Management by Walking Around? Not Good for Patients

Management by walking or wandering around — MBWA — has been a standard tool of executives for decades. But a recent study by the Harvard School of Public Health (HSPH) and the Harvard Business School (HBS) suggests that the practice might do more harm than good in a hospital setting.

Health care as an industry may have specific factors and requirements that necessitate rethinking general business assumptions.

It’s an example of how health care has specific management needs and that practices cannot be blindly adapted from other industries. People who would go into health care management should consider specific training, like an MBA in health administration, rather than assume a one-MBA-degree-fits-all approach.

Hewlett-Packard started using MBWA in the 1970s, although some historians point to famous figures in the past who effectively did the same thing with troops at times of war. The practice gained its current stature when popularized by consultants Tom Peters and Robert Waterman, Jr. in the hit 1982 business book In Search of Excellence. Under the concept, managers move through the office, factory, or other facility randomly and check on projects, regular operations, and progress. The idea is that managers are more likely to boost morale and create a sense of common purpose for the organization.

Many consider the practice to have obvious value. But testing assumptions can be valuable. Sara Singer, associate professor at HSPH, and Anita Tucker, an associate professor at HBS, undertook an 18-month randomized control study of the use of MBWA in 56 work areas within 19 hospitals to improve patient safety. Senior managers “observe frontline employees, solicit ideas about improvement opportunities, and work with staff to resolve the issues.” The researchers looked at nurse perception of improvement and then compared the results against 48 control hospitals.

The results surprised the researchers. On the average, the MBWA programs resulted in a “negative impact on performance,” as perceived by the nurses. According to management theory, that is exactly the opposite of what should have happened. MBWA is supposed to generate greater morale and create better results.

Does that mean MBWA is ineffective in a health care setting? Not necessarily. The researchers found that “prioritizing easy-to-solve problems was associated with improved performance,” while prioritizing high value problems was unsuccessful. Also, “assigning to senior managers responsibility for ensuring that identified problems get resolved resulted in better performance.” In general, having senior managers circulate throughout a hospital was a waste of time unless they could enable “active problem solving.”

What it does show, unambiguously, is that health care as an industry may have specific factors and requirements that necessitate rethinking general business assumptions. Consider classic management solutions, by all means, but adapt them to how a facility works.