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.
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Agreed. Many years ago as an Aide De Camp to a Commander in Chief (CinC) in the Royal Air Force I was party to both the formal “visit” and the informal “wandering about”. In my view the formal certainly had the Hawthorne effect and some wider benefits but the latter were really insightful for both the CinC and the other individuals involved. Much easier to have “unsupervised” conversations in the latter scenario!!
Thanks for your comment. Great to hear examples from different settings. I think the wandering around is the harder thing to do, but also the most fruitful.
It is interesting timing to see an article discussing MBWA and the Hawthorne Effect, as I had recently thought about these and what connection they may have. MBWA definitely needs to have a leader that has a genuine interest in the people and what is happening on the front-lines. I can definitely see how the Hawthorne Effect can result, as Leadership Walk Rounds as you describe them seem more formal and cold (even a bit sterile – excuse the pun). Maybe one idea, if leaders are truly interested in learning more about what goes on in the front lines, is to have a lunch with an employee each week to learn more about their role, challenges faced, and the employee’s thoughts on potential solutions. This may be more difficult though in a hospital setting. Would be interesting to see those hospitals that rate highly (if there is a survey reflecting this) on their ability to care for their employees, and what they have in place to do so.
Thanks Tracy. I think the idea of managers/leaders having lunch with members of their teams is a good idea. They could visit the canteen or staff rooms. It would be hard to do and might take time, but I think they would reap many rewards for the effort.
Steven. Thanks for sharing your excellent paper. I strongly endorse its key points. Good leadership is subtle, never predictable, non-threatening, inspiring, exciting, and inclusive. Planned visits by management are like old school inspections where pupils were prepared to perform at their best with weaker pupils often dispatched to some duties away from the classroom (ward). In other words prone to creating the illusion of effectiveness.
Happy Christmas
Jim Livingstone
Thanks for your comment Jim. It’s useful to hear more examples from outside healthcare and I like your term ‘illusion of effectiveness’. I also like the list of adjectives for good leadership!
I think it is important that leaders are visible and make sure they really understand what is happening. If it is all pre-arranged and stage managed they won’t get real insights.
When I was a Finance Director and it was my week on call I use to spend time trying to help out in any way I could. I could still see what was going on and at the same time could do something useful like negotiating a handover from A&E to a ward, liaising with the Ambulance Trust or even sorting out food for staff when it impossible for them to get a break.
It is really important for leaders to appreciate that they and the people closest to the point of care are trying to achieve the same things and that it is team work that delivers results.
Thanks Duncan. Many people have asked me to elaborate on the difference between Leadership Walk Rounds and MBWA. Real examples like this demonstrate the difference better than I can explain it.
Totally agree with you Steven. MBWA should be spontaneous, varied and random. My favourite thing was to run my hand along surfaces, checking for dust and to check ward stores, very illuminating. The event walk around is more an ego boost for the manager than the front line.
Thanks John. Did you also give positive feedback and help staff solve problems? I’m also an advocate of Tom Peters’ concept of “Boss as CHRO – Chief Hurdle Removal Officer”.
Absolutely and in particular explained why their problems sometimes could’nt be solved, which is every bit as important as making sure you solve them when you take them on-board.
Steve
When I saw the banner comment on this article, I was determined to challenge your thinking. However, having read such a balanced article, I could not agree more. The vital element is the relationship between management and staff based on mutual respect and trust and therefore managing by wandering about is the answers. visibility and understanding are key not ticking boxes.
Thanks Derek. The title of the article is deliberately written as a ‘motion’ to provoke debate, followed by my arguments in support if the motion. I’m delighted you were convinced to support the motion. Many have been, but some are still not convinced.
MBWA really does work – but not in abstraction. You have to marry that with a spirit of inquiry, learning and support. In my manufacturing days I would walk around the factory at least 3 times a day. I’d talk to operators, foremen, shop stewards, storemen – feel the pulse, sense the atmosphere. I learned to pick up on the sound of dodgy material, duff metal batches etc. We fostered the spirit of pulling the stop cord if something was wrong. Ask people what frustrates them, what would make their life easier, develop feedback. We have just been doing this in a household name company full of lean etc. – but even there when we stepped beyond narrow lean / six sigma and took a “Whole Systems” or end to end delivery cycle approach, then we found, in a month, a rich vein in excess of £7.5m of wasted effort and energy to mine. We won’t reduce heads – we’ll enable more business and that is what would happen in a hospital, where I have done the same. What i find astonishing is the remoteness of many senior management teams in acute trusts – senior consultants and surgeons who have never met the CEO or do not have any relationship with the C suite, who have never seen a senior finance team member in their service – the one way street of data up and dictats down. Without the crucial feedback mechanisms the C suite do not learn how their credibility is eroded when, for instance clinics and services are added without allowing for the necessary support staff, or when services are reconfigured and work relocated between trusts and hospitals with no consideration of the impact on critical services such as Imaging. Walk around yes – also talk to people, foster their confidence, listen and act and go back and check whether you have in fact helped.