Why It Matters
A huddle is a short, stand-up meeting — 10 minutes or less — that is typically used at the start of a day or shift to help teams anticipate and actively manage quality and safety issues. Kathy D. Duncan, RN, is faculty for IHI's Leading Quality Improvement: Essentials for Managers and often coaches teams on how to use huddles most effectively. She recently shared her tips for successfully testing and implementing huddles in a variety of settings.
Why are safety huddles important?
Daily huddles can help your team get together as caregivers to understand your main priorities for the day. Huddles can be a great way to start a day, shift, or process by helping your team think critically about how to anticipate potential problems or ways to improve care.
For example, I had the opportunity to visit a hospital whose indwelling catheter days went down by half within a couple of weeks by using daily huddles. They tested using safety huddles by asking a couple of questions: How many people are on indwelling catheters? Can they be removed?
By naming the patients and their room numbers, team members planted the seed in the back of their minds so that, as the day went on, they were saying, “Who doesn’t need their catheter anymore? When can I remove it? Their doctor is here — let me go ask him.” They used safety huddles as an opportunity to say, “We need to understand the patients who are here and what they need.”
What is the daily huddles tool?
The daily huddles tool offers guidelines on how to make sure your huddles stay on track and on schedule. It offers ideas about some tests you could run. For example, you could test using a huddle one day with a single colleague. You could test it with one segment of your patient population.
If you segment your population to test huddles, the tool helps you test how and when to do them. It encourages to you think about who needs to be part of the huddles — which patients do we need to discuss, and which staff members need to be part of the discussion? The tool asks questions you should answer: How many people are too many for a huddle? Have we have invited the right people for the people we’re serving?
Many people might be familiar with using huddles in inpatient settings. How might huddles be used in other settings?
People are beginning to use them in a lot of different settings because of the value of huddles
For example, my mother is in a skilled facility. The staff don’t call what they do a safety huddle, but that’s what it is. They do a briefing in the morning on the Tuesdays the physician rounds. The staff on the unit spend about 45 minutes talking through the needs of each of the patients. They prioritize what the doctor needs to know and how they’re going say it to him in a standard, succinct manner.
Physician office practices may use a daily huddle before they see their first patient. If, say, they open their office at 8:00, they may have a brief huddle to say things like, “We’ve got a larger than normal volume of patients today” or “We’ve got three patients who just got discharged from the hospital.” It could be a day when they need to stagger lunchtimes. The idea is to discuss logistics about what they can anticipate as they go through their day.
For example, a physician who works in a family practice recently told me that one of their biggest challenges was not always knowing which staff was in the office. This led to not being clear on roles and responsibilities. She talked about hearing physicians calling out, “Am I covering for this doctor? Which nurse am I working with today?” She described having a near miss when she didn’t realize she was responsible for covering for another physician’s lab work and she missed a critical lab value until 4:15 that afternoon.
After talking about this, we came up with the idea of putting a daily huddle together. This only needs to be three to five minutes. “Who’s here today? Who’s covering which rooms? What are the big things we’re expecting today?”
What tips do you have for testing daily huddles?
Testing daily huddles would be like testing anything else. Start with somebody who’s willing. I would try it with maybe two people. They could be the practice manager and the receptionist. It could be the charge nurse and a respiratory therapist.
You could focus on a goal your unit is working on. If you’re focusing on mobility, start with the patients who need to ambulate today. Try to segment a small group on maybe one day. Then, at the end of the day, check in with your colleagues and say, “How did that go? Did we learn anything? How did the patients do? Did having a huddle help the team?” Ask five people, “Was that helpful? How long did it take?” Then try again tomorrow.
You may find that maybe the respiratory therapist — although she’s willing — may not be the right person for your test. If your unit has a lot of ambulatory issues, you could ask a physical therapist, “Would you be willing to come to a safety huddle on your patients? We’re focusing on trying to get the patients up today.”
What are some common problems teams run into with huddles and some tips for preventing them?
The main problem is the assumption that huddles are just extra work. “We don’t have time for that.” Everyone is so busy with their list of things they need to do. You might need to help people think of huddles differently. “This five minutes could keep me from hurting a patient.” “This 10 minutes could save me an hour and a half at the end of the day.”
It’s hard to sort of get over that hump, but you can build will if you start with one person and then keep track of the near misses or saves. “We took four people off narcotics today.” “We helped six people sit up or walk today.” That kind of information is encouraging to the staff —even those who aren’t testing — so everyone can understand that huddles have value.
Another challenge can be keeping it brief. Some people might be tempted to say a little more than is necessary, but a huddle is mean to be short and sweet. You can set a 10-minute alarm on your phone and hold it up to make it clear that you mean to be respectful of everyone’s time. The people who are touching those patients are the most valuable people there, so they need to know that they’ll be in the huddle for 10 minutes and then they’ll be back to work. They need to trust that, or they won’t want to participate.
Sharing the results of even small tests can help convince people that huddles are worth their time. “We’ve done this for two weeks and it’s never gone over 10 minutes.” “We tried it at 7:00 and that time was too busy, so we bumped it up to 8:30 and that was better.”
When huddles don’t catch on, it’s often because participants questioned the value or the structure of the huddles. I’ve heard people say, “We did this for months, but then people started dwindling away.” If that happens, you need to review: “What questions were we asking? Were the right people part of the huddle? Were there too many people there? Did it take too long?” If a huddle isn’t valuable to everybody standing in that circle, they will find better things to do.
You may also be interested in:
How to Conduct Safety Huddles That Stick
Editor’s note: This interview has been edited for length and clarity.