Management-By-Walking-Around, a widely adopted technique in hospitals in which senior managers visit the frontlines of their organizations to solicit improvement ideas and resolve issues, has the potential to do more harm than good, according to a new study by researchers from Harvard School of Public Health (HSPH) and Harvard Business School (HBS). In contrast to evidence that suggests MBWA-type programs improve the safety climate in hospitals, this study finds the effectiveness of these programs depends on how they are approached. “Our research cautions managers against adopting practices just because evidence suggests they are effective in one or a few hospitals. Managers really need to understand what makes practices effective in order to replicate their success,” said co-author Sara Singer, associate professor in the Department of Health Policy and Management at HSPH.
The paper appeared online March 31, 2014 in Production and Operations Management. To improve the quality of care and decrease medical errors, many hospitals in the U.S. and U.K. have adopted MBWA, a program that has also been used widely in manufacturing organizations. However, previous studies had not looked closely at the factors and approaches associated with the success of MBWA in hospitals.
Singer and co-author Anita Tucker, associate professor of business administration at HBS, did a randomized controlled study to test the effectiveness of an 18-month MBWA-based program to improve patient safety. They compared the change in nurses’ perception of improvement in 56 work areas in the 20 hospitals that implemented and completed the MBWA program with that of nurses in 138 work areas in 48 randomly selected control hospitals. Contrary to their expectations, the authors found that MBWA had a negative effect on nurses’ perceptions of performance.
They found that senior managers in work areas in the study allocated too much time to analyzing which problems to solve and not enough time taking action, resulting in a negative impact on perceptions of improvement among nurses. Senior managers’ presence on the front lines was only helpful when it enabled active problem solving.
“MBWA can backfire if management fails to meet staff expectations raised by the program,” said Tucker. “When MBWA is successful, it’s the action-taking that results from the program, rather than the mere physical presence of the senior managers, that positively impacts frontline staff performance. Rather than generating large numbers of safety reports without the ability to act on them, organizations should take action on known problems and build capacity for solving more.”
Singer and Tucker’s research suggests that policymakers might improve patient safety more by providing incentives for hospitals to build frontline problem-solving capacity rather than by requiring specific change programs that may not be fully validated.
Support for the study was provided by the Agency for Healthcare Research and Quality RO1 HSO13920 and the Fishman Davidson Center at Wharton.
“The Effectiveness of Management-By-Walking-Around: A Randomized Field Study,” Anita L. Tucker, Sara J. Singer, Production and Operations Management, March 31, 2014, DOI: 10.1111/poms.12226.
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