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At Clinica Family Health, a federally qualified health center in the Denver–Boulder metropolitan area, huddles occur twice each day: once in the morning and once in the afternoon after lunch. The first twenty minutes of each clinic session are blocked off for huddles. Care teams (called “pods” at Clinica) have found this a worthwhile time investment, helping them prepare for each patient's visit. Karen Funk, MD, MPP, Vice President of Clinical Services and a practicing family physician at Clinica, justifies the time used for huddles in this way: “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.” Clinica has a very low rate of no-shows due to advanced-access scheduling, ensuring that this twice daily preparation pays off.
Huddles take place in the pod workstation where practitioner and medical assistant are co-located and regularly work together. When huddles started 10 years ago, this teamlet would pull each chart and review relevant clinical issues together. Now, they have an EHR with embedded tools that prints a one-page visit prep checklist for each patient. This care planner was developed by Clinica to flag guideline-concordant preventive and chronic disease care gaps, including immunizations, diagnostic and laboratory testing, and referrals. The physician–medical assistant teamlet reviews the care planner together so that arrangements can be made to address such issues proactively during the visit. Other pre-visit preparation or paperwork is done side-by-side during this time. Extended team members, including a nurse care manager, behavioral health specialist, and referral case manager, make rounds to each teamlet to discuss patient care plans, as well. For example, the care manager may flag a patient with complex care needs arriving that day and ask the medical assistant to find her when the physician is finished for a post-visit meeting. Likewise, the physician may ask the care manager to see an additional patient on her schedule that day who may benefit from her services.
Huddle time at Clinica is also used to reinforce data-driven quality-improvement efforts on a daily basis. Team members will gather at the data board regularly to review their pod-level performance data and discuss plans of attack for lagging indicators. This sends the message that the entire team is responsible for patient health, and is another way that Clinica creates exceptional team culture and performance with the aid of daily team huddles.
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