Daily interdisciplinary huddles were implemented at a hospital to improve communication and collaboration among healthcare providers. The researchers observed huddles from several units and interviewed staff. They found that while huddles facilitated information sharing, their effectiveness varied due to inconsistencies in facilitation and participation. Recommendations included using electronic whiteboards to standardize the huddle process, engaging all providers, and incorporating bedside nurses' input. Implementing goal-setting and team-building could help maximize huddles' impact on patient outcomes.

1. Use of Daily Interdisciplinary Huddles to
Improve Communication and Collaboration
Staci Wuchner
Tyler Wysong
Alessa Quinones

2. Objectives
• Overview of high-reliability organizations and
accountable care organizations
• Overview of importance for daily
communication
• Review of scholarly article
• Review of methods and findings from field
exploration
• Recommendations

3. Introduction
• Healthcare providers’ goal is to provide efficient, cost-effective,
quality care to patients
• High-Reliability Organizations (HRO) seek to provide this type of
care, with zero defects
• Accountable Care Organizations/ Units (ACOs/ACUs) assist with
achieving the goals of becoming HROs

4. Introduction
• Within ACUs, interdisciplinary groups come
together to provide coordinated, high quality
care to patients
• The Institute of Medicine recommends that
interdisciplinary teams be established to
improve communication and coordination
among the team members.

5. Background
• Interdisciplinary collaboration improves patient
outcomes and decreases healthcare costs
– Poor interdisciplinary communication and
collaboration is linked to significant patient harm
– The changing context of healthcare necessitates
personalized care:
•Diverse and aging populations
•Staffing shortages
•Rising healthcare costs
•Complex organizations

6. Background
• According to Zwarenstein et al. (2013), “many
problems of coordination and communication
may arise from lack of a common cross-
team understanding of the care
priorities for a specific patient at a specific
time and the resulting failure of individual team
members to align their activities to those
priorities, rather than simple
miscommunication” (p. 2).
05/18/15 6

8. Background
• Lack of coordination can lead to:
– Team confusion
– Dissatisfaction by patients and families
– Discharge delays
– Readmissions
– Adverse events (falls, infections, etc)
• Deliberate face-to-face communication is better
able to facilitate “common understanding of
patient needs and alignment of professional
priorities” (Zwarenstein et al., 2013, p. 2) rather
than asynchronous electronic communication
methods.

9. Background
• Systemic, organizational, and interactional
components will determine the success of
interdisciplinary collaboration
• Huddles must be integrated into the daily
workflow
• For effective team work, members must:
– Work together closely
– Have regular and timely meetings
– Have frequent communications with each other
in order to provide optimal patient care

10. Background
• Daily interdisciplinary huddles have been
established in many institutions to improve
interdisciplinary communication
• Allows information sharing and aids in reaching
consensus regarding the patient’s treatment plan
and discharge goals
• Recent article in Modern Healthcare:
• One New York University medical center improved
communication and decreased hospital length of
stay by instituting daily interdisciplinary huddles

11. Scholarly Article
• Health care huddles: Managing complexity to
achieve high reliability (2015)
– Complex Adaptive Systems (CAS) framework
guided the study
•Emphasized conversations, relationships, culture
– Study used literature review, direct observation,
and semi-structured interviews to understand
HOW and WHY huddles have been useful in
healthcare.
Provost, S.M., Lanham, H.J., Leykum, L.K., McDaniel, R.R., & Pugh, J. (2015). Health care huddles: Managing
complexity to achieve high reliability. Health Care Management Review, 40(1), 2-12.

12. Scholarly Article
Huddles
Observed
Participants
Internal medicine
clinic morning huddle
• Medical director
• Clinicians,
• Administrative staff
Pediatric hospital
inpatient
morning/afternoon
huddle
• Manager of patient
services
• Safety officer
• Interdepartmental
representation
Daily operations brief • Manager of patient
services
• Safety officer
• Administrator
• Employees
Operating room
huddle
• OR clinicians
• Staff
Pharmacy huddle • Head pharmacists
• Rotating residents

13. Scholarly Article
• Themes from observations and interviews
Conversation
•Topics that might not
otherwise be discussed
•Conversations between
individuals who may not
otherwise communicate
•Opportunities for
conversations that span
boundaries and
hierarchies
Relationships
•Relationships
among individuals
who might not
otherwise interact
•Newly trained
clinicians can foster
new shared
understandings of
work to be done
Culture
•The repetition and
consistency become part
of the fabric of the
organization
•Diverse group of care
providers assess events
both routine and
unexpected, leading to
new shared
understandings

15. Implications from Scholarly Article
• Huddles provide a venue for meaningful interaction
where participants polish communication and
relational skills
• How can managers maximize the likelihood of
effective huddles?
– Exhibit expectations for all individuals to contribute
during huddles by modeling this behavior
– Commending generative behaviors during huddles
– Setting expectations for reporting and praising
transparency initiatives
– Build into the daily-work routine by having huddles at
regular intervals (daily)

16. Methods
• To improve interdisciplinary communication and
collaboration, IU Health Methodist Hospital utilized
the Transformation Team to restructure the
healthcare provider’s work design
– The daily huddle solution was rendered during a
week-long Rapid Improvement Event (RIE)
• To better understand the interdisciplinary dynamics
found within the daily huddles, our group observed
several daily huddles and interviewed different
disciplines.
– This project was approved/supported by the
Director of Nursing Practice & Quality and the
Transformation Office leader

17. Methods
• Huddles observed:
– A4North Trauma floor
– A2/3North Cardiovascular floor
– A5North/South Neuroscience Progressive Care Unit and floor
– A6N Pulmonary floor
• The huddle observation forms included questions such as:
– Who was the huddle facilitator?
– In what order were the patients discussed?
– What was the overall flow of the huddle?
– What was the overall feel of the culture/climate of the
huddle?
– Did you identify any weaknesses, issues, or concerns during
the huddle process?
– What were the strengths of the huddle?

18. Findings: Huddle Observations
• Process variations:
– Two facilitated by providers; two facilitated by charge nurse
– Most discussed patients by room number; one discussed each
patient by provider
• White boards:
– Information on these white boards included:
– White board physically moved for each huddle on one unit
• Patient’s Initials • Actual Length of Stay • Estimated Discharge Date
• Room Number • Estimated Length of Stay • PT Ordered
• Provider Team • Disposition • Discharge Orders/Barriers to Discharge

19. Findings: Huddle Observations
• Overall climate of the huddles:
– Laid back and open
– Members allowed to speak freely
– No hierarchy or tension
• Flow of the huddles:
– Somewhat disjointed
– Not all providers were present, leading to “skipping
around” to different patients
– Most conversation between provider and case
management about length of stay

20. Methods
• Disciplines interviewed:
– Direct care charge nurse
– Physician
– Nursing manager
– Case manager
– Clinical Nurse Specialists
• Questions related to the daily huddles included:
– Tell me about your huddle process. What do you like
(strengths) /dislike (weaknesses) about this process?
– If you could change anything about the huddle process,
what would it be?
• Qualitative data analysis findings were shared with
some of the interviewed participants to see if our
themes were an accurate representation

21. Findings: Interview Questions
• Likes/ strengths of the huddles
Interdisciplinary involvement
“The people; it’s so important to have
multiple providers represented, such as
ortho[pedics], trauma, hospitalists, as
well as nursing, case management, and
social work.”
Engagement/communication
“All team members have an opportunity to
connect. There is great information
sharing between the disciplines.”
Action-oriented
“The daily huddles hold people
accountable and responsible for follow up.
I like it when the various disciplines are
present so they are able to help solve
problems in the moment.”
Effective and timely process
“We have a very good process and hit the
things we need to hit in a timely manner.
The huddle keeps the team focused and
is vital to patient outcomes.”

22. Findings: Interview Questions
• Dislikes/ weaknesses of the huddles:
Inefficiencies in the huddle
process
“Many huddles occur at the same times
and prevents the physicians/providers
from attending all huddles on units where
their patients are located. It’s hard to
make sure we are making efficient us of
the time without wasting time on people
waiting.”Variations in the huddle
facilitation
“Different charge nurses facilitate the
huddles differently. Some talk about
unnecessary things, or spend too much
time on issues that aren’t pertinent, like
psychosocial problems. We need to follow
the standard work that was created from
Lack of focus on quality
“We are too focused on length of stay; we
could introduce other things to the huddle
that we could impact, like lines, foleys
[indwelling urinary catheters], and falls.”
Not all of the necessary
disciplines are present
“Not all providers are able to come to the
huddles; hospitalists are good about
coming, but Cardiology isn’t always
present, and sometimes they are the only
providers following certain patients.”

23. Findings: Interview Questions
• What participants would change about the
huddles (opportunities):
Engagement from all providers
“We need to have more provider
engagements so they are more proactive
instead of reactive.”
More focus on patient quality
“We are at a point in the process where we
could begin to introduce more quality
information. We should be able to
introduce other things with the group that
could be impacted with the members that
are present.”
Follow standard work processes
to decrease variations
“We should make sure facilitators of
huddles are following a script for what
needs to be discussed so they stay on
task; there are currently too much
extraneous, irrelevant discussions.”
Inclusion of bedside nurses
“I wish we could improve the relational
coordination and interdisciplinary
communication between providers and
nursing. We need a way to include RNs
because they could glean and give a lot of
information to the conversation.”

24. Recommendations
• Electronic white board provided to every unit
– Decrease the need to physically move the white board
– Ability to add other columns for new initiatives
– Easier readability
– Improve communication between the huddle and the
bedside nurses

25. Current White Boards

26. 05/18/15 26
Electronic White Board

27. Recommendations
• Revive the use of standard script developed in
RIE
– Reiterate importance of all facilitators using script
– Revise/update script with current huddle
participants to ensure all necessary topics are
included, and to add any quality points
– The script will assist the facilitator with staying on
track, finishing in a timely manner, and focus on all
of the necessary information

28. Recommendations
05/18/15 28

29. Recommendations
05/18/15 29

30. Recommendations
• Develop a process for getting information from and back to
the bedside nurses
– One unit makes copies of their “dot” sheet and passes them
out to bedside nurses after huddle
– A similar process could be developed for gathering
information prior to the huddle.
• Ensure all providers (or a designee) are present for all huddles
– Stagger huddle times so they are not overlapping
– Develop a process where physicians/practitioners can provide
information to the charge nurse if unable to attend huddles
– Communicate with upper leadership the need for all providers
to be present at huddles; garner their support of and
accountability for the daily huddles

31. Recommendations
• To motivate participants in the interdisciplinary huddles, it
may be beneficial to set goals with measureable
outcomes that can be communicated back to the group
– Goal Setting Theory:
• Setting the goal
• Obtaining goal commitment
• Providing support elements
• The huddle’s infrastructure should support these goals by
tailoring the huddles to ensure timely and effective
communication
• Team building workshops may help to improve the
relational coordination, effectiveness, and cohesiveness
between members of the interdisciplinary huddle
participants

32. Recommendations
• This presentation, including recommendations,
will be presented to the Medical/Surgical Value
Stream Analysis Team for knowledge
dissemination and possible implementation
05/18/15 32

33. Questions?
05/18/15 33

34. References
•Borkowski, N. (2011). Organizational behavior in health care (2nd
ed.). Sudbury, MA: Jones and Bartlett Publishers.
•Cialdini, R.B. (2001). Harnessing the science of persuasion. Retrieved from https://hbr.org/2001/10/harnessing-the-science-of-persuasion
•Cornell, P., Townsent-Gervis, M., Vardaman, J.M., & Yates, L. (2014). Improving situation awareness and patient outcomes through interdisciplinary rounding and structured
communication. The Journal of Nursing Administration, 44(3), 164-169.
•Hina-Syeda, H., Kimbrough, C., Murdoch, W., & Markova, T. (2013). Improving communication rates using lean six sigma processes: Alliance of independent academic medical
centers national initiative III project. The Ochsner Journal, 13(3), 310-318.
•Kohn, L.T., Corrigan, J.M, & Donaldson, M.S. (1999). To err is human. Washington, DC: National Academy Press.
•Lencioni, P. (2002). The five dysfunctions of a team: A leadership fable. San Francisco, CA: Jossey-Bass.
•McKinney, M. (2014). Out by noon: A winning strategy to reduce crowding, shorten stay. Retrieved from http://www.modernhealthcare.com/article/20140412
•/MAGAZINE/304129995
•Nancarrow, S.A., Booth, A., Ariss, S., Smith, T., Enderby, P., & Roots, A. (2013). Ten principles of good interdisciplinary team work. Human Resources for Health, 11(19), 1-11.
•O’Leary, K.J., Buck, R., Flligiel, H.M., Haviley, C., Slade, M.E., Landler, M.P., … Wayne, D.B. (2011). Structured interdisciplinary rounds in a medical teaching unit: Improving
patient safety. Archives of Internal Medicine, 17(7), 678-684.
•Orchard, C.A., Curran, V., & Kabene, S. (2005). Creating a culture for interdisciplinary collaborative professional practice. Medical Education Online, 10(11), 1-13.
•Provost, S.M., Lanham, H.J., Leykum, L.K., McDaniel, R.R., & Pugh, J. (2015). Health care huddles: Managing complexity to achieve high reliability. Health Care
Management Review, 40(1), 2-12.
•Silow-Carroll, S. & Edwards, J.N. (2013). Early adopters of the accountable care model: A field report on improvements in healthcare. New York: NY, Commonwealth Fund.
•Stiefel, M. & Nolan, K. (2012). A guide to measuring the triple aim: Population health, experience of care, and per capita cost. Cambridge, MA: Institute for Healthcare
Improvement.
•Tayabas, L.M.T., Leon, T.C., & Espino, J.M. (2014). Qualitative evaluation: A critical and interpretive complementary approach to improve health programs and services.
International Journal of Qualitative Studies on Health and Well-being, 9(24417), 1-6.
•Weller, J., Boyd, M., & Cumin, D. (2014). Teams, tribes and patient safety: Overcoming barriers to effective teamwork in healthcare. Postgraduate Medical Journal, 90, 149-154.
•Zwarenstein, M., Rice, K., Gotlib-Conn, L., Kenaszchuk, C., & Reeves, S. (2013). Disengaged: A qualitative study of communication and collaboration between physicians and
other professions on general internal medicine wards. BMC Health Services Research, 13(494), 1-9.