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The Huddle: Becoming a Team

How our unit came together to foster teamwork and improve patient care

Collaboration and communication are vital components of a well-functioning multidisciplinary team. Together, these mechanisms ensure the understanding and respect of roles, skills and expectations, as well as appreciation for the contributions of each member of the healthcare team.1 Teamwork is essential to the successful day-to-day operation of a busy hospital unit. There are many strategies to enhance teamwork; however, they are often difficult to implement, especially in larger units with multiple disciplines. Our unit struggled with streamlining communication and needed a way to enhance the teamwork in caring for our patients. This article describes the implementation of a daily huddle, and how it has improved our practice.  

Struggling with Teamwork
As part of a nationally recognized children's hospital, our unit, MS6, is a 28-bed pediatric medical-surgical unit, with a motivated and highly skilled medical team. Our multidisciplinary team provides comprehensive, family-centered care for a complex pediatric patient population of varying diagnoses. The unit consists of three decentralized nursing stations. Daily shifts are comprised of one resource nurse, eight RNs, three patient-care assistants (PCAs), social work, child life specialist and management. In addition to unit staff members, two primary medical teams - rehabilitation therapists and educators - contribute to the overall unit workflow.  As a busy place with a diverse multidisciplinary team, MS6 needed a strategy to enhance teamwork.

Prior to the initiation of a daily huddle, a lack of teamwork and communication was apparent across the multidisciplinary team. The three decentralized nursing stations provide minimal visualization and create an environment that fosters limited interaction amongst staff. RNs and PCAs at one station were unaware of the acuity of patients, procedures, transports and challenges occurring at another station. This resulted in the absence of reliance on peers, lack of available assistance when needed and non-therapeutic collaboration and relationships among RNs and PCAs.

In addition to a deficiency in teamwork between RNs and PCAs, lack of support from social work, child life specialists and management was also apparent. Social work and child life specialists were uninformed of many of the patient and family needs, therefore unable to accommodate nursing requests with minimal notice. Management was also unaware of the rapid changing acuity of patients and the multiple challenges that emerged throughout a shift. The lack of appropriate communication and collaboration resulted in strained relationships and ineffective teamwork.

The Huddle
Four years ago, management initiated the concept of a daily huddle on MS6. Huddles have been used in sports for years to bring everyone together, check on individual players, and implement and update the game plan.2 Huddle is consistently held at the same time and place every morning following shift to shift report. Staff attendance is expected for intended successful collaboration. Daily huddle is held in a consistent format every day, efficiently led by the resource nurse. The resource nurse, as a leadership role, sets the tone for the shift and initiates effective shift planning. A brief description of staffing, the existing patient population, diagnoses, potential admissions, discharges, and scheduled procedures are reviewed.

Initially, staff was apprehensive about the initiation of a daily huddle. Concerns were expressed regarding time management at the beginning of each shift. Staff feared incomplete shift to shift report and delayed start of shift responsibilities. Apprehensions were alleviated as advantages became apparent and staff recognized the positive impact on workflow. Over time, huddle became a well-accepted change on MS6.

Becoming a Team
The implementation of a daily huddle on MS6 has enhanced teamwork and communication throughout the unit. It provides an opportunity to review each staff member's workload, patient acuity and care needs. Daily huddle offers a safe environment for staff to address patient concerns and safety alerts, thus increasing consciousness and facilitating problem solving amongst peers. This has improved awareness of unit workflow, reliance on peers and collegiality which has ultimately enriched the quality of patient care.

The multidisciplinary presence at huddle elicits anticipated and proactive decision making regarding workflow needs. Crises can be managed before they arise, detecting and managing unexpected events more efficiently. This heightened situational awareness promotes interdependency and reliability among staff.  Individuals become conscious of peer and unit needs and are able to assist others more effectively. This raises staff accountability to work and function as a team. The reliability and support, promoted by a daily huddle, has enriched teamwork on MS6. Daily huddle elicits thinking that is not intuitive to each individual staff member but is ultimately beneficial to the whole team.3 As a well-functioning team, MS6 is capable of providing optimal patient care.

Huddle is now a daily fixture on MS6 and staff can't remember how the unit functioned without it. The implementation of daily huddle has enhanced teamwork and communication which has improved awareness of unit workflow, reliance on peers and a new sense of collegiality. Our unit revived a culture of reliability and support between members of a multidisciplinary team. Ultimately, this translates into better quality care for our patients and their families. We are a team.

Aimee Bareiss, Kristina Kaminski and Julia Anne Morrison are staff nurses at Connecticut Children's Medical Center in Hartford, Conn.

References:
1. Dillon PM, et al. Simulation as a means to foster collaborative interdisciplinary education. Nursing Education Perspectives. 2009;30(2):87-90.
2. Dagley, J, and Hill K. (2010). Looking for better teamwork? Form a huddle. Reflections of Nursing Leadership. 2010;36(2). http://www.reflectionsonnursingleadership.org/pages/vol36_2_col_hill_dagley.aspx
3. Stewart E, and Johnson. Huddles: increased efficiency in mere minutes a day. 2007. https://www.transformed.com/workingPapers/Huddles.pdf.

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