Gemba Walks: A Path Toward Becoming a High-Reliability Organization
By Lakmali Ranathunga, MD, chief medical officer, Miami Valley Hospital North, Upper Valley Medical Center
Gemba rounds an approach where leaders visit "where the work is done"—are being implemented at Premier Hospitals as a strategy for becoming a high-reliability organization. These rounds occur three times a week and are structured to focus on specific themes, such as infection control practices, communication methods, patient experience strategies, and safety protocols.
The primary goals of Gemba rounds are to improve communication between staff and leadership, enhance staff engagement, reduce healthcare-associated infections (HAIs), lower patient readmissions, and boost patient satisfaction. By engaging directly with staff in their work environments, leadership seeks to build a culture of openness, understand daily operational challenges firsthand, and involve employees in collaborative problem-solving. Specific objectives include identifying real-time barriers to patient safety, fostering accountability and team alignment, and addressing staff concerns to create an environment focused on continuous improvement.
During Gemba rounds, senior leaders and nursing directors visit each unit and engage with frontline staff. These rounds occur three times a week with a structured focus on specific themes, such as infection control practices, communication methods, patient experience strategies, and safety protocols.
Leaders ask open-ended questions to encourage staff feedback on workload, patient care challenges, and communication effectiveness. They also review infection prevention measures, observe daily workflows, and solicit ideas for reducing HAIs. These rounds promote a culture of trust, allowing staff to feel supported in voicing concerns and suggesting improvements. Additionally, specific quality metrics, such as hand hygiene compliance and HAI rates, are reviewed and discussed with the team to reinforce safety practices. Leaders follow a Gemba Board after each round to ensure the process remains efficient and timely.
The impact of Gemba rounds is already evident. Communication has improved, with staff reporting increased visibility and support from leadership. Staff engagement levels have risen as teams feel more empowered to contribute ideas and solutions, leading to several actionable changes in workflow. HAIs are expected to decrease as infection control practices are reinforced and monitored during rounds. Patient satisfaction scores are also projected to improve, particularly in communication and responsiveness.
Feedback from Gemba rounds helps foster a culture of transparency and continuous improvement, aligning staff and leadership around shared goals for patient safety and satisfaction. The initiative demonstrates that leadership engagement on the front lines profoundly impacts addressing operational challenges and enhancing patient care. Gemba rounds will continue and adapt based on ongoing feedback to sustain these positive changes.
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