Walkrounds in practice: corrupting or enhancing a quality improvement intervention? A qualitative study

Background: Walkrounds, introduced as Leadership (or Executive) WalkRounds,™ are a widely advocated model for increasing leadership engagement in patient safety to improve safety culture, but evidence for their effectiveness is mixed. In the English National Health Service (NHS), hospitals have been strongly encouraged to make use of methods closely based on the walkrounds approach. A study was conducted to explore how walkrounds are used in practice and to identify variations in implementation that might mediate their impact on safety and culture. Methods: The data, collected from 82 semistructured interviews in the English NHS, were drawn from two components of a wider study of culture and behavior around quality and safety in the English system. Analysis was based on the constant comparative method. Findings: Our analysis highlights how local, pragmatic adjustments to the walkrounds approach could radically alter its character and the way in which it is received by those at the front line. The modification and expansion of walkrounds to increase the scope of knowledge produced could increase the value that executives draw from them. However, it risks replacing the main objectives of walkrounds-specific, actionable knowledge about safety issues, and a more positive safety culture and relationship between ward and board-with a form of surveillance that could alienate frontline staff and produce fallible insights. Conclusion: The study's findings suggest some plausible explanations for the mixed evidence for walkrounds' effectiveness in creating a safety culture. On a practical level, they point to critical questions that executives must ask themselves in practicing interventions of this nature to ensure that adaptations align rather than conflict with the intervention's model of change.