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Three simple steps to implement and improve daily huddles
Case studies from practices that use this communication technique
Downloadable resources for easy implementation
A practice team caring for complex patients must communicate and coordinate efforts among its members on a regular basis. Implementation of brief, in-person, scheduled meetings once or twice a day with relevant team members helps to ensure an efficient clinic day with fewer surprises. Huddles provide an opportunity to anticipate patient needs and prepare for changes in staffing and logistics so the day runs more smoothly. Over time, they can serve as a platform for additional practice improvement and role expansion. Robust, routine huddles contribute to an interdependent team culture, improved relationships and the delivery of safe and reliable patient care.
Why should we huddle?
Huddles can be implemented quickly by any practice and are an effective way to:
Align the team at the start of a clinic session
Build team culture and improve communication for a more engaged workforce
Prospectively plan for patients who require extra time and assistance
Prepare for staff, provider or equipment changes
“When the team comes together to plan care on a regular basis, we become more high-functioning and efficient and accomplish so much more with our patients.”
Karen A. Funk, MD, MPPVice-President Clinical Services, Clinica Family Health Services
“When the team comes together to plan care on a regular basis, we become more high-functioning and efficient and accomplish so much more with our patients.”
Karen A. Funk, MD, MPP
Vice-President Clinical Services, Clinica Family Health Services
Establish the routine
Develop relationships and designate roles
Evolve and improve over time
There are many ways to have effective huddles, but a consistent presence from key players is essential to making them rewarding and useful.
Consider the purpose of the huddle in your practice and how it could be most useful for your team. This can be as simple as the provider and medical assistant (MA)/clinical support dyad discussing point-of-care needs for incoming patients that day.
Some practices find that including team members such as case managers, social workers, behaviorists, nursing supervisors and front-desk staff can offer valuable input to clinic flow and patient needs. These practices include the entire practice for a few minutes of daily announcements before breaking into smaller teams, or teamlets. Quiz Ref IDIdeally, all team members who are involved with the practice unit should be invited and included.
Quiz Ref IDHuddles should:
Last about five to 15 minutes, maximum. Many clinics meet just once in the morning
Start at a consistent time that integrates smoothly into the practice’s workflow, such before morning clinic hours or before the afternoon clinic session
Initial experimentation with times may be necessary. It is okay if your team finds that the scheduled time does not actually work well for the team. Remember to be flexible as you find the perfect time. Even while you are figuring out the best time to meet, always start and end the huddle on time to ensure consistency and to evaluate whether the time frame works for your team.
The ideal location for a huddle is a convenient spot where everyone can fit comfortably and talk freely about patients. If patients have not yet entered the clinic’s working area, a nurses’ station or work room may work. Some practices will project the day’s schedule on a screen or wall so the team can review patients and available openings. The person who is leading the discussion should have access to a computer to walk the team through important patient issues that they can expect to encounter during the clinic session. It is okay for people to be standing during a huddle; in fact, this can help maintain focus and encourage efficiency during the meeting.
What are some ways to include team members who are shared across teams or teamlets?
Resources shared across teams or teamlets, such as case managers, pharmacists and behavioralists, can rotate among huddling teamlets to quickly touch base on issues for patients that day.
How can we make time for this new process?
The beauty of huddles is that they are short yet effective. A strong commitment to starting and ending on time will help make them a success. Many practices find that the time investment is more than made up for by improved clinic operations. However, it is important to establish a consistent time that integrates well into the clinic workflow. The team may struggle if huddles are considered to be an added obligation that falls outside of work hours or occurs while patients are waiting.
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Distinguishing roles in the huddles helps to ensure that they will run smoothly. Physicians and practice leaders can serve as role models and reinforce the right attitude: focused, timely and present.
This can be a rotating or permanent role. Practices have found success designating a nurse or MA to champion huddles. This provides continuity and can be a great tool for building a strong culture of teamwork among the team or teamlet members. Conversely, if there are multiple MAs or nurses who are involved on the team, rotating leaders may help make everyone feel more involved. As a result, the entire team is more likely to take ownership of providing the best care to patients throughout the day. It leads to an “all-hands” culture where patients truly are cared for by a whole team of people.
The leader role can evolve over time. Leaders should ensure that the gathering starts and ends on time and should give other team members the opportunity to speak up when necessary. For example, a patient with a history of depression may have an appointment scheduled that day. If the behavioral health specialist is at the morning huddle, she may want to give a brief update or indicate that she plans to be available during the patient’s appointment. Quiz Ref IDHuddle leaders should keep huddles short and focused, perhaps by putting bigger issues in a “parking lot” until they can be discussed at a different forum or meeting.
As the practice begins implementation, a checklist or template may be especially useful. Huddles can become more organic over time but may benefit from a set structure, at least during the first few meetings. The leader can use the template to keep the conversation concise and focused. Five to 15 minutes pass quickly when you have a day’s worth of patients to discuss!
How should we create our huddle checklist?
The checklist should include the items that the practice aims to discuss. Several practices have created helpful huddle checklists. The VA uses this checklist. The checklist that we have included in this document is a hybrid version of several checklists that have been found useful in different practices. Remember that your huddles, which will meet the needs of your practice and patients, will likely develop over time. Your checklist should evolve to meet these changing needs.
Identify and define additional roles. Consider what each person will prepare for the huddle based on team member roles and the agenda. Preparation is essential to making huddles useful as well as in engaging team members. Here are some useful roles for different members of the team:
The nurse manager or administrator can review staffing needs and absences for the day and reallocate accordingly
Physicians, nurses and MAs can review their schedules for complex patients and flag any advance preparation required, including:
Allocating more time
Behavioral health, pharmacy or case-management referrals
Diabetes or other health education
Updates about recent patient events, such as a hospitalizations, emergency room visits, consults or surgery
Schedulers can note available clinic capacity that day and make the team aware of any same-day openings and urgent or cancelled visits
MAs can flag preventive and chronic care needs
Communicating these items to the team ensures that everyone is aware and works collaboratively to meet each patient’s needs. Anticipating a call to an interpreter or coordinating a visit from behavioral health will ensure that the team is providing the best possible care to its patients. Anticipating procedure setups, such as a Pap smear or suture removal, reduces the number of trips out of the room during a visit, decreasing interruptions and increasing practice efficiency.
How can the information exchanged in a huddle benefit the team?
Team members may use this information to prioritize and allocate their work based on patient and team needs throughout the day. For example, an MA may offer to assist with phone calls or cover another provider on a day that his physician is not seeing as many patients. With everyone anticipating and planning together, the team becomes more flexible and adaptive during times when the practice is handling high patient volume and acuity.
Practices include a quick check-in at the beginning of the huddle to center the team and get everyone on the same page. A shout-out to a teammate (“Lori jumped in to pick up phones yesterday when we were really backed up.”) or a story about great care that was provided to a patient (“Mrs. Price’s cancer screening came back positive; it’s a good thing that Evan placed the order while she was being roomed, so we were able to catch it early.”) reminds everyone on the team how valuable they are. It is also a great opportunity to start the day on a positive note.
To remain on schedule, limit how many stories can be shared, or draw a single shout-out or patient compliment from a submission box. Huddles can end with a unifying team cheer or the team’s statement of purpose. Then the team begins their busy day on the same page about what their priorities will be for the upcoming clinic session.
How is a huddle different from a team meeting?
Huddles are brief, daily discussions that focus on the action plan of the day, rather than solving underlying process problems or broader workflow issues. Opportunities for improvement that the team identifies in a huddle can be saved for more in-depth discussion in longer team meetings. Huddles that exceed the allotted time due to extended discussions may benefit from a designated facilitator and indicate the need for additional forums for team members to communicate about these larger issues.
The team will remain enthusiastic about huddles if they continue to provide value. Focus on improving them so that they provide clear benefits to the team and patients. Practice leaders can round on team members and ask, “How can huddles be more useful for you and our patients?” Particularly when implementing in the practice, make huddles a standing agenda item at team meetings. As huddles evolve, the checklist can be adjusted.
Team members may benefit from having an impartial person review the checklist and provide feedback on aspects such as communication, teamwork and facilitation skills. Coaches can also assess time management in the huddle. Coaches are usually not involved in that day’s clinical operations and can be either internally-trained champions or external experts, hired for a discrete period of time. A good coach should be able to provide positive, constructive feedback to all members of the team.
When huddles are brief and high-yield for all involved, participants are more likely to engage. Explore barriers to participation, perceived or real, and always consider ways to make them more valuable. Quiz Ref IDUse different tactics to encourage huddles as they become part of the practice’s culture:
Teamlet competitions (e.g., publicizing which teamlets huddled the most)Incentives (e.g., lunch, snacks or notes of appreciation for pods that huddle >90 percent of the time)Positive reinforcement or coaching during individual performance discussionsVisual indicators of huddle success, such as:
Green sticker: team successfully huddledYellow sticker: incomplete or missing peopleRed sticker: did not occur
Teamlet competitions (e.g., publicizing which teamlets huddled the most)
Incentives (e.g., lunch, snacks or notes of appreciation for pods that huddle >90 percent of the time)
Positive reinforcement or coaching during individual performance discussions
Visual indicators of huddle success, such as:
Green sticker: team successfully huddled
Yellow sticker: incomplete or missing people
Red sticker: did not occur
Involvement in huddles also strengthens engagement. If the participants are not engaged, try rotating the role of leader so everyone can more actively participate.
Finally, show the results of huddles. Are patients being seen more efficiently? Is the team better prepared for more complex patients? Is the team better able to address patient health concerns because they collectively and proactively anticipate patient needs? Maybe more behavioral health visits are being made or more follow-up care is being coordinated or performed while the patient is at the office for their visit. Sharing positive results will help the team see the value of the huddles, and team members will become more engaged when they see the difference that it is making for their patients and in the team’s level of cohesion.
Leader engagement is important as well. Successful huddles need time, space and constructive feedback to become truly effective. Clinic leaders can model being on-time, engaged and prepared. They can also work with huddle leaders to help develop their new skill set.
Because huddles are the team’s daily opportunity to communicate about patients and formulate the plan for the day, they can be used to circulate other important information. If the team is focusing on decreasing patient wait time or increasing referrals to the diabetes educator, the huddle can be used to remind the team and reinforce these initiatives at the beginning of the day. Announcements, such as a scheduled downtime in the electronic health record (EHR) system, can also be made during this dedicated time.
As you would in a scheduled meeting, assign brief time limits to specific checklist items, and stick to them to keep the huddle on time and efficient. If the leader has a hard time getting through the checklist and watching the time, have another member of the team watch the time and keep the team on track and on time. A leader or coach could also observe and help the team develop efficiency to get through the necessary items in a timely manner.
“Save time during the day, improve office culture and provide better care by having a daily team huddle #STEPSforward”
Quiz Ref IDThe huddle can provide a forum where the team can connect with each other before a clinic session. Huddles give the team the opportunity to provide the best care possible to their patients through proactively and efficiently working together throughout the day. This module can help your team get started with this simple but impactful practice.
teamletsteamlets: a small portion of the larger team, usually consisting of a provider and MA dyad.
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Target Audience: This activity is designed to meet the educational needs of practicing physicians.
Statement of Competency: This activity is designed to address the following ABMS/ACGME competencies: practice-based learning and improvement, interpersonal and communications skills, professionalism, systems-based practice and also address interdisciplinary teamwork and quality improvement.
Alejandro Aparicio, MD, Director, Medical Education Programs, AMA
Rita LePard, CME Program Committee, AMA
Ellie Rajcevich, MPA, Practice Development Advisor, Professional Satisfaction and Practice Sustainability, AMA
Sam Reynolds, MBA, Director, Professional Satisfaction and Practice Sustainability, AMA
Christine Sinsky, MD, Vice President, Professional Satisfaction, American Medical Association and Internist, Medical Associates Clinic and Health Plans, Dubuque, IA
Krystal White, MBA, Program Administrator, Professional Satisfaction and Practice Sustainability, AMA
Eunice Yu, MD, Internal Medicine, Fellow in Primary Care Innovation and Leadership, Iora Health
Carole Warde, MD, Director, Center of Excellence in Primary Care Education, Greater Los Angeles VA Health System; Stephanie Nothelle, MD, Geriatrics Fellow, Johns Hopkins Hospital; Ellie Rajcevich, MPA, Practice Development Advisor, Professional Satisfaction and Practice Sustainability, AMA; Sam Reynolds, MBA, Director, Professional Satisfaction and Practice Sustainability, AMA; Christine Sinsky, MD, Vice President, Professional Satisfaction, American Medical Association and Internist, Medical Associates Clinic and Health Plans, Dubuque, IA
About the Professional Satisfaction, Practice Sustainability Group: The AMA Professional Satisfaction and Practice Sustainability group has been tasked with developing and promoting innovative strategies that create sustainable practices. Leveraging findings from the 2013 AMA/RAND Health study, “Factors affecting physician professional satisfaction and their implications for patient care, health systems and health policy,” and other research sources, the group developed a series of practice transformation strategies. Each has the potential to reduce or eliminate inefficiency in broader office-based physician practices and improve health outcomes, increase operational productivity and reduce health care costs.
Disclosure Statement: The content of this activity does not relate to any product of a commercial interest as defined by the ACCME; therefore, neither the planners nor the faculty have relevant financial relationships to disclose.
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