Creating a culture where everyone can prevent defects

In response to a fatal adverse event in 2004, Virginia Mason (VMMC), a 336-bed medical center in downtown Seattle, immediately embarked upon a leadership-led initiative to “Ensure the safety of patients through the elimination of avoidable death and injury. Executive accountability and alignment was achieved in unprecedented fashion with this focus."*

As a key component of this work, all members of the VMMC executive team conduct weekly walk-rounds. These rounds involve every operational department within the hospital from dietary to the intensive care units—and offer workers on each unit a weekly opportunity to see and talk with leaders about safety and quality. The key points about these walk-rounds are:

1. All members of the executive team participate, including the CEO, CFO, CIO, etc. Walk-rounds are calendared and are prioritized over other appointments.
2. Leaders receive ongoing formal training in how to conduct the walk-rounds; they are also put on a buddy system.
3. The walk-rounds are a combination of structured and unstructured time. Leaders bring an interview sheet that includes a checklist.
4. Unit managers are contacted ahead of time, and there is an opportunity within the visit for the leader to connect separately with the manager.
5. Each unit uses a “Tier 3 wall” that shows how that unit’s work aligns with corporate safety goals.
6. After reviewing the Tier 3 wall, the executive leader meets and talks with staff about barriers and opportunities to achieving patient safety goals.
7. The leaders have a chance to meet with patients and families during the walk-rounds.
8. The executive leader sends a thank-you note to the unit following every visit.

The information gained during walk-rounds is collected on a standard sheet, and any problems are communicated to the administrative leader of the unit that was visited. VMMC plans to expand the walk-round program to include section heads and managers in the near future.

VMMC’s team cites several major takeaways from the walk-round program. First, they’ve found that this initiative helps create an organization with horizontal integration, open line of sight and trusting dialogue. It also helps to further VMMC’s goal of creating an organization in which everyone at every level is an “inspector” for quality and safety: that is, everyone has the authority and responsibility to prevent defects and engage the team in preventing defects.

^* Virginia Mason 2010 Quality and Patient Safety Factors