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Patient Safety Focus: How Executive Walk Rounds Can Improve Your Lab’s Safety Culture


How Executive Walk Rounds Can Improve Your Lab’s Safety Culture
By Karen Appold

The focus on patient safety across the country has hospitals looking at all facets of their operating procedures. One practice being used to shed light on problems is known as executive walk rounds. This rather simple concept, in which the institution’s executive leaders visit patient care areas or ancillary services like the lab, allows executives to engage care providers and discuss safety concerns on the front lines of patient care. Although largely unproven as a method for improving safety culture, growing numbers of hospitals are instituting the practice.

One of the first reports of executive walk rounds was published in 2005. The study targeted more than 20 clinical units and looked at the impact of the practice on perceived safety climate. Results from an established survey tool suggested a positive effect on nurses’ attitudes about the safety climate. The authors concluded that greater implementation of executive walk rounds might serve as an important tool to improve safety culture and, ultimately, patient safety (1).

But when it comes to patient safety improvement initiatives, more often than not, laboratorians must choose between taking an evidence-based approach versus a practical one. How should laboratory professionals choose various interventions and what should hospital leaders target for implementation? Some experts advocate for a “balanced diet” approach, combining momentum-generating projects like executive walk rounds and important practices with strong evidence, such as prevention of catheter-related blood stream infections or system-level interventions like computerized physician order entry (2).

A hospital executive takes notes
before engaging lab staff on executive walk rounds. 

Kaveh G. Shojania, MD, director of the University of Toronto Centre for Patient Safety, Canada Research Chair in Patient Safety and Quality Improvement, and associate professor of medicine at the University of Toronto, offered insight on how executive walk rounds can be applied to the clinical lab setting. “The goal of an executive walk round in a lab would be to identify problems that front-line technologists face and to engage management in solving them. In a lab setting, this would entail either having hospital executives tour the lab or, if the lab is large enough, having the lab director tour each section of the lab with the director of that area in addition to a senior technologist.”

The keys to program success are the active role of an executive advocate and the willingness of staff to openly discuss safety issues on their unit. Regular meetings between the advocates and the units should provide a forum for enhancing executive awareness, increasing staff confidence and trust in executive involvement, and swiftly and effectively addressing areas of potential patient harm. “Topics could range from safety or quality issues to efficiency problems, particularly because gains in efficiency can often have safety or quality benefits,” explained Shojania. “Resolving efficiency or issues faced by technologists will improve the morale and hopefully the lab’s culture.”


  • Thomas EJ, Sexton JB, Neilands TB, Frankel A, et al. The effect of executive walk rounds on nurse safety climate attitudes: A randomized trial of clinical units. BMC Health Serv Res. 2005;5:28. Available online. Accessed November 10, 2009.
  • Ranji SR, Shojania KG. Implementing patient safety interventions in your hospital: What to try and what to avoid. Med Clin North Am. 2008;92:275-293. Available online. Accessed November 10, 2009.

Karen Appold is an editorial consultant for the clinical lab industry.

Patient Safety Focus Editorial Board

Michael Astion, MD, PhD
Department of Laboratory Medicine
University of Washington, Seattle

Peggy A. Ahlin, BS, MT(ASCP)
ARUP Laboratories
Salt Lake City, Utah 
James S. Hernandez, MD, MS 
  Mayo Clinic Arizona
Scottsdale and Phoenix

Devery Howerton, PhD

Centers for Disease Control and Prevention
Atlanta, Ga.

Sponsored by ARUP Laboratories, Inc.