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Workflow and Process Case Report

Implementing Team Huddles in a San Francisco, CA University: A Case Study

STEPS in Practice

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The hepatology clinic at University of California, San Francisco is an outpatient practice that serves patients with complex hepatic conditions, including patients who have undergone liver transplants. The busy academic practice books approximately 6,500 patient visits a year.

Clinic leaders initiated daily team huddles as a component of a broader Lean implementation, triggered in part by persistently low patient satisfaction scores. Facilitated by the practice manager, the team huddles are held each day at 9:30 AM and include the entire care team—attending physicians, fellows, nurse practitioners, physician assistants, and administrative staff. The team comes together for 15 minutes to discuss the agenda for the day. They identify any potential issues, such as a provider being out sick, and develop plans to minimize any negative effects, such as longer wait times for patients.

During the huddles, the team also reviews a status report for the previous day, which the practice manager generates each morning from the electronic medical record. The report includes four pieces of data that relate to the overall goals for the clinic:

  • Number of new and return patient visits

  • Number of “no shows” and the reasons for them (the staff contacts patients to inquire about the cause of missed appointments)

  • Average visit time

  • Number and status of referrals received, both internal and external

During the huddles, team members also identify any ongoing issues that are adversely affecting their daily work, such as inefficient patient rooming practices, difficulties consistently collecting copays, or delays in obtaining diagnostic tests. Once a problem is identified, team members suggest a potential solution to test, an individual is identified who will be accountable for implementing the solution, and a timeline for the change is determined. These staff-initiated solutions have resulted in rapid improvements to problems that contribute to delays for patients and frustration among care providers. If a problem cannot be solved by the team, it is escalated to the clinic leaders, who address the problem or bring it to the attention of medical center leaders.

The huddle also serves as an opportunity to recognize staff and care providers for their positive contributions to the clinic. The practice manager reads emails and comments from patients and shares results from the week's patient survey. According to Bilal Hameed, MD, associate chief of the clinic, the team huddles have resulted in many improvements that have boosted morale and job satisfaction among clinic staff and care providers, as well as among patients. “Our clinic staff has been empowered to identify problems and test solutions. Now they feel heard, respected, and an important part of the team. Providers get what they need for their patients and are less frustrated. It doesn't take six months or a year to fix a problem that affects their daily work. It's solved right away.”

Where CME credit is designated, the activity is part of the American Medical Association's accredited CME program. The AMA is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.
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