Huddling for high reliability and situation awareness

Abstract

Background Studies show that implementing huddles in healthcare can improve a variety of outcomes. Yet little is known about the mechanisms through which huddles exert their effects. To help remedy this gap, our study objectives were to explore hospital administrator and frontline staff perspectives on the benefits and challenges of implementing a tiered huddle system; and propose a model based on our findings depicting the mediating pathways through which implementing a huddle system may reduce patient harm. Methods Using qualitative methods, we conducted semi-structured interviews and focus groups to obtain a deeper understanding of the huddle system and its outcomes as implemented in an academic tertiary care children’s hospital with 539 inpatient beds. We recruited healthcare providers representing all levels using a snowball sampling technique (10 interviews), and emails, flyers, and paper invitations (six focus groups). We transcribed recordings and analysed the data using established techniques. Results Five themes emerged and provided the foundational constructs of our model. Specifically we propose that huddle implementation leads to improved efficiencies and quality of information sharing, increased levels of accountability, empowerment, and sense of community, which together create a culture of collaboration and collegiality that increases the staff’s quality of collective awareness and enhanced capacity for eliminating patient harm. Conclusions While each construct in the proposed model is itself a beneficial outcome of implementing huddles, conceptualising the pathways by which they may work allows us to design ways to evaluate other huddle implementation efforts designed to help reduce failures and eliminate patient harm.

Highly Reliable Health Care in the Context of Oncology Nursing: Part II

“…Based on information from Goldenhar et al, 2013;Hines et al, 2008;Reason, 1997;Weick & Sutcliffe, 2007. Complex, multidrug chemotherapy protocols often are used to treat cancer, and the greater the number of medications administered, the greater the potential for error. Some chemotherapy agents are given by more than one route (i.e., subcutaneous or IV), in varying doses (i.e., standard dose or high doses), and over varying periods of time (i.e., bolus or continuous infusions).…”

Implementing Healthcare Improvement

“…Research suggests that where organisational effort is invested to support and include such processes, these can have a positive effect on staff engagement in reporting and learning activities [72] and on patient safety [77]. Utilising a range of processes that draw upon and strengthen different aspects of an organisation's culture might enable healthcare organisations to deliver more sustainable improvements in patient safety [78].…”

Redefining the clinical gaze

“…The paper by Goldenhar et al 25 provides insight and understanding into some of the mechanisms of safety culture change and the challenges that are posed as these are put into action. They note that huddles or briefings are not a new phenomenon, but the mechanism has not been fully understood.…”

“…The approach discussed by Goldenhar et al 25 goes someway to address the challenge set out by Leape et al 3 in that there is a change in the medical ethos, a flattening of hierarchy, promotion of teamwork and clear lines of accountability and responsibility in a transparent system of care. The work undertaken is therefore relevant for all of those involved in healthcare and provides an insight into how to address the deficiencies of the current construct in healthcare design.…”