To huddle or not to huddle

The huddle concept is not new.  Many organisations and teams have tried this out and either succeeded or failed.  Huddles take a variety of formats and are used for a variety of purposes.

Make them brief – 5 to 10 minutes

Know when to make them multi-disciplinary or uni-disciplinary

Challenges include:

  • getting everyone to stop what they are doing and gather into a huddle
  • viewing the huddle as yet another task that takes you away from patients
  • clearly demonstrating the benefits
  • finding the right time

Be clear about purpose

A huddle can be reactive – for example is triggered by an event such as a patient fall then ensure that you use the huddle to quickly assess how the fall could have been prevented, what can be learnt from it and what could be done differently in that moment – it is more of a real time conversation rather than a full debrief

Huddles can be proactive – preventing patient safety issues and staff concerns.  A process that gathers the team together to talk about the day, the shift, the next few hours.  This is different from the beginning of the day briefing because it can happen at any point of the day.

A huddle is not a handover

There needs to be a process of linking and therefore learning from one to the other.  Issues highlighted in the morning briefing for example can be then discussed at the huddle and then through to the debriefing.  Checking in and taking the pulse of the department at any given time.  They need to be helpful and focused and create a shared understanding of what is needed and when.  Different types include:

  • Formalised huddles – planned huddles at specific times with attendance being mandatory in a designated area and with the huddle facilitated by the most senior person
  • Information capturing huddles – others use tools to capture information such as a ‘huddle sheet’ which can list the areas of discussion such as a list of patients with indwelling catheters, a lits of patients at risk of falling and so on
  • Unplanned impromptu huddles  – called at any time – to regroup, or seek collective advice and can be called by anyone from the team.  This could even happen in a patients room – for example if they have fallen it is a way of assessing the environment in real time with everyone inputting their views on what could have been done differently

Huddles are not purely for clinicians

Some organisations have created ‘meeting free zones’ from 7 till 9 and provided time for managers and leaders of particular areas to come together to talk from about 10 mins on issues that affect across the whole organisation.  This can include representation from operational services; catering, cleaning, portering, procurement and so on.

Other organisation wide huddles have included all the senior clinical leads covering a hospital at night for example where they come together at different times of the night to discuss the high risk patients who could deteriorate.

While the safety huddle is one tool in our patient safety kit, it is also much more. It connects people and helps drive the organisation-wide culture change needed to improve safety and quality across the board.

References

Dr Alison Cracknell via http://www.health.org.uk/programmes/scaling-improvement/projects/scaling-patient-safety-huddles-enhance-patient-safety-and

Dr Alison Cracknell video via https://www.youtube.com/watch?v=2JfSBwA-vm0

Western Sussex Hospitals via https://www.youtube.com/watch?v=2DUgg8yRpvc and https://www.youtube.com/watch?v=RVlQDJitTjo

Nottingham University Hospital via https://www.youtube.com/watch?v=NHSnGaqelCQ

Great Ormond Street Hospital via https://www.youtube.com/watch?v=ZzH-DSPQkyQ

Agency for Healthcare Research and Quality. About TeamSTEPPS. http://teamstepps.ahrq.gov/about-2cl_3.htm.

Institute for Healthcare Improvement. Use regular huddles and staff meetings to plan production and to optimize team communication. www.ihi.org/resources/Pages/Changes/UseRegularHuddlesandStaffMeetingstoPlanProductionandtoOptimizeTeamCommunication.aspx