The importance of huddles

With football season in its full glory, many of us may watch more than 100 huddles every weekend. The modern-era football huddle’s origin was traced back to Paul Hubbard, a quarterback for Gallaudet University, a school for the blind and deaf. To keep his team’s plays secret, Hubbard gathered his team off the line of scrimmage. Although secrecy was the stated reason, I would like to think enhanced communication amongst interested parties may have improved outcomes. Huddles became so important in football that just this year, Patrick Mahomes, Kansas City Chiefs’ Super Bowl–winning quarterback, honored Len Dawson, the recently deceased all-time great quarterback for the Chiefs, by recreating Dawson’s trademark “choir huddle.” Dawson, who is featured in the Pro Football Hall of Fame, is best known for his enhancement of an established communication tool.

Although communication is important in football, it is critical in the enhancement of patient safety. The safety huddle, defined by the Institute for Healthcare Improvement, is a short meeting involving interdisciplinary health care team members (no more than 10-15 minutes in duration) that proactively enables teams to focus on patient safety, thereby facilitating communication.¹ The safety huddle is a key element of highly reliable health care systems. As anyone who regularly attends safety huddles can tell you, there is always a tendency for operational issues, more related to efficiency than safety, to creep into the safety huddle. Why wouldn’t all aspects of an operation be improved by enhanced team communication? Because of this, operational efficiency can be enhanced by a formal daily check-in.

Goals of a huddle

When effectively used in the outpatient setting, huddles help to define
the following²:

• Provider and staffing availability
• Machine or lab availability
• Patients or procedures that might require extra time outside the standard appointment template
• Anticipated scheduling challenges
• Optimization of resources, both human and technology

Value of a huddle

There are multiple ways to run a huddle. But to have buy-in from your teams to initiate the process, articulating anticipated value from the process will create the appropriate momentum. Oleg Tumarkin, director of Global Performance Improvement Inc, published a piece titled “The Effective Huddle,” estimating a 25% to 40% boost in productivity with the use of an effective huddle.³ Although the number seems optimistic, the theoretical advantages of an effective huddle should yield significant gains in every aspect of safety and operational efficiency. Tumarkin cites 3 ways a huddle can be impactful:

1. Performance: Individuals are forced to be thoughtful, plan ahead, analyze completed work, and share with team members. Huddles reduce workflow interruptions and are a foundation to the process of continuous
quality improvement.

2. Support for a learning environment: All organizations aspire to be considered a learning organization. In huddles, everyone learns from others’ experiences and learns to assess their own work—hopefully in a
safe environment.

3. Transparency: This is a characteristic often associated with effective teams and organizations. Huddles build trust through systematic interactions on a frequent basis. This trust allows an honest and effective evaluation
of performance.

There are 2 more intangible benefits to the daily huddle. The first is the ability to identify leaders, especially those who are introverted. Unlike standard meetings where some may participate out of proportion to the value of their contribution, the huddle, by nature of its structured process, allows all to participate equally. This not only allows but also mandates that all members share their ideas and performance outcomes. It also allows identification of those individuals, with the ability to address and solve problems in a timely manner. The second is using the brief amount of time to inspire your team. Although this may seem like a soft activity, it can be unifying. Again, let’s go back to the football paradigm. Most football huddles end with a clap of the hands or a single word, such as “team.” End your huddle with a few words of inspiration or gratitude.

How to run a huddle

As we move through a suggested template, keep in mind 2 things:

1. Skeptics might say we do this every day in an informal manner, but the truth is that anything less than a formal huddle will lead to missed issues, which could impact your operations;

2. There is no single best practice that will serve each setting equally.

Having observed huddles in both the inpatient and outpatient arenas across several sites in a single health care system, I would estimate approximately 90% of huddle content is identical with the remaining content tailored to the need of the individual site. As a matter of fact, one of the principles in the development of a huddle is to not be afraid to experiment in content, structure, and personnel.

1. Get physician/executive leadership buy-in. The team will not take the process seriously if they feel it is not worthy of the leader’s time.

2. Schedule the huddle for the same time every day. The huddle will not be credible or effective as an operational tool if it is often canceled, missed,
or ignored.

3. Do not let the huddle interfere with the work that needs to be done. Keep it short. In the present environment, everyone is likely busy. If the huddle takes 40 minutes and only decreases work by 20 minutes, it will fail. People must quickly recognize that the huddle makes their life easier.

4. Establish a leader. This does not always have to be the senior person in the room. Maybe a medical assistant or an ultrasound technician leads the huddle. Just make sure the huddle leader knows their role prior to the start of the huddle.

5. Leave time for emerging issues and ad hoc reports. Maybe you only need a weekly report on productivity or efficiency metrics.

6. Regularly reevaluate the huddle’s effectiveness. Again, this does not need to be the executive team, but representatives from all disciplines in your office. The frequency of evaluation should decrease as you discover what works for your office.

The huddle can be an efficient way to communicate across your entire office or department. This communication will create both a safer and more efficient environment.

References

1. Shaikh U. Improving patient safety and team communication through daily huddles. Institute for Healthcare Improvement. January 29, 2020. Accessed November 8, 2022. https://psnet.ahrq.gov/primer/improving-patient-safety-and-team-communication-through-daily-huddles

2. Stewart EE, Johnson BC. Improve office efficiency in mere minutes. Fam Pract Manag. 2007;14(6):27-29.

3. The effective huddle. Global Performance Improvement Inc. 2022. Accessed November 8, 2022. https://gpicorporation.com/en/knowledge/huddle/