Daily Huddles-I: Helping People Do a Better Job

Thirty years ago, W.E. Deming characterized the job of a supervisor: “The aim of supervision should be to help people and machines and gadgets to do a better job.” (p. 23, Out of the Crisis, 1986, Center for Advanced Engineering Studies, MIT, Cambridge, MA).

Deming also emphasized that aims and goals require methods.

In the last two months, I’ve worked with supervisors in a couple of ambulatory surgical centers to help their people do a better job. The work is part of a project with colleagues at IHI (www.ihi.org) to help the centers sustain changes in their use of surgical checklists.

By What Method?

One method we’ve tested is a short daily huddle for a unit team, led by the team’s supervisor.

By short, we mean less than five minutes. The supervisor (or stand-in when the supervisor cannot lead the huddle) follows a standard agenda, illustrated at left.

Ambulatory surgical centers are busy places. Nonetheless, our colleagues at the two centers have been able to carve out a few minutes each day to focus their team’s attention on safety concerns.

The supervisors report several benefits, worth the cost of five minutes of team time at the start of work.

(1) Every day, there is a specific team time to reflect on and share safety concerns with each other and the supervisor, reinforcing the message that everyone contributes to a safe environment.

(2) The huddle reduces the need for team members to find the supervisor during the day to report non-urgent issues that still require attention.

(3) The supervisor has one time every day to update the team on important non-urgent issues, no need to track down individuals.

(4) Looking back at yesterday’s work and patient cases is a relatively low burden for recall.

(5) Looking ahead at today’s work and patient cases with a focus on safety reinforces safety awareness and vigilance.

In efforts to promote greater attention to safety, we’ve observed that supervisors in ambulatory surgical centers often rely on verbal reminders and requests of staff to pay attention to safety. The huddle takes this inclination and roots it in the context of yesterday and today’s work and sets the stage for more effective ways to improve safety awareness and practice--ultimately, reconfiguration of work that uses visual cues and error-prevention designs.

Supervisors are linking the huddle to a couple of other management practices, too.  

(1) Visual management:  supervisors are testing a display at their huddle location to track concerns and share safety data.

(2) Observation of work methods:   supervisors are testing specific observation of the way work is supposed to happen—for example, how closely teams in the OR actually follow a scripted “time out.”

In sequencing the introduction of management methods, the daily huddle looks like a good starting point for a unit interested in sustaining specific safety practices. 

With a bit of experience with daily huddles, visual display and observation of work methods come next and are linked to the huddle--ideally, the huddle takes place in front of the visual display and observations of work methods inform the supervisor's view on safety performance.

Why does each agenda item deserve attention?

Agenda Item	Why include this item?
Safety concerns in past day: patients, staff, doctors	Daily probe by supervisor. This item gives team members a chance to reflect and state concerns that the team and supervisor need to hear and address. The concerns include staff and doctors as well as patients to drive the message that a safe environment is safe for everyone and to identify opportunities to keep staff and doctors safe, too. Example: Operating room RN was concerned about staffing of the sterile processing department during the last case of the day, in case equipment needed and OR team cannot leave the patient. Supervisor promised to align schedule of SPD with surgical case schedule.
Safety concerns for today’s patients	Highlight of patients that fall outside of typical pathway, a heads up for team. Example: patient with severe latex allergy. In this case, not only does the team hear about the specific case but the instance serves as a reminder to the team of the standard methods for allergy.
Review of tracked issues: status	Teams are testing a status list on their unit management display. Issues that can’t be addressed immediately are written down so not forgotten and then updates reported. Example: replacement of temporary sharps containers in the Post-acute care unit (recovery area) with standard containers.
Any other issues?	Opportunity to ask questions affecting work flow or anything else. The issues are not discussed or “solved” (that takes too much time) but captured by the supervisor to address outside the huddle. Example: black/white printer in nurses’ station off-line with network card, need to print to adjacent color printer.
Announcements	Opportunity for supervisor to give updates on training or special events—this seems like a “given” whenever a supervisor has a team gathered. However, the point is to keep this item short and use other ways (the schedule board or announcements board) to provide details. Example: three endoscopes are “down” but have been replaced with loaned equipment, no impact on work today.