San Francisco clinic’s daily huddles make efficiency a team sport
Huddle sessions didn’t take off quickly at Maxine Hall Health Center, a public health primary care clinic in San Francisco. The early gatherings were chaotic, but practice leaders regrouped and revitalized the effort. They worked to identify the best huddle format and the ideal time for the staff to meet. The payoff: improved teamwork, better preparation and a greater ability to coordinate care for patients.
It took a little more than a year, but daily team huddles did become part of the routine and made a positive impact. Now there is a sense that “if you missed huddle, you missed important information for your day,” said Catherine James, MD, the clinic’s medical director.
The daily team huddle is a strategy highlighted in a module that is part of the AMA’s STEPS Forward™ collection. The huddle brings together the staff—from physicians to those scheduling appointments—for a brief meeting once or twice daily to talk about, among other things, items that will make the clinic run more smoothly that day.
At Maxine Hall Health Center, they established a routine that worked best for the staff. They started huddles at 8 a.m. in a central team room where clinicians and other members of the care team are located. Everyone was encouraged to attend, including behavioral health clinicians, nutritionists, pharmacists, specialists, scribes, front-desk staff, nurses and volunteers. After the huddle, smaller teams—known as “teamlets”—met for two or three minutes to coordinate their patient schedules for the day.
Leaders set the example
To help ensure that the team members showed up on time and were ready to huddle regularly, the clinic leadership modeled the behavior needed to make the team huddle a successful and necessary part of the day. That included making it to the meeting, and making it on time.
The leaders also used enthusiastic, positive reinforcement when people demonstrated good huddling behavior. The recognition was done publicly, as well as privately in performance reviews. Also, an invested leader—the charge nurse—was designated to call the huddle each day so everyone arrived on time.
As part of the effort to make the five-minute huddles less chaotic, huddle leaders went in with a checklist of items to cover. They started with staffing and logistical information pertinent to the day and had quick reminders about ongoing quality-improvement work, such as a depression-screening initiative.
Available appointment capacity for the day was discussed, as well as each clinician’s next available appointment. That discussion helped improve patient-care coordination. For example, Dr. James may have a patient who needs hypertension follow-up in six weeks, but she knows her next appointment availability is seven weeks away. The team huddle makes her aware that one of the pharmacists has an appointment opening in three weeks and now Dr. James knows her patient can schedule an interim follow-up appointment with that clinician. The huddle ends with general announcements and shout-outs.
Four years after the push to improve team huddles, the San Francisco clinic saw the meetings become more organic, no longer needing a set checklist. People attend because they know it will improve their day, as well as their patients’ experiences.
Key to keeping a team enthusiastic and engaged in the huddles is ensuring they evolve and improve and making sure they continue to provide value. Checklists can be adjusted and practice leaders can ask team members for feedback on how to make huddles more useful for the care team and patients. The module offers a number of ways for practices to continue to increase team engagement, such as:
- Teamlet competitions; for example, publicizing which teamlets huddled the most.
- Incentives; for example, lunch, snacks or notes of appreciation for pods that huddle more than 90 percent of the time.
- Positive reinforcement or coaching during individual performance discussions.
- Visual indicators of huddle success, such as a green sticker for teams that successfully huddled; yellow stickers for huddles that were incomplete or missing people; red stickers for teams that didn’t huddle.
The STEPS Forward module offers more detailed information to help practices learn about implementing a daily team huddle. The module takes physicians through three steps to communicate in real time about the day’s events, which will help boost practice productivity and team morale.
The module may be completed for continuing medical education credit. There are seven new modules now available from the AMA’s STEPS Forward collection, bringing the total number of practice improvement strategies to 43; several thanks to a grant from, and collaboration with, the Transforming Clinical Practices Initiative.