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Team Huddle: The Right Way to Start Your Day

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MBar1 has 1 years experience as a RN and specializes in Med/Surg.

2 Articles; 1,232 Profile Views; 19 Posts

Do Huddle Meetings Really Improve Team Communication?

Team huddle is just one of many interventions aimed at improving communication.

Team Huddle: The Right Way to Start Your Day

Communication: A Vital Utility 

Communication can be defined simply as the sharing of information. Even more broadly, communication can be distilled down to the act of a sender producing the content of a message in any of the many forms available to us, to then transfer this information from one entity to another at varying speeds.[5] A receiver intercepts the incoming message, then proceeds to decode the content into terms that are easy to comprehend, and that reduces the chances of error.[5] In healthcare, error is evaded at all costs as the consequences can be catastrophic, and in some instances, permanent. That is why so much effort is put forth to ensure that the means of communication is operating at peak effectiveness at all levels and why simply communicating with one another is not as straightforward as it may seem. How we communicate with one another in practice is largely based on the mode by which information is transferred from one provider to the next. Even more, the logistics of the message, that is, the organization of the content, word choice, and use of clinical terms is also seen as paramount to the productiveness of communication.[4]

“Huddle” is one of the numerous communication strategies that is recommended by the Agency for Healthcare Research and Quality (AHRQ) and the Department of Defense (DoD) in response to a publication from 1999 titled, To Err is Human, which presented what seemed to be an inconceivable figure of annual mortality rates due to medical errors.[3] This figure presented an astonishing 98,000 deaths annually due to what is defined as failure to do what was intended or failure to implement the correct plan to accomplish a common goal.[3] Among the contributory factors, failure of communication, however defined, was implicated in this avoidable reality.[3]

An entire curriculum had been created in response to these issues as existing team-based training programs lack sufficient evidence in regards to their effectiveness, and were not designed to retrofit or conceive new programs based on their existing architecture.[4] At some point between 2001 & 2003, AHRQ and DoD almost decided to base their program on the Federal Aviation Administration (FAA) circular for airworthiness for commercial and private aviation. However, this was scrapped and TeamSTEPPS was created.[3] TeamSTEPPS is an acronym that reads; Team Strategies and Tools to Enhance Performance and Patient Safety. It is a curriculum aimed at practice investigators and those at the institutional level to implement, to, well, strategize the team approach and to streamline the care process, while improving upon patient safety. This U.S based program is making its way to Canada in collaboration with the Canadian Patient Safety Institute.[2]

So, whichever preconceived notions you had regarding the utility of a.m team huddle, as you can see, there is a reason for it, and more importantly, there are people who see a larger vision over the horizon- as you should too. Team huddle is just one of many interventions aimed at improving communication.[1] (See pocket guide).

What Does “Huddle” Mean? 

Team huddle is an event that typically takes place at routinely scheduled times on a daily basis and involves relevant members of the care team. It is a meeting that tends to take place early on in the day and lasts for about 10-20 minutes.[8] The goal of team huddle is to communicate pertinent information regarding patient care as well as unit and hospital operation. It is a tool used to facilitate communication between team members face to face, in an open forum, usually at or near the nurses station.[8] Similar to a town hall event, participants are there to listen and share without fear of judgment or being penalized for holding a certain opinion or thought.

Team huddle gives team members the opportunity to adapt their workflow for the day and prioritize patient and unit needs.[8] Members of the team are given the opportunity to communicate information that brings necessary parties to the forefront of an imminent problem or concern, and in turn, contribute to the formation of a timely solution. Typically those involved in huddle include front line providers, management, unit attendees, clerical staff, and any one of the many other important stakeholders involved in patient care.[8] However, this does vary on an institutional basis.

Team huddle can be seen as a preventative strategy that allows the unit to run smoothly and efficiently. Time can then be spent focusing on quality patient care, instead of putting out fires that could have been prevented. Huddle should be held at the right time, at the right place, and with the right people.[8]

Why Are Team Huddles Effective? 

Team huddles provide a forum in which open discussion can take place regarding patient care. Topics that are typically discussed include goals for the day, patients to be discharged or transferred, patient-specific care plans such as falls prevention, unit census, workload/assignments, etc.[6] Discussing patient care using prioritization hierarchies and anticipating patient needs allows front line staff to plan out their day right from the get-go. This allows the team to be efficient, flexible, and adaptive for when the high volumes, heavy workloads, and admission/discharges begin to consume the day. 

And of equal importance, huddle provides the opportunity to connect leaders with front line staff and to bring awareness to safety and quality control concerns from both ends.[7] 

“Plan to Prioritize and Prioritize with a Plan”

Huddles are most engaging when they are structured, but brief, and perceived as valuable. This fosters engagement from members of the team, and hopefully over time, becomes a staple within the units practice culture. Having everyone on the same page in such a fast-paced and high acuity environment is paramount. This can only be accomplished through effective communication and joint effort among those involved.

Going Forward … 

What may seem like a sacrifice of your time may actually be a time-saver in the long run. I guarantee that no one in healthcare has ever said “too much information is bad” or “less information is more”. I am certain that having the opportunity to mention that the confused 90yr old in room 424 (1) is known to bed exit and does not yet have a plan in place to prevent falls, will surely save you more time in the long run. Because post-fall orders, calling family, charting, speaking to the multidisciplinary team, and dealing with avoidable injury would suck more time out of your day than spending 10 minutes attending huddle. Bar none. And of course, the care we work so desperately hard to hold to the highest standard would be flagged as preventable if appropriate intervention had been taken. We certainly do not want that for our patients. Nor do we want to foster a culture in which we become complacent with being “reactive” as opposed to “proactive” towards our day to day efforts.

 

References

[1]Agency for Healthcare Research and Quality. (2014). Pocket Guide: Team Strategies and Tools to Enhance Performance and Patient Safety. Retrieved from:
https://www.ahrq.gov/teamstepps/instructor/essentials/pocketguide.html

[2]Canadian Patient Safety Institute. (2019). Use Team Strategies and Tools to Enhance Performance and Patient Safety. Retrieved from:
https://www.patientsafetyinstitute.ca/en/education/teamstepps/pages/default.aspx

[3]Institute of Medicine. (1999). To Err is Human: Building A Safer Health System. Retrieved from:
http://www.nationalacademies.org/hmd/~/media/Files/Report%20Files/1999/To-Err-is-Human/To%20Err%20is%20Human%201999%20%20report%20brief.pdf

[4]King, H. B. , Battles, J. Baker, D. P. , Alonso, A. , Salas, E. , Webster, J. , Toomey, L. , Salisbury, M. (2008). TeamSTEPPS: Team Strategies and Tools to Enhance Performance and Patient Safety. Retrieved from:
https://www.ncbi.nlm.nih.gov/books/NBK43686/#advances-king_1.s4

[5]Mosaic. Communication Theory [White Paper]. Retrieved from:
https://mosaicprojects.com.au/WhitePapers/WP1066_Communcation_Theory.pdf

[6]Stanford Health Care. Nursing: Patient Centered Care and Education. Retrieved from:
https://stanfordhealthcare.org/health-care-professionals/nursing/patient-care/team-rounds.html

[7]Sikka, R. , Kovich, K. , Sacks, L. (2014). How Every Hospital Should Start the Day. Retrieved from:
https://hbr.org/2014/12/how-every-hospital-should-start-the-day

[8]Yu, E. (2015). Daily Team Huddles: Boost Productivity and Team Morale. Retrieved from:
https://edhub.ama-assn.org/steps-forward/module/2702506

Image:
[1] BsnSCD.com & Ballard, D (uploaded user). (2015-2016). Stethoscope Images, Stethoscope Wallpapers [Virtual image]. Retrieved 2019-10-27, from http://bsnscb.com/stethoscope-wallpapers/39100985.html


MBar1 is a Registered Nurse (RN) and specializes in Med/Surg.

2 Articles; 1,232 Profile Views; 19 Posts

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hannahgb has 46 years experience and specializes in retire-numerous.

23 Posts; 100 Profile Views

I think that used to be "report" when the whole shift was there!!!

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scribblz has 13 years experience as a BSN, CNA, LPN and specializes in Med Surg, Tele, Geriatrics, home infusion.

63 Posts; 1,661 Profile Views

I find a "huddle" to be a great meeting of the minds/ team work/ brainstorming session when done right. I work 7p-7a on a 25 bed med surg unit and myself and several others rotate being "charge". When I'm charge I like to chat with each of the night nurses about their assignment around 0430. Hopefully this has given everyone enough time to read up on their people and get a feel for their needs/ plan for the day for that patient/ predict issues that may came up with them. After that comes the hardest part of my night, creating a fair assignment for the oncoming shift and designating one of them to be charge. I then "huddle" and report off with a quick run down on the floor to the charge nurse and the ANM. This saves the day nurses from all losing precious time between 7am and 8am but gives a good heads up into the day ahead.

I like the system, but it is very time consuming to be charge with a full assignment.

Curious to hear about "huddle" Dynamics and communication wins/fails on other units.

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Tweety has 28 years experience as a BSN, RN and specializes in Med-Surg, Trauma, Ortho, Neuro, Cardiac.

4 Followers; 29,019 Posts; 48,749 Profile Views

I have mixed feelings.  We are required to do huddle every shift change, when we are also required to count narcotics, and do bedside shift change report.  Shift change used to take minutes now takes considerably much longer.  Still I'm not against all these changes.

I use it to important information from the institution and who is confused and proposes a challenge that we all can help watch.  I certainly am not going to say as the article above states "the confused 90 year old doesn't have a fall precaution plan in place", that's for the text books.  I'm going to say "If you hear a bed alarm in 640, go running!"

 

Edited by Tweety

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Sour Lemon has 9 years experience.

3 Followers; 4,329 Posts; 32,784 Profile Views

I'm not sure there's a great way to say this without being offensive, but I checked out your profile and the first thing I saw was:

"I am a new graduate and have been working in med/surg for ~7 months now.

 ...I am interested in working on programs/initiatives away from the bedside to explore more of a leadership/educator role."

This is exactly the sort of person who would think "team huddles" are a good idea.

Med/surg orientation alone is usually 3-4 months. So you've been independent for a few months now, and you're ready to move on to telling the rest of us how to do our jobs more effectively.

You're not the only one, of course. And I really don't mean to attack you on a personal level, it's just frustrating that these "great ideas" always tickle down from people who are completely clueless.

A 10-20 minutes meeting, at the start of any shift, takes up valuable time and removes staff from the floor. From my personal experience, which may differ from everyone else's, the employers with the worst staffing and the heaviest workloads and the ones who want to add "huddles". They're spent reminding us of all the things we should be doing, but don't actually have time or staffing to do.

On a well staffed unit, we have time to communicate with each other without being forced into circle-time.

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MBar1 has 1 years experience as a RN and specializes in Med/Surg.

2 Articles; 19 Posts; 1,232 Profile Views

33 minutes ago, Sour Lemon said:

 

 

48 minutes ago, Sour Lemon said:

I'm not sure there's a great way to say this without being offensive, but I checked out your profile and the first thing I saw was:

"I am a new graduate and have been working in med/surg for ~7 months now.

 ...I am interested in working on programs/initiatives away from the bedside to explore more of a leadership/educator role."

This is exactly the sort of person who would think "team huddles" are a good idea.

Med/surg orientation alone is usually 3-4 months. So you've been independent for a few months now, and you're ready to move on to telling the rest of us how to do our jobs more effectively.

You're not the only one, of course. And I really don't mean to attack you on a personal level, it's just frustrating that these "great ideas" always tickle down from people who are completely clueless.

A 10-20 minutes meeting, at the start of any shift, takes up valuable time and removes staff from the floor. From my personal experience, which may differ from everyone else's, the employers with the worst staffing and the heaviest workloads and the ones who want to add "huddles". They're spent reminding us of all the things we should be doing, but don't actually have time or staffing to do.

On a well staffed unit, we have time to communicate with each other without being forced into circle-time.

Ideas are all we have. Opinions towards these ideas dictate the outcome of them (good or bad). I hope your opinions towards your day to day efforts haven't skewed away from the potential for meaningful change. I hope you haven't shot down the "great ideas" implemented by those above you (or perhaps among those on your level- those who feel that they are not limited by their experience). 

 

I am new to the profession. I am smart. I learn quickly and effectively. And I will not be discouraged by your comment. 

 

Have a good day 

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13 Followers; 4,056 Posts; 31,300 Profile Views

On 1/24/2020 at 9:14 AM, MBar1 said:

This allows the team to be efficient, flexible, and adaptive for when the high volumes, heavy workloads, and admission/discharges begin to consume the day. 

I'm with you on the general concept as long as only important information is shared and it is done so in a concise manner.

But I am going to challenge the above quote a little.

No amount of huddling will facilitate smooth handling of high volumes and heavy workloads when there is not enough help. I'm sorry, but staff supposedly needing information about what should happen is not the problem. The amount of staff on duty is the rate- and quality-limiting factor in terms of high vol/surges/heavy workloads.

Conducting huddles under the premise of helping teams learn/understand how they can prioritize appropriately, be flexible, efficient and adaptive amidst heavy workloads and high volumes is disingenuous.

Now for something more positive. Good things in huddle, conducted by staff, 5 min or less:

"Happy Birthday to so-and-so"

"[X] is on backorder. For now we are  ________. "

"We are utilizing [violence alert/safety plan/etc] in [room 1234]. Remain alert and [do x, y, z] and contact [so-and-so] pronto if any concerns"

Procedure change announcements/reinforcements; relevant new developments

Brief thank yous and comments of compliment as raised by those present (i.e. peer-to-peer).

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Emergent has 25 years experience.

8 Followers; 2 Articles; 2,930 Posts; 66,873 Profile Views

Another gimmick to try to miraculously offset poor staffing in my opinion. 

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