsible… EMAIL An initiative of the Quality and Patient Safety Directorate Clinical Governance: we are all responsible… 15 .

This is arranged through the CEO/General Manager/Service Manager Office.An initiative of the Quality and Patient Safety Directorate Clinical Governance: we are all responsible… Appendix 2: Sample Executive/Senior Management Team: Quality and Safety the Walk-round Members It is useful to maintain a listing of the identified senior staff who lead or participate in Quality and Safety Walk-rounds. Executive/Senior Managers (one lead for each walk-round): NAME TITLE [insert details] we are all responsible… CEO/General Manager/Service Manager Clinical Governance: POINT OF CONTACT [insert email and phone contact details] Lead/Executive/Clinical Director/ Director of Quality and Safety Chief Operating Officer Head of Finance Head of Human Resources Head of ICT Quality Improvement/Risk Management/Health and Safety/Technical Services/Estates/Facilities (May be involved in the visit or provide advice and support in follow up to the visit) NAME TITLE POINT OF CONTACT Occasionally. These are as follows: Non-Executive Directors NAME 16 . a Non-Executive Director (Board Member) may accompany the Walk-round team.

An example template is as below: Dear all [insert date] ClinicalXXXX Governance: we are all responsible… ward has been scheduled for a Quality and Safety Walk-round on the dd/mm/yyyy from XX:XX am to XX:XX am. 17 . XXXX (Senior Manager) will be accompanied by XXXX Plus any other member The aim of the Walk-round is to allow the senior management team to learn about safety issues on the unit/team that are of concern to staff or patients. A copy of the Quality and Safety Walk-round leaflet and notice can be attached. If you have any queries or require further clarification. The senior team would like to use the visit as an opportunity to speak to all staff of any grade or profession.An initiative of the Quality and Patient Safety Directorate Clinical Governance: we are all responsible… Appendix 3: Sample Communication Prior to the Walk-round An email reminder can be sent to the unit/team the week before their Walk-round visit. You may wish to bring it to the attention of all your team to help them understand the purpose of the visit. The senior managers would also welcome the opportunity to speak with patients if possible. Attached is a leaflet. which explains the purpose and process of the visit. A notice is also attached. Many thanks and kind regards. at the start of the visit. Please inform staff members of the walk-round and their opportunity to engage in the process. They will ask questions to which there are no right or wrong answers. please contact me via email or contact details below. and would therefore appreciate it if you could kindly arrange this on the day (if appropriate).

An initiative of the Quality and Patient Safety Directorate Appendix 4: Sample Quality and Safety Walk-round Notice Clinical Governance: we are all responsible… Quality and Safety Walk-round XXX Unit/Team XXX Date Clinical Governance: we are all responsible… XXX Time Walk-round Senior Management Team: XXXX (Senior Manager lead) Notetaker : XXXX Unit/Team: XXXXXXXX (CN/MM) XXXX (Assistant Director/ Directorate Nurse/Midwife Manager) XXXX (Business/Programme Manager) XXXX (Medical Lead) XXXX (specialty/ward overview): 18 .

Simmonds T. References Frankel. Lead/ Executive Clinical Director.An initiative of the Quality and Patient Safety Directorate Clinical Governance: we are all responsible… Appendix 5: Sample Walk-round Leaflet Clinical Governance: we are all responsible… Quality and Safety Walk-rounds What is the aim of the Walk-round? The aims in introducing Quality and Safety Walk-rounds are: ■ Demonstrate senior managers’ commitment to quality and safety for patients. Frankel A. T. we want to ensure that all preventable harm is eliminated and this will need the help of all members of staff and of patients and the public. They will also assist in working to meet the National Standards for Safer Better Healthcare (2012). E. ■ Identify. and ■ Strengthen commitment and accountability for quality and safety. (2003) “Patient Safety Leadership Workarounds” Joint Commission Journal on Quality and Safety 29 (1):16-26 Leonard M. and ❙ Incident reporting & safety culture in the organisation. patients not getting their medications on time. M. Simmonds. the Quality Framework for Mental Health Services in Ireland (2007) and preparing for the new governance arrangements within the health system. All members of staff who participate are encouraged to respond and participate in the discussion. Neppl. Head of Finance. Chief Operating Officer. Issues that can be raised may include: ❙ Good practice and safety developments.: Achieving (2004) Safe and Reliable Healthcare Strategies and Solutions. Graydon-Baker. timely reporting and feedback. Gustafson.. A member of the senior management team will visit each area accompanied by a patient representative/ advocate or patient liaison officer (where possible) as well as a administrative support to record key issues discussed. acknowledge and share good practice. ❙ Communication – within teams and with patients.. The walk-round team and the staff can meet and hold the discussions in any area that suits the local team. ❙ How can the senior management team help?. patients not being reviewed when required. thanking all individuals for their participation and highlighting the main areas discussed actions agreed. building relationships. Director of Nursing/Midwifery. Clinical Governance: we are all responsible… ■ Increase staff engagement and develop a culture of open communication. T. we will agree the actions to be taken forward together to make the area safer for patients.g. etc. trust and patient service quality and safety. We ask staff to think of an example of good practice and a patient safety experience that they have addressed and bring this to the meeting to share with us. What will happen to the information we gather? Senior managers will respond to the local team within an agreed time frame.. It is better to focus on the walk-round rather than a formal meeting. For Information Contact: [insert details 19 . This may be in the patient areas or in a quiet room within the main clinical area.. Vega K. Chicago: Health Administration Press. Members of the visiting walk-round team will then ask some questions to start a dialogue. ❙ What can we do together to improve?. ❙ Your key patient safety concerns. staff and the public. C. Who is involved? You and a member of the senior management team: CEO/GM/ Service Manager. What happens at the Walk-round? A member of the walk-round team will explain and introduce the process including the agreements for confidentiality and patient safety disclosures.. Quality and Safety Walk-rounds will assist organisations in demonstrating their commitment to staff engagement. e. and Head of Human Resources or ICT. A. and Gandhi. Where does the walk-round take place? It is useful for the walk-rounds to start with a tour of the unit/team and meeting with patients (where possible). ❙ How does your local team operate?. At the end of the process. ■ Support a proactive approach to minimising risk. How do they fit in with the quality and safety programme? Our aim is to minimise harm – that is.

Best wishes. in existing reports. Attach the Action Plan report from the last walk-round (if relevant) and the Quality and Safety Walk-round Discussion Guide. Clinical Governance: we are all responsible… Please find attached a sample question guide. Following this rigidly. [insert date] The Quality and Safety Walk-round visit which you are leading is scheduled to visit XXXX unit/team on dd/ mm/yyyy from xx:xx am to xx:xx am. on the walk-round may distract from the flow of the discussion. If you require any further details or clarification about the visit. ■ Quality improvements. and ■ Health and safety issues. ■ Incidents/near misses. ■ Staffing complements/absenteeism. An open dialogue is more effective. ■ Unit/team risk register. please do not hesitate to contact me. This information serves as background material to assist you in preparing for the conversation with the unit/team. The information you might consider reviewing. ■ Complaints/compliments. in preparation for visit might include: ■ Relevant quality and performance indicators. 20 . ■ Infection prevention and control issues.An initiative of the Quality and Patient Safety Directorate Clinical Governance: we are all responsible… Appendix 6: Sample Preparation for the Senior Managers Leading the Quality and Safety Walk-round Dear All .

3. If you wish to make any amendments to the attached report or to the comments above. All positive feedback and suggestions for improvements are also noted and these are included in the email sent to the team following the walk-round (see below). Clinical Governance: we are all responsible… A suggested email template is as below: Dear XXXX. 21 . As agreed. I would be grateful if you could please let me know by XXX 20XX. we would like to note the positive feedback we received during the visit:1. Suggestions for unit/team to consider as part of promoting further good practice are: 1.An initiative of the Quality and Patient Safety Directorate Clinical Governance: we are all responsible… Appendix 7: Sample Communication after the Quality and Safety Walk-round A copy of the draft Action Plan is circulated to all those present at the walk-round for comment and approval. it can be useful to focus on a small number of high priority issues identified on a Quality and Safety Walk-round. The final action plan will then be emailed to all concerned to ensure agreed actions are taken forward. please find attached a draft version of the action plan that highlights safety action points that together we will take forward with the intention of resolving or raising further awareness on the issue. 3. 2. 2. [insert date] Thank you for investing the time and participating in the Quality and Safety Walk-round to XXXX unit/ team on dd/mm/yyyy. In some instances. In addition. Kind regards and many thanks It is good practice to distribute the draft action plan within an agreed time frame.

2. 3. Kind regards. Suggestions for unit/team to consider as part of promoting further good practice are: 1. Thank you. Please keep me briefed on the progress to enable me to update the Quality and Safety Walk-round database.An initiative of the Quality and Patient Safety Directorate Clinical Governance: we are all responsible… Appendix 8: Sample Final communication after the Quality and Safety Walk-round The final action plan is circulated to all participants in the walk-round within an agreed timeframe. 22 . Clinical Governance: we are all responsible… [insert date] Thank you for participating in the Quality and Safety Walk-round to XXXX unit/team on dd/mm/yyyy. Again. we would like to note the positive feedback we received during the visit: 1. 3. Progress on all other issues are normally captured at the next walkround visit for that particular area (or as agreed by the executive/senior management team). 2. The named person for coordinating the Quality and Safety Walk-rounds takes responsibility for following up progress on the action plans as the deadlines approach. Further to my email (dated XXX) please find attached the final action plan that takes account of your comments and highlights the agreed priority issues that will be taken forward. Our agreed time scale for addressing the issues is dd/mm/yyyy. An example email template is as below: Dear All.

ISSUE OR CONCERN RAISED WHAT HAS ALREADY BEEN DONE TO ADDRESS ISSUE ACTION TO BE TAKEN FOLLOWING WALKROUND PERSON RESPONSIBLE Clinical Governance: we are all responsible… DUE DATE Areas: Incident Reporting. Process. Equipment. Prevention and control of HCAI. TOPIC Appendix 9: Sample Quality and Safety Walk-round Action Plan Template An initiative of the Quality and Patient Safety Directorate Clinical Governance: we are all responsible… 23 . Leadership. Communication. Teamwork. Environment. Continuing Professional Development.

Process. Environment. Continuing Professional Development. Prevention and control of HCAI. Communication. Teamwork.24 SUGGESTIONS Clinical Governance: we are all responsible… Areas: Incident Reporting. Equipment. Leadership FEEDBACK Appendix 9: Sample Quality and Safety Walk-round Action Plan Template (continued) An initiative of the Quality and Patient Safety Directorate Clinical Governance: we are all responsible… .

DEPARTMENT/ DIRECTORATE/ DIVISION UNIT/TEAM DATE DAY OF WEEK Appendix 10: Sample Quality and Safety Walk-round Schedule TIME SENIOR MANAGER Clinical Governance: we are all responsible… PATIENT REPRESENTATIVE/ ADVOCATE/ PATIENT LIAISON OFFICER NOTE TAKER REPRESENTATIVE OTHER An initiative of the Quality and Patient Safety Directorate Clinical Governance: we are all responsible… 25 .

An initiative of the Quality and Patient Safety Directorate Clinical Governance: we are all responsible… Clinical Governance: we are all responsible… 26 .

An initiative of the Quality and Patient Safety Directorate Clinical Governance: we are all responsible… Clinical Governance: we are all responsible… 27 .

An initiative of the Quality and Patient Safety Directorate Clinical Governance: we are all responsible… Clinical Governance: we are all responsible… 28 .

g. on the appointment of the National Director. Designing systems for measuring staff perceptions of the patient safety culture. Designing a framework for quality and safety to cover all stages of the chain from organ donation to transplantation. – Information management . Enhancing the way we manage and learn from incidents through revised incident management policies and guidelines. and Corporate Planning and Corporate Performance. – Quality and performance indicators . Strengthening and embedding the role of clinical directors. and efficiency of health services. While it is the QPS Directorate role to determine and define systems and processes for quality and safety within the HSE.51. Human Resource. – Clinical effectiveness and audit . Room 1. – Learning and sharing information . Contact Details Quality and Patient Safety Directorate.monitoring and analysing data to provide information to support the quality improvement process and learning. Directorates.promoting risk management as everyday practice. their families and members of the public.providing systems and tools to assist service providers in embedding national standards and HSE recommended practices. – Staffing and staff management – appreciating the importance of caring for the morale of front line staff. Communication. e. Steevens. This commitment is intended to create momentum for positive change towards increased patient safety.hse. – Patient safety and risk management .the initiative through which healthcare organisations declare their commitment to patient safety. Health Care Acquired Infection programme.ie/go/qps The HSE is a signatory to Patient Safety First .measurement of quality and safety through the adoption and development of indicators in collaboration with the national clinical programmes. Clinical Strategy and Programmes. – Patient and public involvement – Continually involving service users in improving care delivery and developing systems for listening to and seeking their feedback. safety.patientsafetyfirst.developing a strong system of integrated corporate and clinical governance.ie For further information please see www. implementation is the responsibility of and achieved by the Integrated Services. Philip Crowley. Widening the use of the Health Intelligence Ireland information system and National Quality Assurance Intelligence System (NQAIS) to help drive quality. Achieving a critical mass of senior healthcare staff with a knowledge and understanding of improvement science through the Diploma in Leadership and Quality in Healthcare. For further information see www. Dr. Health Service Executive.We are all responsible…and together we are creating a safer healthcare system About the Quality and Patient Safety Directorate The Quality and Patient Safety (QPS) Directorate of the Health Service Executive (HSE) was established in January 2011. The National Director for Quality and Patient Safety has responsibility for leading and supporting: – Capacity and capability .innovating and improving how we share learning. Through participation in this initiative. Advocating and designing patient safety initiatives. Leading the HSE relationship with regulatory and statutory. Dr. Dublin 8 Tel: +353 (0)1 6352038 email: nationalqps@hse. The national director is a member of both the HSE Senior Management Team and the Board of the HSE. The role of the QPS Directorate is to provide leadership and be a driving force by supporting the statutory and voluntary services of the HSE in providing high quality and safe services to patients. Supporting the National Office of Clinical Audit and undertaking a planned programme of QPS audits providing independent assurance on safety and quality. Finance. Children and Families.ie . Cancer Control. those involved aspire to play their part in improving the safety and quality of healthcare services.

governance@hse.ie Web : http://www.ie .© Health Service Executive Quality and Patient Safety Directorate May 2013 ISBN 978-1-906218-60-7 Quality and Patient Safety Directorate Health Service Executive Dr Steevens’ Hospital Dublin 8 Ireland Telephone: +353 1 6352344 Email : clinical.hse.