Patient-Centered Medical Home (PCMH) has become a very well known model in Primary Care today. However, practice teams are faced with caring for complex patients and the need to communicate with other care team members on a regular basis. Team Huddles are an essential part for a busy practice to prepare PCPs and practice staff for the day to maximize the quality and quantity of time that can be spent with patients. Team Huddles enable the PCP and clinic staff to have frequent but short briefings so they can stay informed, review work, make plans and move ahead rapidly.
Team Huddles are also an effective way to align the team at the start of a clinic session. They build team culture, improve communication plan for patients who require extra time and assistance, prepare for PCP and clinic staff to have a smooth and non-chaotic day.
The huddle can provide a forum where the team can connect with each other before a clinic visit. Huddles give the team the opportunity to provide the best care possible to their patients through proactively and efficiently working together throughout the day.
Below are 4 experiences of implementing Team Huddles in their practice from Healthcare facilities across the U.S.:
1. 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.
Dr. James recalls several techniques that helped the team be 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.
2. At Clinica Family Health, an FQHC in Denver/Boulder metro area, huddles occur twice a day, in the morning and after lunch. The first twenty minutes of each clinic session are blocked off for huddles. Care teams at Clinica (called Pods) have found this a worthwhile time investment, allowing them to 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 bases we become 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 preparation pays off.
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 action 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.
3. At Martin’s Point Healthcare in Bangor, Maine, huddles started as informal meetings between a single provider and clinical support staff to improve communication. 10 years later, that simple meeting has evolved into a 10 to 15 minute high-energy meeting at the beginning of each clinic day where the entire practice arrives ready to discuss to the day’s plan. Paula Eaton, the clinic’s administrator, has been a key champion of driving this evolution. She recalls, “At the first official huddle, even the doctor didn’t show up. I had to keep asking, ‘How can we make this useful to the team?’” She asks this question as critically important to developing the level of engagement seen in their daily team huddles. She describes huddles as “what we are doing today and how that is moving us closer to our goals. Every day is an opportunity to make improvements.”
The huddles at Martin’s Point Healthcare has met challenges over the years. A meeting facilitator goal was created to keep huddles on track, by tabling and recording issues that required longer discussions for team meetings. Paula says, “Huddles are not really meetings; the team makes the plan, then off we go.” When huddles drag on, the team found that staff lose interest and focus. Initially, the huddle leader role rotated between team members, but the team has become comfortable with one patient-service representative taking on this role.
Paula shares, “Huddles can be as simple or complex as you want them to be. If people find huddles useful, the time will be there. Time is always a constraint; it’s how we utilize it that gets people to go. Making huddles ‘mandatory’ is beside the point.”
4. Many of the TranforMED practices that have implemented team huddles have a hard time imaging a day without them now. “Huddles were a foreign idea to us initially, but now they are an integral part of the workday,” says Randall C. Rickard, MD, of Family Practice Partners in Murfeesboro, TN.
Rickard’s practice is housed in 2 different buildings, creating some unique communication challenges. Its TransforMED facilitator suggested daily huddles as a way to bring everyone in the practice together for a few minutes. “We now begin each day with mini-meetings between our doctors, nurses and receptionist. Team members are empowered and directed toward day-specific goals to reduce wait times and improve efficiency.”
Team Huddles are critical within your practice. It is a great way to improve communication, staff empowerment, patient care, and much more. A quick informative meeting can mean big wins for both your practice and your patients.
For more information on how to implement Team Huddles in your practice please contact Julie Stephens, Project Director at j.stephens@NeKYrhio.org or 606.776.9595.
REFERENCES
- American Medical Association. Implementing a daily team huddle. Available at: http://www.stepsforward.org/modules/team-huddles.
- American Academy of Family Physicians. Huddles: Improve Office Efviciency in Mere Minutes. Available at: http://www.aafp.org/fpm/2007/0600/p27.html.