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Executive walk rounds are a promising tool for improving the safety climate of hospitals

Many hospitals are implementing the practice of executive walk rounds (EWRs). EWRs consist of visits by hospital executives to patient care areas to discuss patient safety issues with providers. The executive may ask providers to discuss specific events or general processes that could put patients at risk for harm, ask for suggestions to improve patient safety, and verbalize their commitment to improving safety at the hospital. Discussions between the executive and providers are documented and can lead to action, which is followed by feedback to participants.

EWRs are a promising tool for improving the safety climate of hospitals, according to a recent study that was supported in part by the Agency for Healthcare Research and Quality (HS11544). In the study, Eric J. Thomas, M.D., of the University of Texas Medical School at Houston, and his colleagues randomized 23 intensive care units or wards treating similar types of patients at a teaching hospital to receive EWRs or usual care. They administered the Safety Climate Survey prior to and after EWRs were begun to assess providers' attitudes about safety. EWRs were conducted at each EWR unit by one of six hospital executives once a month for three visits.

Before EWRs, the mean safety climate scores for nurses were similar in the control units and EWR units (78.97 vs. 76.78), the percent of positive safety attitude scores (64.6 vs. 61.1 percent) was similar as well. After EWRs, the mean safety climate scores were not significantly different for all providers. However, nurses in the control group had lower scores than nurses in the intervention group who participated in an EWR session (74.88 versus 81.01 and 52.5 vs. 72.9 percent). Nurses who participated in EWRs also responded more favorably to a majority of items on the survey.

More details are in "The effect of executive walk rounds on nurse safety climate attitudes: A randomized trial of clinical units," by Dr. Thomas, J. Bryan Sexton, Ph.D., Torsten B. Neilands, Ph.D., and others, in the April 2005 BMC Health Services Research 5, online at

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