"Management By Walking Around" may hurt outcomes

The Management-By-Walking-Around (MBWA) technique, in which hospital leaders directly interact with frontline staff to seek suggestions for improvement or resolve problems, may do more harm than good, according to a new study published in Production and Operations Management.

Sara Singer of Harvard School of Public Health and Anita Tucker of Harvard Business School conducted a randomized controlled study involving an 18-month MBWA-based program intended to improve patient safety. Singer and Tucker analyzed changes in nurses' perception of improvement in 56 work areas at 20 hospitals and compared them to the responses of nurses in 138 work areas in 48 control hospitals, according to the study.

Participation in the management rounding program correlated with a decline in perceptions of performance, Singer and Tucker found. Under the program, senior managers devoted too much time to analyzing problems and too little time to practical solutions, which negatively affected nurses' perceptions of improvement, the authors wrote. Nurses only considered senior managers' presence an asset when it actively enabled solutions.

Part of the problem, the researchers said, is that managers must realize MBWA is a means to an end rather than an automatic improvement. "MBWA can backfire if management fails to meet staff expectations raised by the program," Tucker said in a statement. "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."

Healthcare leaders "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," according to the statement.

Effective healthcare management can be hard to come by, according to a March blog post in the Harvard Business Review, because organizations often don't look for a manager with the right combination of traits, FierceHealthcare previously reported.

To learn more:
- here's the study abstract
- here's the statement