Ep 14: Leadership walkarounds - ritualistic peacocking or solid trust building?

We've all heard about or been part of them - leader walkarounds.

Are walkarounds backed by solid evidence - do they build break down silos, enhance trust, and foster psychological safety, or more symbolic peacocking activities to be *seen* to care, rather than *actually* caring?

Today's article is Foster, M., & Mazur, L. (2023). Impact of leadership walkarounds on operational, cultural and clinical outcomes: a systematic review. BMJ Open Quality, 12(4), e002284.

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Episode Transcript

(00:07):
We've all heard about them later.
Walk arounds. The idea is simple.
Get leaders out of their officesand onto the front lines,
engaging with staff, listening and learning.
It sounds great on paper, a Direct Line to understanding
what's really happening. But here's the burning question,
Are these walk arounds truly genuine exercises to learn and

(00:29):
engage, fostering trust and sparking real change?
Or are they sometimes just symbolic rituals, performative
acts that leave staff feeling cynical and even worse off?
What really is the impact of a walk around?
When do they work? And, crucially, when might they
backfire? G day, everyone.
I'm Ben Hutchinson. This is Safe as a podcast

(00:51):
dedicated to the thrifty analysis of safety, risk and
performance research. Visit safetyinsights.org for
more research. Today's study is a systematic
review of the research on the links between leadership walks,
walkarounds, and clinical outcomes.
Simply put, what effects, positive or negative, do safety

(01:13):
walkarounds have in practise? This is a 2023 study from Foster
and Mesa titled Impact of Leadership Walkarounds on
Operational, Cultural and Clinical Outcomes, a systematic
review published in the BMJ OpenQuality.
So systematic review includes A comprehensive selection of
articles that meet the inclusioncriteria.

(01:36):
So this study didn't investigatewalkarounds itself, but it's
investigated the studies that did, drawing key trends.
Just 12 studies met the inclusion criteria.
It's not really a lot. And note it was only looking at
healthcare research. So for a bit of background,
different types of leadership walkarounds exist.

(01:57):
It could be management by walking around gamble walks or
patient safety leadership walkarounds, and more.
A prior literature review of thepatient safety leadership
walkarounds found that despite the limitations of studies,
walkarounds were generally effective in informing leaders
on safety issues that impacted frontline staff and patients.

(02:19):
Walk arounds may remove the ineffectual, layered and
indirect communication flows that commonly exist between
senior leaders and frontline workers.
But despite some benefits of walk around interventions, walk
arounds may also bring unintended consequences.
Some research highlights impaired perceptions,
performance following the walk around interventions and reduced

(02:40):
trust that follows from the interventions.
A bit of a tangent very quickly.While this study looked at
broader leadership walkarounds, I know some people are critical
of safety, whacking the term safety in front of things like
safety leadership, safety walkarounds instead of
leadership or walkarounds. While not necessarily defending

(03:01):
this trend, I think it also shows a misunderstanding of
research domain specificity. Safety leadership, for instance,
has been shown in several studies to not just be the same
thing as general leadership general domains, but I digress.
So what did they find? Based on these 12 studies, Walk

(03:21):
arounds were generally found to help staff, nurses and
physicians feel psychologically safer to report and discuss and
learn from errors. What this means is that when
leaders are visibly present and engaging, they create an
environment where people feel less afraid to speak up, share
mistakes, and learn from them. Rather than keeping issues
quiet, they can build trust. These results also suggested

(03:45):
that longer exposure to walk around interventions combined
with feedback mechanisms appeared to be associated with a
more definitive and positive impact from the walk arounds on
operational and cultural outcomes.
So it's not just about doing a one off walk around.
The more consistently leaders are out there listening and

(04:05):
importantly following up with feedback, the more real positive
change, seeing how operations run and in the overall climates
of their workplace. And further, according to the
paper, the manifestation of suchpositive associations could be
viewed as an early warning system of potential system
latent failures. So what this means is by

(04:26):
encouraging people to freely talk and share concerns, the
walkarounds can act like an early warning system.
Help me to pick up on hidden problems in the system before
they cause serious problems. Some more specific findings.
Well, one study found that monthly walkarounds over a three
month period actually found lower safety climate scores in

(04:46):
the non walkaround intervention group, the control group.
The intervention group, the oneswho are exposed to the
walkarounds reported higher survey perceptions.
Another study found walkarounds resulted in greater perceived
effort among team members, 85% reporting having a better
understanding of patient safety,76% indicated an increase in
reporting, and 91% of unit managers reported having

(05:10):
conversations with staff following the walk around
intervention. All executives in this data set
report that they had gained new learnings from the walk arounds
and considered them valuable andfurther, 86% of these executives
reported that they had taken actions as a result of the
feedback that they gained duringthe walk around.
Other data found that near miss incident reports increased 44% /

(05:33):
24 months following the walk around programme.
And in another study, hospital units that participated in the
walk around programmes reported a 21% increase in the
perceptions of performance from staff compared to the control
groups that didn't have the walkaround intervention.
The authors also explored the characteristics of walk arounds
that seem to be connected with enhanced performance.

(05:55):
So, for instance, successful walk arounds were well organised
and coordinated, creating a feeling of an organisational
programme and not some ad hoc leadership visits.
Leaders were found to use a formof humble inquiry to spearhead
conversations and provide feedback to staff, nurses and
physicians. Humble inquiry, by the way, is a

(06:15):
term from Ed Shine referring to the gentle art of drawing
someone out, of asking questionsto which you do not already know
the answer, of building a relationship based on curiosity
and interest in the other group.It's more than just a technique
for asking questions, but more as a fundamental shift in
mindset. Also, walkarounds were found to
promote a vision of culture, of patient safety when no blame

(06:38):
cultures and learning from errors were valued and
supported. The authors note that
practically speaking, walkarounds, when optimised,
seem quite effective in the areas with lower perception of
cultural climates of patient safety, and they're more
effective in areas where there are already sort of more
scepticism that organisational leaders truly stand behind

(06:58):
patient safety efforts. So it could help counter some of
this learned scepticism. Further, the authors speculate
that in organisations with leaders already mature in very
specific localised engagement philosophies like just culture,
use of walkarounds may be particularly effective since the
walkaround can actually be more cohesive and effective.

(07:18):
In contrast, if organisations and leaders are less familiar
with improvement based philosophies and these sorts of
programmes, a more centralised intervention might be of more or
more suitable choice to spearhead changes focused on
these climates of patient safety.
So some limitations Limitations in the study relate more to the
source data than they do in thispaper.

(07:40):
Overall, there was a general lack of really robust quality
evidence, small sample sizes, low participation rates, and
types of feedback mechanisms that were or weren't in play.
There's also even more limited data based on demographics like
race, age, gender, and how theseinfluence people's perceptions
of walkarounds. So what do we make of the

(08:00):
findings? Overall, there's at least some
evidence that leadership walkarounds can lead to positive
aspects on operational and climatic outcomes, at least in
healthcare, though the effects on clinical outcomes is weak.
Nevertheless, walkarounds need to be done for the right
reasons, as genuine exercises tolearn and engage humble inquiry,

(08:22):
not symbolic rituals for show. One study found that walk
arounds even worsened staff perceptions because it likely
wasn't done for the right reasons, not generating trust.
That's it on Safe as I'm Ben Hutchinson, please help share,
rate and review and check at safetyinsights.org for more
research. Finally, feel free to support

(08:45):
Safe As by shouting a coffee link in the shy notes.