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Daily Team HuddlesBoost Practice Productivity and Team Morale

Learning Objectives
1. Describe distinct roles for team members in a daily team huddle
2. Identify ways to ensure that daily team huddles become routine
3. Discover ways to improve daily team huddles in your practice over time
4. Recognize the value of daily team huddles to the operations of your practice and the impact on patient care
0.5 Credit CME
How will this module help me?

  1. Identifies 3 strategies to implement and improve daily huddles.

  2. Discusses case studies from practices that have implemented team huddles.

  3. Provides downloadable resources for easy implementation.

Introduction

Team huddles are a critical method to maintain smooth operations in your practice. They enable the care team to anticipate any special situations or unique needs for that day and generally last 10-20 minutes. This creates the opportunity for members of the care team to adapt their workflow for the day and support the needs of the patients and the team.1

The goal for a team huddle is to be an effective and efficient tool for communicating about patients and the flow of the clinic session.1 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 or twice daily adaptation is beneficial to the entire practice because everyone begins to think like a team.2 Huddles provide an opportunity to anticipate patients' needs, prepare for changes in staffing, avoid surprises allowing the clinic to run more smoothly.

Three STEPS for an Effective Team Huddle

  1. Establish a Team Huddle Routine.

  2. Develop Relationships and Identify Roles.

  3. Implement, Evolve, and Improve over Time.

Step 1 Establish a Team Huddle Routine.

To have an effective team huddle that is both rewarding and productive, it is important to involve the right team members, determine a convenient location, and schedule times that work well for everyone. Quiz Ref IDIdeally, all team members who are involved with the daily practice operations should be included in the team huddle. Including all team members—case managers, social workers, behavioral health specialists, nurses, medical assistants, and front desk personnel—brings more value to discussions around patient needs and clinic flow.

A team huddle should last between 5 and 20 minutes and should occur at times and locations that are convenient for all team members to attend. 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. It is important to start and end on time to ensure consistency and reliability.

Set expectations by emphasizing the importance of daily and timely attendance.

The location of the huddle should be convenient and easy to access, where everyone has the freedom to discuss topics confidentially. If patients have not yet entered the clinic's working area, a nurses' station may work. Practices find it beneficial to use space that allows the team to review the day's schedule and patient appointments together. The person who leads the discussion should walk the team through any important challenges that may arise during the clinic session. It is okay for people to be standing during a huddle; in fact, this may help team members maintain focus.

“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
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Q&A

  • How is a huddle different from a team meeting?

    Huddles are brief discussions that focus on the action plan of the day and allow for quick changes to the workflow based on the needs for that clinic session. Team meetings occur less frequently and focus on topics that are more in-depth or seek to resolve underlying process problems or broader workflow issues.

  • How can we make time for a team huddle when we are already so busy?

    At first, it may seem like a daunting task to have a daily huddle if this is new to your practice workflow. However, clinic operations are typically far more efficient when you invest the time for a daily huddle. When you first start, you may want to keep the huddles to 10 minutes and commit to starting and ending on time.

Step 2 Develop Relationships and Identify Roles.

Distinguishing roles in the team huddle helps to ensure that it will run smoothly. When defining roles, consider topics that each team member will prepare—based on roles and the agenda.

Identify a huddle leader.

The primary responsibility of the huddle leader is to ensure that every huddle is focused on the day's work and that all team members have the opportunity to voice opinions and concerns. Having a huddle leader provides continuity and can be a great method for building a strong team culture. 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 meeting.

Other roles can include:

The nurse manager or administrator: Review team staffing needs, absences, and reallocating responsibilities for the day. For example, during flu season, a new work flow could be reviewed when vaccine becomes available.

Physicians, nurses, and medical assistants: Review patients with chronic or complex needs and flag required advance preparations, such as:

  • Behavioral health, pharmacy, or case management referrals.

  • Diabetes or other health education.

  • Allocating more time or space for the visit.

  • Updates about recent patient events, such as hospitalizations, emergency room visits, consults, or surgery.

  • Scheduling interpreters.

  • Procedure setup.

Schedulers: Discuss available clinic capacity for day and ensure the team is aware of any same-day openings as well as urgent or cancelled visits.

Everyone should be aware of their individual responsibilities and should be prepared to collaborate with other team members in an effort to meet each patient's needs.

Physicians and practice leaders should set a good 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.

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Q&A

  • How can the information exchanged in a huddle benefit the team?

    Team members may 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 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. When the team is proactive and plans together, the clinic becomes more efficient, flexible, and adaptive during times of high patient volume and acuity.

Step 3 Implement, Evolve, and Improve Over Time.

As the practice begins implementation of team huddles, a checklist or template for agenda items may be especially useful. Huddles can become more organic over time, but initially they may benefit from a set structure. A checklist or template can be used by the team huddle leader to keep the conversation concise and focused. The time will pass quickly when you have a day's worth of patients to discuss.

The team will remain enthusiastic about huddles if huddles continue to provide value. Focus on improving the agenda so that the huddles provide 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?”

Consider hiring an expert. Professional coaches that are not involved in that day's clinical operations can be hired for a discrete time 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.

Increase team engagement. When huddles are brief and perceived as valuable, participants are more likely to be engaged. Explore barriers to participation, and always consider ways to improve. Use different strategies to encourage participation in team 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 teamlets that huddle more than 90% of the 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.

Track results. Track important clinical factors that may be impacted by team huddles and share the results with the team. Some of these factors may be linked to larger 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. 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.”) sets a positive tone for the day and reminds everyone on the team how valuable they are. 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.

Conclusion

Team huddles provide everyone with an opportunity to connect before a clinic session in an effort to provide high-quality patient care.

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AMA Pearls

AMA Pearls

Incorporate important announcements or quality improvement check-ins.

Team huddles are a daily opportunity to communicate about patients and formulate the plan for the day, but they can also be used to circulate other important information if done quickly. 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 about these initiatives. Other announcements, such as a scheduled downtime in the electronic health record (EHR) system, can also be made during this dedicated time.

If the team is struggling with timing, assign time limits for agenda items.

If the huddle leader has a hard time getting through the agenda in a timely fashion, have another member of the team watch the time in order to keep the team on track. A leader or coach could also observe and help the team develop efficiency to get through all necessary agenda items.

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Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:

0.5 Medical Knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program;

0.5 Self-Assessment points in the American Board of Otolaryngology – Head and Neck Surgery’s (ABOHNS) Continuing Certification program;

0.5 MOC points in the American Board of Pediatrics’ (ABP) Maintenance of Certification (MOC) program; and

0.5 Lifelong Learning points in the American Board of Pathology’s (ABPath) Continuing Certification program;

It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.

Article Information

AMA CME Accreditation Information

Credit Designation Statement: The American Medical Association designates this enduring material activity for a maximum of .50 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships.

ABMS MOC Statement: Through the American Board of Medical Specialties (“ABMS”) ongoing commitment to increase access to practice relevant Maintenance of Certification (“MOC”) Activities, this activity has met the requirements as an MOC Part II CME Activity. Please review the ABMS Continuing Certification Directory to see what ABMS Member Boards have accepted this activity.

Renewal Date: December 10, 2016; October 03, 2019

References
1.
UCSF Center for Excellence in Primary Care. (2013).  Healthy Huddles. https://cepc.ucsf.edu/healthy-huddles
2.
Substance Abuse and Mental Health Services Administration. (2007).  Huddles: Increased Efficiency in Mere Minutes a Day. https://www.integration.samhsa.gov/workforce/team-members/Huddles_Increased_Efficiency_in_Mere_Minutes_a_Day.pdf
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