Implementing a daily team huddleBoost practice productivity and team morale, by communicating in real time about the day’s events

1. Three simple steps to implement and improve daily huddles

2. Case studies from practices that use this communication technique

3. 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.

“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

1. Establish the routine

2. Develop relationships and designate roles

3. 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.

Sample huddle checklist

(MS WORD, 37 KB)

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!

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.

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 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.

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.