At Maxine Hall Health Center, a public health primary care clinic in San Francisco, huddles were not an immediate success. When the clinic sessions continued to be chaotic, leadership decided to reinvigorate the practice's huddle efforts. It took more than a year for the huddles to become routine and impactful, as leaders worked with the team to identify the huddle format and timing that produced the highest value. Now, there is a clinic-wide sense that “if you missed huddle, you missed important information for your day,” says Catherine James, MD, part-time medical director and CMO for Primary Care at Maxine Hall Health Center.
Full Team Huddles
Huddles start at 8:00 a.m. in a central team room where physicians and medical assistant teammates are co-located. The huddle is called and led by the nurse manager. The entire clinic staff is encouraged to attend, including behavioral health clinicians, nutritionists, pharmacists, specialists, transcriptionists, front-desk staff, nurses, and volunteers.
Huddles begin with staffing and logistical information, followed by quick reminders about ongoing clinic quality-improvement work, such as a depression-screening initiative. Then two critical pieces of scheduling information are discussed: the available appointment capacity that day and each provider's next available appointment. This includes anyone who offers appointments to patients—nurses, pharmacists, behavioral health specialists, as well as physicians. This step of identifying the next available appointment was added to the huddle checklist as huddles evolved, and it has greatly improved patient-care coordination among the team. For example, when a physician needs a patient to be seen for hypertension follow-up in six weeks but does not have an available appointment for seven weeks, the physician can schedule an interim follow-up appointment with one of the pharmacists that he or she knows from the huddle has availability in three weeks. The physician is thus able to prioritize patient care with minimum inconvenience or disruption to patients or the clinic schedule. The five-minute huddle concludes with general announcements and shout-outs.
Subsequent Teamlet Huddle
After the full team huddle, team members split off into their own designated teamlets to spend an additional two to three minutes to coordinate their scheduled patients for the day. Four years into huddling, they run organically without reference to a checklist, although one was used initially to structure the huddles.
Making huddles a success
Dr. James recalls several other techniques that helped the team show up on time and ready to huddle regularly. First, clinic leadership committed to serving as models for appropriate huddle behavior, including being punctual and present. Second, the team used enthusiastic, positive reinforcement when people demonstrated good huddling behavior, both publicly and privately during performance reviews. Finally, an invested leader, the charge nurse in this case, was designated to call the huddle each day so everyone arrived at the correct time. Since making the decision to commit to regular team huddles, Maxine Hall Health Center has seen improvements in teamwork, preparation, and the ability to coordinate care for their patients.
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