Autumn Newsletter - Page 6



(Awkwardly) walking the floor
Supporting quality walks and service visits, Kate Jury
Connecting the ward with the board
We all know that service visits (previous terminology du
jour was quality walks) are an integral part of how the
board gains ‘soft intelligence’ on services (see page one).
Going out and speaking to staff, and where possible
patients, is an excellent way to secure an understanding of
front line challenges and service quality – or is it?
Part of the challenges around service visits is in
answering the where? why? and when?:

How much can the average non-executive director tell from
a 15 minute drop-in to a busy ward or department? Even
when linking up with executive directors (clinical and non- •
clinical) service visits can still sometimes feel like at best
shallow scrutiny at worst quite awkward and intrusive. Over
many years we have seen examples of visiting initiatives
causing untold confusion, difficulty and even complaints
from ward based staff who may often mawkishly liken the

visit to a ‘royal line-up’ or ‘parade’.
Boards have tried to address this problem by rebadging the
visits as ‘safety walks’ but this again, has done little to
abate confusion amongst staff and indeed the visitors
themselves. One ward manager announced of her safety
visits that “they are great – I tell the NED all of my
maintenance issues and suddenly I get a new sink, new
locks and new lights – marvellous”! Sadly, what this
actually indicates is that the usual processes for resolving
issues with estates or other services are not being raised or
dealt with effectively through normal channels.
How many times can front line staff be asked if ‘they are
busy’? and ‘what are their biggest challenges’? and ‘do
your staff feel they give the best care’? Perhaps the really
honest answers would be… “yes I am clearly understaffed
and rushed off my feet, consequently my biggest challenge
is YOU standing awkwardly on my ward right in the middle
of breakfast with your sleeves rolled down talking to my
housekeeper about the quality of food for patients which is
going cold as we speak!”
Where – Do we visit the same busy services over and
over again or do we make an effort to really get out
and about. Some of the best service visits involve
going to visit the porters (if hospital based), clinical
records departments or remote community nursing
teams or ambulance stations.
Why – Making sure that there is a clear brief (and
framework) for why you are doing the visits. Is it to
speak to staff on a ward following a large incident? Is it
to check in with staff following a service change or
speak to patients about new services? Go with a clear
outline of what you would like to get out of the visit.
When – Most visits occur when it is most convenient
to the visitor, early in the day, at lunch time or late
afternoon. Some of these times can be incredibly busy
particularly for ward based staff. Also consider harder
to reach staff groups like night staff and weekend staff,
take into account the experiences of locums and bank
staff to get a rounded sense of services.
Two key things are vitally important to remember with
service visits:
a) That the people undertaking the visit operate within
protocols (i.e. they adhere to protected mealtimes; IPC;
patient confidentiality etc.). The visits should also be
purposeful, even if that purpose is simply to raise visibility.
b) That the staff or service being visited get some value
out of the process, that they gain feedback or that they
see some action or escalation across services to address
concerns.
Service visits can absolutely add value if done with the
right intentions and the right planning and execution; the
ultimate litmus test of all is that staff (and the visitors
themselves) would be disappointed if they stopped!
6





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