The Daily Huddle: Adapting a Best Practice from Hell’s Kitchen

Like world-class restaurants, progressive healthcare organizations have adopted the pre-shift concept, more typically referred to as a team “huddle.”

By Jacquelyn Hunt

Americans are captivated by the restaurant industry. We tune-in to countless cooking cable channels and watch popular movies such as Burnt, Chef, and Ratatouille. We love to see how the masters make amazing dishes, served stylishly, in a consistent fashion. These “inside looks” show us best practices in the world’s top restaurants including the pre-shift, where the restaurant staff gather briefly prior to their shift to learn the day’s featured dishes and to plan for client reservations and special events. The team is positively engaged to assure a flawless dinner service.

Jeff Hookham, CEO of the restaurant wait staff training company 4 Remarkable Service, writes: “Running a pre-shift meeting is like flossing your teeth. Everyone knows you need to floss at least once a day but for whatever reason some people just don't do it. And just as there are consequences for not flossing, skipping pre-shifts can impact your bottom line.”

Like world-class restaurants, progressive healthcare organizations have adopted the pre-shift concept, more typically referred to as a team “huddle.” Clinic care teams, surgical suites, and hospital floors use huddles to quickly share information related to the day’s activities, make real-time adjustments and develop coordinated plans that help individuals and teams perform more effectively. A team huddle provides a short respite from the hectic pace of a busy practice to allow care team members to regroup with fresh strategies, improve communication, and deliver more effective, personalized care.

According to the Institute for Healthcare Improvement, huddles give the care team “concentrated time together to plan their roles and responsibilities, as well as to discuss opportunities for improvement in their work.” The best part is that there’s nothing complex about huddles. They can be added to any practice’s routine—they just take commitment and a willingness to experiment.     

What Are Huddles?

Huddles are simply short, structured briefings between key members of a care team. They can be conducted within any unit of a health system that shares common responsibilities for patient care. Huddles often take place at a consistent time every day (busy practices might even huddle twice a day—in the morning and again in the afternoon) and in a central location, such as a hallway or nurses’ station that is convenient for all members.

Typically, huddles are done while standing, which removes the structure often associated with formal meetings and allows participants to exchange information quickly and freely. In a clinic setting, participants usually include a physician, medical assistant, and a nurse (a.k.a. the core team), but participants may vary and practices often experiment to identify the right mix of individuals. Huddle agendas often involve reviewing the day’s schedule to allow team members to share insights such as patients who may need more time or attention, to address schedule conflicts, and to consider apparent care gaps. Some organizations add weekly or bi-weekly huddles with extended team members, such as the care/case manager, pharmacist, and behavioral health specialist. In this case, the huddle agenda can expand in scope, focusing on the population at-large or particular at-risk groups.

While seemingly simple in concept, huddles can still be challenging to implement and incorporate into practice—and to maintain over time. Like in the restaurant industry, there is no direct revenue generated from a pre-shift huddle. Negotiating huddle schedules and competing priorities for team members’ time are common challenges. Physicians have to value the input of other members of the care team, as well as the potential gains in efficiency and quality of outcomes. But the advantages of huddles make the effort worthwhile. They provide an organizational mechanism to translate complexity into an action plan. They are both system-driven and system-sustaining.

Huddles Are a Key Element of Team-Based Care

During a huddle, team members have the opportunity to discuss challenging patients or scenarios, review recent hospitalizations, needed referrals, gaps and exceptions, or other emerging issues that should be addressed. Not surprisingly, this approach promotes top-of-license staff performance which, in turn, allows physicians to focus their time and attention where it is most valuable and rewarding—on the patient. Huddles help smooth daily “production” and anticipate otherwise avoidable issues. In the end, huddles enhance communication, promote knowledge transfer across settings, and improve both the patient and provider experience of care.

Technology Makes Huddles More Efficient and Effective

Population health IT solutions, such as Enli CareManager, ideally support a team-based care model, which includes huddles. CareManager allows providers to identify and risk-stratify patients based upon a variety of criteria, including condition, gaps in care, or health determinant risk. During the huddle, care team members access CareManager to develop real-time strategies to address patients’ unique needs and easily automate the distribution of tasks captured within an individual care plan. 

J. Hunt, PharmD, MS