In just minutes a day, safety huddles promote transparency, teamwork and real-time review. But most of all, they help teams provide safe care.
By Christina Hall, M.H.A.; Barbara Hicks, B.S.N., R.N.; Celeste Chamberlain, Ph.D., CPHQ
In just a few minutes a day, children's hospitals can increase safety awareness among front-line staff members, help teams develop action plans to address identified safety issues, and foster a culture of safety. Sound too good to be true? To help break down silos in health care, safety huddles can foster the sharing of information about potential or existing safety problems facing patients or staff members. While the idea of huddles isn't new, sticking with them over the long term can be a struggle. But it's that long-term investment that yields the most positive results and can most greatly impact patient safety.
St. Christopher's Hospital for Children (SCHC) in Philadelphia took on the challenge of implementing a daily huddle routine. While attending a corporate meeting in 2013, SCHC's leadership learned about the importance of safety huddles. For more than a year, the hospital's chief nursing officer conducted morning huddles with nursing supervisors and managers to discuss nursing-sensitive indicators. After learning about the benefits of an organization-wide huddle, the leadership team decided to transform the nursing huddle into the safety huddle.
Prior to implementing the safety huddle model, departments worked in silos with minimal sharing of safety events or concerns. Leaders decided to institute the revised huddle format because they saw the benefit of pooling ideas, resources and people to solve actual problems in real time and prevent potential problems from cropping up. A review of the literature around safety huddles demonstrated that a daily patient safety huddle would further enhance the hospital's goal of becoming a high-reliability organization (HRO).
The BMJ Quality & Safety noted in a 2013 article that patient safety huddles improve outcomes by increasing the quality of information teams share with each other because a greater degree of accountability is required of huddle participants. Staff members in direct patient care roles report feeling more empowered to bring forth concerns and propose solutions to issues.
According to Health Care Management Review, safety huddles are an effective step in the journey to becoming a HRO, and one of the biggest ways huddles promote safety is by fostering communication among team members through structured and unstructured conversations. The safety huddle model also promotes early recognition and communication of safety concerns, organizational learning, harm mitigation and enhances working relations and increases trust across departments.
How safety huddles work
SCHC implemented the safety huddle model in October 2013. Unlike many organizations, the multidisciplinary SCHC safety huddle takes place face-to-face Monday through Friday from 8:15 to 8:30 a.m. All departments and clinical disciplines attend, which can include 50 to 75 people. The CEO or the CNO leads the huddle utilizing a standardized template to address safety themes, including:
- Hospital and emergency department bed capacity and staffing
- Rapid response and code blue activation
- Serious safety events
- Team member safety events
- Good catches
- Physician concerns, staff concerns and staff recognitions
- Patients and families requiring special attention
Including the C-suite and other leaders is key to a successful huddle. Including the people with the authority and resources to overcome institutional or financial barriers to resolve issues employees bring forward in the huddle is also critical to success.
Issues team members raise during the safety huddle are prioritized for follow-up within 24 or 72 hours. Events on the 24-hour list include direct-impact patient safety events and those issues that appear to have a relatively easy solution. Examples include items such as bed delays, physician ordering delays, broken doors, temperature issues, lack of handoff, medication dispensing errors, iPhone updates, and electronic medical record (EMR) system issues.
Those issues designated for 72-hour follow-up are more complex and include items such as: visitor restriction issues, code cart delays and broken equipment. These issues may require more thorough review by the interdisciplinary team or an improvement in how hospitals systems are managed.
This format, while it involves leadership, does not rely on leaders to find all the solutions. Instead, it empowers front-line staff members to implement solutions. Individuals take ownership of the events team members report on at the huddle, and they are expected to report back within the time frame assigned. Teams meet immediately following the huddle to develop strategies related to issues the group identified.
If a workgroup is already addressing the issue, it's referred to that specific group. If not, employees form a new workgroup. These immediate post-huddle meetings are a key benefit of SCHC's safety huddle strategy—promoting time-sensitive events discussion, improvement and report back within a designated time frame.
All events are categorized, trended over time and reported at the weekly quality, innovation and patient safety meeting. There are also some events that the group can't resolve in 24 or 72 hours. This includes things like a patient's weight appearing in the chart from a previous admission and the system not allowing the end user to change it. Such events require more extensive work. In this situation, the informatics team worked directly with the EMR system to resolve the error. Leadership realizes there will be issues that require continued attention, and teams can't resolve them in 72 hours. This has led to creation of a "Level III" or "Greater than 72 hours" list.
Tracking safety improvement
Since implementing safety huddles, teams increased their reporting of near-miss events each quarter since the end of 2013. That quarter, 148 out of 447 events reported did not reach the patient. By the end of 2014, 364 out of 659 events reported did not reach the patient. This is an improvement from 33 percent to 55 in one year.
Another improvement is evident in the hospital's Agency for Health Research and Quality (AHRQ) Patient Safety Culture Survey scores on questions that address patient safety. For example, in one year, there was an 8 percent increase to the statement: We are informed about errors that happen in this unit.
Achieving safety goals
The safety huddle has provided an important step toward helping the hospital achieve its safety goals. To promote a more focused and standardized methodology for addressing safety issues, the hospital restructured its medical staff quality improvement committee and patient safety committee. A new model that has integrated the patient safety, quality improvement and infection prevention departments promotes a stronger, more effective and efficient process for addressing patient safety culture improvement. The safety huddle model has been recognized as best practice in the corporate health system.
The hospital created a video of the huddle to promote transparency and educate other members of the health care system. This represents a shared mental model aimed at reducing patient harm, providing situational awareness of at-risk events or circumstances, increasing transparency, and promoting multidisciplinary team collaboration for real-time review.
Christina Hall and Barbara Hicks are quality improvement coordinators; and Celeste Chamberlain is former director for Quality Improvement at St. Christopher's Hospital for Children in Philadelphia. Send questions or comments to firstname.lastname@example.org.