Latest / Safe As Podcast / Ep 14: Leadership walkarounds - ritualistic peacocking or solid trust building?

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Ep 14: Leadership walkarounds - ritualistic peacocking or solid trust building? · Safe As Podcast

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  We've all heard about them later.
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  Walk arounds. The idea is simple.
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  Get leaders out of their offices and onto the front lines,
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  engaging with staff, listening and learning.
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  It sounds great on paper, a Direct Line to understanding
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  what's really happening. But here's the burning question,
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  Are these walk arounds truly genuine exercises to learn and
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  engage, fostering trust and sparking real change?
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  Or are they sometimes just symbolic rituals, performative
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  acts that leave staff feeling cynical and even worse off?
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  What really is the impact of a walk around?
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  When do they work? And, crucially, when might they
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  backfire? G day, everyone.
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  I'm Ben Hutchinson. This is Safe as a podcast
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  dedicated to the thrifty analysis of safety, risk and
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  performance research. Visit safetyinsights.org for
• 0:58
  more research. Today's study is a systematic
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  review of the research on the links between leadership walks,
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  walkarounds, and clinical outcomes.
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  Simply put, what effects, positive or negative, do safety
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  walkarounds have in practise? This is a 2023 study from Foster
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  and Mesa titled Impact of Leadership Walkarounds on
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  Operational, Cultural and Clinical Outcomes, a systematic
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  review published in the BMJ Open Quality.
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  So systematic review includes A comprehensive selection of
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  articles that meet the inclusion criteria.
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  So this study didn't investigate walkarounds itself, but it's
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  investigated the studies that did, drawing key trends.
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  Just 12 studies met the inclusion criteria.
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  It's not really a lot. And note it was only looking at
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  healthcare research. So for a bit of background,
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  different types of leadership walkarounds exist.
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  It could be management by walking around gamble walks or
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  patient safety leadership walkarounds, and more.
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  A prior literature review of the patient safety leadership
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  walkarounds found that despite the limitations of studies,
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  walkarounds were generally effective in informing leaders
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  on safety issues that impacted frontline staff and patients.
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  Walk arounds may remove the ineffectual, layered and
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  indirect communication flows that commonly exist between
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  senior leaders and frontline workers.
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  But despite some benefits of walk around interventions, walk
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  arounds may also bring unintended consequences.
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  Some research highlights impaired perceptions,
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  performance following the walk around interventions and reduced
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  trust that follows from the interventions.
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  A bit of a tangent very quickly. While this study looked at
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  broader leadership walkarounds, I know some people are critical
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  of safety, whacking the term safety in front of things like
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  safety leadership, safety walkarounds instead of
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  leadership or walkarounds. While not necessarily defending
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  this trend, I think it also shows a misunderstanding of
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  research domain specificity. Safety leadership, for instance,
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  has been shown in several studies to not just be the same
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  thing as general leadership general domains, but I digress.
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  So what did they find? Based on these 12 studies, Walk
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  arounds were generally found to help staff, nurses and
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  physicians feel psychologically safer to report and discuss and
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  learn from errors. What this means is that when
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  leaders are visibly present and engaging, they create an
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  environment where people feel less afraid to speak up, share
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  mistakes, and learn from them. Rather than keeping issues
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  quiet, they can build trust. These results also suggested
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  that longer exposure to walk around interventions combined
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  with feedback mechanisms appeared to be associated with a
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  more definitive and positive impact from the walk arounds on
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  operational and cultural outcomes.
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  So it's not just about doing a one off walk around.
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  The more consistently leaders are out there listening and
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  importantly following up with feedback, the more real positive
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  change, seeing how operations run and in the overall climates
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  of their workplace. And further, according to the
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  paper, the manifestation of such positive associations could be
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  viewed as an early warning system of potential system
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  latent failures. So what this means is by
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  encouraging people to freely talk and share concerns, the
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  walkarounds can act like an early warning system.
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  Help me to pick up on hidden problems in the system before
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  they cause serious problems. Some more specific findings.
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  Well, one study found that monthly walkarounds over a three
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  month period actually found lower safety climate scores in
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  the non walkaround intervention group, the control group.
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  The intervention group, the ones who are exposed to the
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  walkarounds reported higher survey perceptions.
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  Another study found walkarounds resulted in greater perceived
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  effort among team members, 85% reporting having a better
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  understanding of patient safety, 76% indicated an increase in
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  reporting, and 91% of unit managers reported having
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  conversations with staff following the walk around
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  intervention. All executives in this data set
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  report that they had gained new learnings from the walk arounds
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  and considered them valuable and further, 86% of these executives
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  reported that they had taken actions as a result of the
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  feedback that they gained during the walk around.
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  Other data found that near miss incident reports increased 44% /
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  24 months following the walk around programme.
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  And in another study, hospital units that participated in the
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  walk around programmes reported a 21% increase in the
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  perceptions of performance from staff compared to the control
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  groups that didn't have the walk around intervention.
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  The authors also explored the characteristics of walk arounds
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  that seem to be connected with enhanced performance.
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  So, for instance, successful walk arounds were well organised
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  and coordinated, creating a feeling of an organisational
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  programme and not some ad hoc leadership visits.
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  Leaders were found to use a form of humble inquiry to spearhead
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  conversations and provide feedback to staff, nurses and
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  physicians. Humble inquiry, by the way, is a
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  term from Ed Shine referring to the gentle art of drawing
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  someone out, of asking questions to which you do not already know
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  the answer, of building a relationship based on curiosity
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  and interest in the other group. It's more than just a technique
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  for asking questions, but more as a fundamental shift in
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  mindset. Also, walkarounds were found to
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  promote a vision of culture, of patient safety when no blame
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  cultures and learning from errors were valued and
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  supported. The authors note that
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  practically speaking, walkarounds, when optimised,
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  seem quite effective in the areas with lower perception of
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  cultural climates of patient safety, and they're more
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  effective in areas where there are already sort of more
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  scepticism that organisational leaders truly stand behind
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  patient safety efforts. So it could help counter some of
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  this learned scepticism. Further, the authors speculate
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  that in organisations with leaders already mature in very
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  specific localised engagement philosophies like just culture,
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  use of walkarounds may be particularly effective since the
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  walkaround can actually be more cohesive and effective.
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  In contrast, if organisations and leaders are less familiar
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  with improvement based philosophies and these sorts of
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  programmes, a more centralised intervention might be of more or
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  more suitable choice to spearhead changes focused on
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  these climates of patient safety.
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  So some limitations Limitations in the study relate more to the
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  source data than they do in this paper.
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  Overall, there was a general lack of really robust quality
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  evidence, small sample sizes, low participation rates, and
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  types of feedback mechanisms that were or weren't in play.
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  There's also even more limited data based on demographics like
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  race, age, gender, and how these influence people's perceptions
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  of walkarounds. So what do we make of the
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  findings? Overall, there's at least some
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  evidence that leadership walkarounds can lead to positive
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  aspects on operational and climatic outcomes, at least in
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  healthcare, though the effects on clinical outcomes is weak.
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  Nevertheless, walkarounds need to be done for the right
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  reasons, as genuine exercises to learn and engage humble inquiry,
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  not symbolic rituals for show. One study found that walk
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  arounds even worsened staff perceptions because it likely
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  wasn't done for the right reasons, not generating trust.
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  That's it on Safe as I'm Ben Hutchinson, please help share,
• 8:38
  rate and review and check at safetyinsights.org for more
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  research. Finally, feel free to support
• 8:45
  Safe As by shouting a coffee link in the shy notes.