We’ve all heard about or been part of them – leader walkarounds.
Are walkarounds backed by solid evidence – do they break down silos, enhance trust, and foster psychological safety, or more symbolic peacocking activities to be *seen* to care, rather than *actually* caring?
Today’s article is Foster, M., & Mazur, L. (2023). Impact of leadership walkarounds on operational, cultural and clinical outcomes: a systematic review. BMJ Open Quality, 12(4), e002284.
Make sure to subscribe to Safe As on Spotify/Apple, and if you find it useful then please help share the news, and leave a rating and review on your podcast app.
I also have a Safe As LinkedIn group if you want to stay up to date on releases: https://www.linkedin.com/groups/14717868/
Shout me a coffee (one-off or monthly recurring)
Spotify: https://open.spotify.com/episode/6gcXDxTBKch5TONXnVPpTq?si=ua0a42XXQiOvvpowXKWxcA
Transcript:
We’ve all heard about them, leader walkarounds. The idea is simple. Get leaders out of their offices and onto the front lines, engaging with staff, listening and learning. It sounds great on paper, a direct line to understanding what’s really happening. But here’s the burning question. Are these walkarounds truly genuine exercises to learn and engage, fostering trust and sparking real change, or are they sometimes just symbolic rituals, performative acts that leave staff feeling cynical and even worse off?
What really is the impact of a walk around? When do they work and crucially? When might they backfire?
G’day everyone, I’m Ben Hutchinson and this is Safe As, a podcast dedicated to the thrifty analysis of safety, risk and performance research. Visit safetyinsights.org for more research. Today’s study is a systematic review of the research on the links between leadership walks, walkarounds and clinical outcomes. Simply put, what effects, positive or negative, do safety walkarounds have in practice? This is a 2023 study from Foster and Mazur, titled, “Impact of Leadership Walkarounds on Operational, Cultural and Clinical Outcomes – A Systematic Review”. Published in the BMJ, Open Quality.
So systematic review includes a comprehensive selection of articles that meet the inclusion criteria. So this study didn’t investigate walkarounds itself, but it’s investigated the studies that did, drawing key trends. Just 12 studies met the inclusion criteria, that’s not really a lot, and note, it was only looking at healthcare research. So for a bit of background, different types of leadership walkarounds exist, there could be management by walking around, gamble walks, or patient safety leadership walkarounds, and more. A prior literature review of the patient safety leadership walkarounds found that, despite the limitations of studies, walkarounds were generally effective in informing leaders on safety issues that impacted frontline staff and patients. Walkarounds may remove the ineffectual layered and indirect communication flows that commonly exist between senior leaders and frontline workers. But despite some benefits of walk around interventions, walkarounds may also bring unintended consequences. Some research highlights impaired perceptions performance following the walk around interventions and reduced trust that follows from the interventions.
A bit of a tangent very quickly, while this study looked at broader leadership walkarounds, I know some people are critical of safety whacking the term safety in front of things like safety leadership, safety walkarounds instead of leadership or walkarounds. Well not necessarily defending this trend, I think it also shows a misunderstanding of research. Domain specificity, safety leadership for instance, has been shown in several studies to not just be the same thing as general leadership, general domains, but a digress.
So what did they find? Based on these 12 studies, walkarounds were generally found to help staff, nurses and physicians feel psychologically safer to report and discuss and learn from errors. What this means is that when leaders are visibly present and engaging, they create an environment where people feel less afraid to speak up, share mistakes and learn from them rather than keeping issues quiet, they can build trust. These results also suggested that longer exposure to walk around interventions, combined with feedback mechanisms, appeared to be associated with a more definitive and positive impact from the walkarounds on operational and cultural outcomes. So it’s not just about doing a one off walk around, the more consistently leaders are out there listening and importantly following up with feedback, the more real positive change you see in how operations run and in the overall climates of their workplace.
And further, according to the paper, the manifestation of such positive associations could be viewed as an early warning system of potential system latent failures. So what this means is by encouraging people to freely talk and share concerns, the walkarounds can act like an early warning system, help me to pick up on hidden problems in the system before they cause serious problems. Some more specific findings, one study found that monthly walkarounds over a three month period actually found lower safety climate scores in the non walk around intervention group, the control group. The intervention group, the ones who are exposed to the walkarounds reported higher survey perceptions.
Another study found walkarounds resulted in greater perceived effort among team members, reporting having a better understanding of patient safety, indicated an increase in reporting and of unit managers reported having conversations with staff following the walk around intervention. All executives in this data set report that they had gained new learnings from the walk arounds and considered them valuable. Further, of these executives reported that they had taken actions as a result of the feedback that they gained during the walk arounds. Other data found that near missed insert reports increased over 24 months following the walk around program and in another study hospital units that participated in the walk around programs reported a increase in the perceptions of performance from staff compared to the control groups that didn’t have the walk around intervention.
The authors also explored the characteristics of walkarounds that seem to be connected with enhanced performance. So for instance, successful walkarounds were well organized and coordinated, creating a feeling of an organizational program and not some ad hoc leadership visits. Leaders were found to use a form of humble inquiry to spearhead conversations and provide feedback to staff, nurses and physicians. Humble inquiry by the way is a term from Ed Shine referring to the gentle art of drawing someone out, of asking questions to which you do not already know the answer, of building a relationship based on curiosity and interest in the other group. It’s more than just a technique for asking questions but more as a fundamental shift in mindset. Also walkarounds were found to promote a vision of culture of patient safety where no blame cultures and learning from errors were valued and supported.
The authors note that practically speaking, walkarounds when optimized seem quite effective in the areas with lower perception of cultural climates of patient safety and they’re more effective in areas where there are already sort of more skepticism that organizational leaders truly stand behind patient safety efforts. So it could help count to some of this learned skepticism. Further, the authors speculate that in organizations with leaders already mature in very specific localized engagement philosophies like just culture, use of walkarounds may be particularly effective since the walk around can actually appear more cohesive and effective. In contrast, if organizations and leaders are less familiar with improvement based philosophies in these sorts of programs, a more centralized intervention might be of more suitable choice to spearhead changes focused on these climates of patient safety.
So some limitations. Limitations in this study relate more to the source data than they do this paper. Overall, there was a general lack of really robust quality evidence. Small sample sizes, low participation rates, and types of feedback mechanisms that were or weren’t in play. There’s also even more limited data based on demographics like race, age, gender and more and how these influence people’s perceptions of walkarounds.
So what do we make of the findings? Overall, there’s at least some evidence that leadership walkarounds can lead to positive aspects on operational and climatic outcomes, at least in healthcare, though the effects on clinical outcomes is weak. Nevertheless, walkarounds need to be done for the right reasons. There’s genuine exercises to learn and engage, humble inquiry, not symbolic rituals for show. One study found that walkarounds even worsened staff perceptions because it likely wasn’t done for the right reasons, not generating trust.
SafetyInsights.org 