Leadership Walk Rounds are just one of the leadership and management fads I’ve seen in my medical career so far.
Having been on several wards in several hospitals when these have occurred I have noticed a number of problems which lead me to believe these should be banned and replaced with some real, difficult, down and dirty, hard to measure – but easy to see, nitty gritty LEADERSHIP.
1. The fact that Leadership Walk Rounds are such a big event suggests to me that the ‘leaders’ involved don’t walk round very often. It would be much better if they practiced MBWA – Management by Wandering Around – as Tom Peters describes in his books. And for any managers reading this who wish to counter that these are not big events – in my experience, they are for the frontline staff you are visiting.
2. Leadership Walk Rounds create a Hawthorne Effect – when staff know there’s going to be a Leadership Walk Round they will change the environment and their behaviour depending on what they think is important to the leaders who will be walking round. I have witnessed staff being coached on the right answers to anticipated questions from the managers, and being shown for the first time ever where important paperwork and policies are kept. The ward will be cleaner, better staffed, and cupboards will be stocked. If one definition of culture is ‘what we do around here when no-one is looking’ then Leadership Walk Rounds are definitely not the way for managers to assure themselves and the Board that wards are delivering safe, quality care and a good patient experience within a ‘good’ culture.
3. Leadership Walk Rounds can perpetuate the ‘them and us’ feeling between managers and frontline staff as the managers appearing on the frontline is an event, an exception to the rule, not the norm. From the perspective of staff working on the ward, the managers make the long walk from their offices to the ward once in a while. The rest of the time they keep their distance. And when they do come once in a while, they sweep in with their Blackberries in hand, dressed in corporate attire, and for the most part only speak to senior staff on the ward.
4. The atmosphere on a ward pending arrival of the Managers for a Walk Round is tense and fraught. There is a feeling that the managers are coming to inspect and criticise, with little real appreciation of the challenges faced by front line staff. This is clearly not indicative of a constructive culture.
5. Leadership Walk Rounds pay lip-service to real leadership and engagement. Real MBWA is hard because managers would need to make time to be on the frontline and get their hands dirty helping out with all sorts of nitty gritty problems. Leadership Walk Rounds are easy because they fit better with management than with leadership. They only have to be done once in a while. The date and time of the Walk Round can be recorded. The problems observed can be documented on a grid, and a list of actions and persons responsible can be drawn up leaving a perfect paper trail of governance and accountability. But the leadership void remains.