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Less burnout, better safety culture in hospitals with hands-on executives, new study shows

walkroundsA specific method for fostering interaction between hospital executives and front-line health-care workers can reduce burnout and improve a hospital's safety culture, new research from Stanford and other institutions has found.

"Caregiver burnout is a huge problem for health care," said Stanford's Jochen Profit, MD, in a conversation with me about the new study, which he led. Profit is also a neonatologist at Lucile Packard Children's Hospital Stanford. "Across the industry, a third to half of our staff are burned out. How do you maintain quality and safety in that environment?"

The method that Profit's team evaluated holds an answer. Called executive walk-rounds, it consists of regular, safety-focused visits by hospital executives to the units where patients receive care. The study, published last week in BMJ Quality & Safety, evaluated the effects of walk-rounds on the staff of neonatal intensive care units, the nurseries that care for the sickest newborns. Walk-rounds provide doctors, nurses and other caregivers with an opportunity to point out safety problems, and, ideally, also give executives a chance to tell staff about resolutions used for the problems they've raised.

The study surveyed worker engagement and safety culture in 44 NICUs during a quality improvement project led by the California Perinatal Quality Care Collaborative. The surveys asked workers if walk-rounds were used at their institution and whether they had participated in the process. They also asked about caregivers' levels of burnout, the hospital's overall culture of safety and about feedback returned from hospital leadership to front-line caregivers to follow up on suggestions made during walk-rounds.

"Walk-rounds are a way for organizations to make sure they make the lines of communication open," Profit said. "It can help show that they care for the people in the trenches." Walk-rounds might help clear up confusion about the hospital's chain of command or resolve difficulties with getting equipment or supplies in a timely fashion, to name a few anecdotal examples from the study.

Follow-up was the key to successful walk-rounds, the study showed. About 30 percent of the hospitals surveyed used walk-rounds, and these differed in the extent to which staff said they received feedback on how the safety suggestions they identified were resolved. Staff at hospitals with the highest levels of follow-up said they had lower rates of burnout, better communication about errors, and better teamwork and safety climates.

Paul Sharek, MD, who was also an author on the paper, pointed out that the results are encouraging but that there is more hospitals can do to improve communication about safety problems. Whereas many hospitals use walk-rounds on only a monthly basis, Sharek, who is chief clinical patient safety officer at Lucile Packard Children's Hospital Stanford, oversees a quality management program at the hospital that is built around daily tiered huddles for staff, starting at the unit level.

"These culminate at a daily 'ops huddle' where multiple executives hear about patient safety issues every day, Monday to Friday. Any issues that need further escalation are addressed that day," Sharek said. Feedback moves quickly back to front-line caregivers, too.

Profit wants to see more of that approach. "We could do a much better job at ensuring that walk-rounds are as efficacious as possible by providing direct feedback to providers who engage in the exercise," he said. "It would benefit the caregivers' own mental health, benefit the institutions, and ultimately benefit patients."

Previously: Using mindfulness interventions to help reduce physician burnout and Automated safety checklists prevent hospital-acquired infections, Stanford team finds
Photo by Army Medicine

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