Daily Team HuddlesBoost Productivity and Teamwork

Learning Objectives

1. Identify strategies to incorporate daily huddles into practice workflows

2. Devise a daily huddle structure and cadence that suits your practice

3. Measure the success of the daily huddle and revise your approach accordingly

A brief daily team huddle between physicians and other team members is a highly effective method to improve productivity and communication within your practice.

A huddle is a tool to quickly communicate about patients and the flow of that day's clinic session. Daily huddles last 15 minutes or less and focus on the day's action plan and any necessary adjustments to the day's workflow. The goals of a huddle are to increase practice efficiency and effectiveness and enhance teamwork by anticipating patient and team member needs for the day (Figure 1).^1,2 Huddles work because they elicit a pattern of practice-level thinking that may not always be intuitive at an individual level. This type of daily adaptation benefits the entire practice because everyone begins to think as a team, proactively instead of reactively.³

For smaller practices (3 or fewer physicians), team huddles might involve all physicians and nonphysician team members in 1 room. For larger practices, team huddles may actually be “teamlet” huddles, involving 1 physician and the team members they work most closely with (eg, their nurse and medical assistant for the day).

Daily team huddles are distinct from the daily morning huddles that practice managers may have with the nonphysician team members to discuss staffing and other logistics. The focus of this toolkit is physician-centered huddles.

1. Set Logistics and Expectations

2. Develop Relationships and Improve Team Morale

3. Assess and Improve

To achieve an effective team huddle, involve the right team members, set an agenda, determine a convenient location, and schedule a time that works well for everyone.

WHO

Quiz Ref IDIdeally, team huddles should include all team members who are part of daily practice operations:

• Physicians

• Advanced practice practitioners

• Nurses and nurse managers

• Medical assistants

• Case managers and care coordinators

• Social workers

• Behavioral health specialists

• Pharmacists

• Patient liaisons and front desk/scheduling personnel

Including all team members adds more focus on patient needs and clinic flow discussions.

Distinguishing roles in the team huddle helps to provide clarity and facilitates a more productive clinical session. When defining roles, consider topics that each team member will prepare, based on care team roles and the goals of the clinic session. Everyone should be aware of their individual responsibilities and be prepared to collaborate with other team members to meet each patient's needs.

Quiz Ref IDIt is crucial to identify a huddle leader. A huddle leader provides continuity and including one in a huddle can be an excellent method for building a strong team culture. The primary responsibility of the huddle leader is to focus every huddle on the day's work and ensure that all team members have the opportunity to voice opinions and concerns in an open and supportive setting. Rotating the role of the huddle leader to different team members helps make everyone feel more involved. When bigger issues arise in discussion, the huddle leader can direct the conversation by putting those topics in a “parking lot” to discuss at a future team meeting.

WHAT

Huddles can become more organic over time, but initially, they may benefit from a set structure. A team huddle leader can use a checklist or template to keep the conversation concise and focused. The time will quickly pass when you have a day's worth of patients to discuss. Incorporating a pre-visit checklist can also support organization and efficiency for the huddle.

Things to cover during the team huddle include:

• Clinic capacity for the day (number of overbooked slots or busy times, same-day openings still available, canceled appointments, etc.)

• Staffing levels and staff absences for the day

• Patient needs for the day, such as referrals for behavioral health, pharmacy consults, diabetes education, case management, interpreter services, outside records, or procedure setups

WHERE

The location of the huddle should be convenient and easy to access, where everyone has the freedom to discuss topics confidentially. For example, a nurses' station may work if patients have not yet entered the clinic's working area. Practices find it beneficial to use space that allows the team to review the day's schedule and patient appointments together. It is okay for people to be standing during a huddle; in fact, this may help team members maintain focus. Huddles work better in person than virtually; therefore, in-person attendance should be encouraged.

WHEN

Quiz Ref IDA team huddle should last between 5 to 10 minutes and occur at times convenient for all team members to attend. It is beneficial to start and end on time to ensure consistency and focus on essential information only. Many practices find that meeting before morning clinic hours or before the afternoon clinic session allows for the best attendance. You may want to experiment with times to find what works for the team.

Set expectations by emphasizing the importance of daily and timely attendance. Physicians and practice leaders can set a positive example and serve as role models to the rest of the team. Clinic leadership should model behaviors like consistent attendance, arriving on time, and focusing their attention on the discussion.

You will notice more natural teamwork and team cohesion as you start to huddle with your team regularly. Team members will begin to learn patterns and use this information to prioritize their work and allocate their time based on patient and team needs throughout the day. For example, a medical assistant may offer to assist with phone calls or cover another clinician on a day that a physician is not seeing as many patients. Anticipating a call to an interpreter or coordinating a visit to a behavioral health specialist will ensure that the team is ready to provide the best possible care to its patients. Anticipating procedure setups, such as a Pap smear or suture removal, ensures that needed supplies are already available and reduces the number of trips out of the room during a visit—decreasing interruptions and increasing practice efficiency.

Over time, this change shifts the team to thinking proactively rather than reactively. When the team is proactive and plans together, the clinic becomes more efficient, flexible, and adaptive during times of high patient volume and acuity. This video from Bellin Health illustrates how a daily huddle to kick off the day can improve scheduling, care, and clinic workflows.

Quiz Ref IDConsider hiring an expert. Professional coaches that are not involved in the day-to-day clinical operations can be hired for a discrete period to provide positive, constructive feedback to team members participating in huddles. The practice may benefit from having an impartial person review the checklist and provide additional feedback on communication, teamwork, and facilitation skills.

Incentivize team engagement. When team members perceive value in brief huddles, they are more likely to be engaged. Explore barriers to participation, and always consider ways to improve. Use different strategies to encourage involvement in team huddles as they become part of the practice's culture:

• Teamlet competitions (eg, publicizing which teamlets huddled the most)

• Incentives (eg, lunch, snacks, or notes of appreciation for teamlets that huddle more than 90% of their scheduled time)

• Positive reinforcement during individual performance discussions

• Visual indicators of huddle success, such as:

  • Green sticker: Huddle was successful

  • Yellow sticker: Huddle was incomplete or missing team members

  • Red sticker: Huddle did not occur

The team will remain enthusiastic about hurdles if they continue to provide value. Focus on improving the agenda so that the huddles deliver clear benefits to both patients and the team. Practice leaders can ask individual team members, “How can huddles be more useful for you and our patients?”

Track Results

Quiz Ref IDTrack clinical factors that may be impacted by team huddles and share the results with the team. Some of these factors may be linked to bigger priorities such as wait times or patient satisfaction—and the outcomes can be tracked over time. Is the team better prepared for patients with complex needs? 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.

Celebrate Success

Celebrating success sets a positive tone for the day and reminds everyone how valuable they are to the team. 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 it is making for their patients.

• A shout-out to a teammate

  Example: “Lori jumped in to pick up phones yesterday when we were really backed up.”

• A story about exceptional care for a patient

  Example: “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.”

Team huddles forge connections before a clinic session for everyone to prepare and communicate about the day ahead, enabling the clinic to boost productivity and provide the highest quality care for patients.

Journal Articles and Other Publications

• Pimentel CB, Snow AL, Carnes SL, et al. Huddles and their effectiveness at the frontlines of clinical care: a scoping review. J Gen Intern Med. 2021;36(9):2772-2783. doi:10.1007/s11606-021-06632-9

• Agency for Healthcare Research and Quality. Implementing primary care team huddles worksheet. 2014. Last reviewed November 2018. Accessed August 16, 2022. https://www.ahrq.gov/evidencenow/tools/team-huddles.html

• Bain Insights. How simple team huddles can make a business better. Forbes. March 4, 2016. Accessed August 16, 2022. https://www.forbes.com/sites/baininsights/2016/03/04/how-simple-team-huddles-can-make-a-business-better/?sh=65f2fdca1d0e

• Fogarty CT, Schultz S. Team huddles: the role of the primary care educator. Clin Teach. 2010;7(3):157-160. doi:10.1111/j.1743-498X.2010.00369.x

• Johnson I. Communication huddles: the secret of team success. J Contin Educ Nurs. 2018;49(10):451-453. doi:10.3928/00220124-20180918-04

• Trejo FE, Igel CM, Chuang M, Bajaj K, Bernstein PS. Checklists, huddles, and debriefs: critical tools to improve team performance in obstetrics. Clin Obstet Gynecol. 2019;62(3):518-527. doi:10.1097/GRF.0000000000000464

Videos and Webinars

• Bellin Health. Bellin Health team-based care: the model in action—in between visit workflow. April 19, 2018. Accessed August 16, 2022. https://www.youtube.com/watch?v=83E95xahBiI

Playbooks and Toolkits

• Saving Time Playbook (PDF)

• Team Meetings: Strengthen Relationships and Increase Productivity

• Pre-Visit Laboratory Testing: Save Time and Improve Care

• Pre-Visit Planning: Save Time, Improve Care, and Strengthen Care Team Satisfaction

Success Stories

• Daily Team Huddles Case Report: Maxine Hall Health Center

• Daily Team Huddles Case Report: Clinica Family Health

• Daily Team Huddles Case Report: Martin's Point Healthcare

• Daily Team Huddles Case Report: University of California, San Francisco