Safety Culture and Workforce Well-Being Associations with Positive Leadership WalkRounds.



Interventions to decrease burnout and increase well-being in health care workers (HCWs) and improve organizational safety culture are urgently needed. This study was conducted to determine the association between Positive Leadership WalkRounds (PosWR), an organizational practice in which leaders conduct rounds and ask staff about what is going well, and HCW well-being and organizational safety culture.


This study was conducted in a large academic health care system in which senior leaders were encouraged to conduct PosWR. The researchers used data from a routine cross-sectional survey of clinical and nonclinical HCWs, which included a question about recall of exposure of HCWs to PosWR: "Do senior leaders ask for information about what is going well in this work setting (e.g., people who deserve special recognition for going above and beyond, celebration of successes, etc.)?"-along with measures of well-being and safety culture. T-tests compared work settings in the first and fourth quartiles for PosWR exposure across SCORE (Safety, Communication, Operational Reliability, and Engagement) domains of safety culture and workforce well-being.


Electronic surveys were returned by 10,627 out of 13,040 possible respondents (response rate 81.5%) from 396 work settings. Exposure to PosWR was reported by 63.1% of respondents overall, with a mean of 63.4% (standard deviation = 20.0) across work settings. Exposure to PosWR was most commonly reported by HCWs in leadership roles (83.8%). Compared to work settings in the fourth (< 50%) quartile for PosWR exposure, those in the first (> 88%) quartile revealed a higher percentage of respondents reporting good patient safety norms (49.6% vs. 69.6%, p < 0.001); good readiness to engage in quality improvement activities (60.6% vs. 76.6%, p < 0.001); good leadership accessibility and feedback behavior (51.9% vs. 67.2%, p < 0.001); good teamwork norms (36.8% vs. 52.7%, p < 0.001); and good work-life balance norms (61.9% vs. 68.9%, p = 0.003). Compared to the fourth quartile, the first quartile had a lower percentage of respondents reporting emotional exhaustion in themselves (45.9% vs. 32.4%, p < 0.001), and in their colleagues (60.5% vs. 47.7%, p < 0.001).


Exposure to PosWR was associated with better HCW well-being and safety culture.





Published Version (Please cite this version)


Publication Info

Sexton, J Bryan, Kathryn C Adair, Jochen Profit, Jonathan Bae, Kyle J Rehder, Tracy Gosselin, Judy Milne, Michael Leonard, et al. (2021). Safety Culture and Workforce Well-Being Associations with Positive Leadership WalkRounds. Joint Commission journal on quality and patient safety, 47(7). pp. 403–411. 10.1016/j.jcjq.2021.04.001 Retrieved from

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John Bryan Sexton

Associate Professor in Psychiatry and Behavioral Sciences

Bryan is the Director of the Duke Center for the Advancement of Well-being Science.  He leads the efforts around research, training and coaching, guiding quality improvement and well-being activities.  


A psychologist member of the Department of Psychiatry, Bryan is a psychometrician and spends time developing methods of assessing and improving safety culture, teamwork, leadership and especially work-force well-being.  Currently, he is disseminating the results from a successful NIH R01 grant that used RCTs to show that we can cause enduring improvements in healthcare worker well-being. 


A perpetually recovering father of four, he enjoys running, using hand tools on wood, books on Audible, and hearing particularly good explanations of extremely complicated topics.


Jonathan Gregory Bae

Associate Professor of Medicine

Patient safety and quality improvement, hospital based performance improvement, care transitions and hospital readmissions, general internal medicine hospital care, resident and medical student education.


Kyle Jason Rehder

Dr. Glenn A. Kiser and Eltha Muriel Kiser Professor of Pediatrics

Mechanical Ventilation, ECMO, Patient Safety and Quality, Communication, Education

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