Huddling to Improve Staff Support

Creating a space and time to communicate can bring a team together. Unit 4800 nursing leadership held one-on-one meetings with staff and were able to identify areas the staff felt important to address. In addition, the leadership reviewed our recent Gallup survey and found opportunities to improve support.

The areas of opportunity that arose included:

» Staff not feeling supported by leaders when the unit was very busy

» Staff not getting to go on lunch and breaks

» Supply issues that affected patient care and efficiencies

» Staff not feeling appreciated

The approach began with a review of the published management literature to determine what solutions might be feasible and effective for our team. The findings from the review of the literature focused on recommendations by the Agency for Healthcare Research and Quality (AHRQ) and TeamSTEPPS. We found that there was a proven quality and safety initiative recommended by both organizations, the daily huddle. After review and discussion, we decided to initiate the daily huddle.

What is a Daily Huddle?

A daily huddle is a standup meeting of 10 minutes or less, used at the start of each shift, providing the team a way to maintain a focus on patient safety. Each session is a daily review of new safety approaches or providing updates on areas of focus. The huddle provides a time to look back at the previous day’s work to review safety performance and to look ahead to patients scheduled for the day, allowing us to flag safety concerns proactively.

Some Benefits of This Approach Are:

» Engaging the team in thinking and talking about checklist use, communication behaviors, and related safety work.

» Providing a time to exchange information and updates.

» Recognizing issues in quality, communication behaviors, and related safety work that can be addressed by training, coaching, and revising tools and methods (which also allows the opportunity to identify issues that need escalation and resolution beyond the local team.)

» The huddle gives the supervisor a chance to update the team about specific safety or quality initiatives that will affect daily work.

Levels and Types of Huddles

» Daily huddles: A regular discussion of the safety performance of the unit. There is a standing written agenda for the huddle that enables a review of safety performance of the previous day and anticipate issues in the current day. Daily huddles over time can happen when the supervisor is not present. This occurs when team members see the value and have the skills to run the huddle themselves.

» Visual management: The huddle takes place in front of a visual display that provides status of current issues and data on safety performance. Unit 4800 began the process by announcing it at our staff meeting the month before the start date. We shared why we needed to establish the huddle. We also shared the format for the huddle with clarity that leadership would run the huddle the first weeks to establish the flow and model the behavior, then afterwards the charge nurse would join leadership in running the daily huddle. The poster and agenda are visible to all, which allows for reinforcement of safety measures. If needed, we will add items for followup by placing post-it notes on the poster. The agenda changes if an item is no longer an issue. For example, we removed patient educator as we now have a designated nurse. We also added ten-minute breaks within the later parts of the shift, as we realized we needed to encourage all rest periods.

Daily Huddle Layout

Time

Five minutes at 2 p.m. Day Shift; NOC started later

Duties Create an agenda of issues to be resolved

Attendees

All staff invited to attend and all providers were welcome

Points Of Discussion

Category Discussion

Quality and Safety Issues or Concerns

Patient Education Needs

Lunch Breaks

Charting, CARES, CHEMO Checks

Our initial focus was on falls and track, in addition to VTE measures, or any concerning items

Identified: “Who needs help to ensure our patients receive their needed education?”

Identify: “Who has taken their break and what is the plan for the remainder of the shift?”

Clarified: “Who needs clinical help? And, who can assist?”

Staff Recognition Shared: “What did they do to make a difference?

“Daily Huddle Component Kit.” AHRQ. Agency for Healthcare Research and Quality, June 2017. https://www.ahrq.gov/hai/ tools/ambulatory-surgery/sections/sustainability/management/huddles-comp-kit.html.