Daily safety briefings or huddles have become a long-standing practice in hospitals across the country—and for good reason. These briefings identify current and future safety risks by increasing awareness and understanding of safety events and vulnerabilities that are within the environment and encouraging collaboration to resolve those issues in real time.
This daily snapshot of safety can have a significant impact on an organization’s safety culture by demonstrating a leadership commitment to the safety of patients and staff, providing the opportunity for front-line leaders to speak up about and be accountable for safety, and enhancing the organization’s ability to learn and improve system weaknesses using Robust Process Improvement tools. The overarching goal is to use daily safety briefings to reduce harm for patients and staff.
Despite the clear benefits, some organizations struggle to keep huddles meaningful and productive to identify safety risks. Potential barriers may be a lack of senior leadership attention to and support for resolving risks and front-line managers’ lack of knowledge about what issues should be discussed in a huddle. Some organizations may also experience a culture of mistrust, fear of speaking up and even intimidating behaviors. In too many cases the focus of the briefing drifts from patient and staff safety to operations, staffing and bed management.
Since briefings require commitment, time and resources, it is important to periodically stop and reflect on what you are learning from your briefings to get the greatest benefit from this effort.
Here are some key questions to consider:
Is Our Huddle Process Running Smoothly?
- A defined agenda (order of reports) and a “scripted” report with metrics for each department to share helps to keep the huddle focused on key safety issues. Scripting takes into account events in the previous 24 hours, anticipated risks for the next 24 hours, updates on the resolution of safety risks identified the previous day and requests for assistance.
- With the COVID-19 pandemic, many organizations have moved to a virtual platform to ensure social distancing. One of the benefits of meeting face to face is the opportunity for a meeting after the meeting, where leaders have an opportunity to address concerns immediately after the huddle. Instead of virtual meetings, consider identifying a larger space to allow for adequate social distancing. If not, create opportunities to continue face-to-face work in small groups after the meeting or use virtual breakout rooms for post-huddle discussions.
- Safety briefings should occur seven days a week. Although a weekend briefing may look different due to fewer participating departments, it is critical to have a structured daily approach to identify potential risks.
Do We Have the Right People Engaged in the Briefing?
- It is important to have a representative from every department at the briefing. Active daily involvement of the CEO and senior leaders demonstrates a focused commitment to patient and staff safety; their visible leadership helps to build a culture of safety, where everyone feels free to speak up. In many organizations, the CEO leads—or at least opens or closes—the briefing. This engagement is a wonderful opportunity to model and coach positive behaviors for front-line leaders.
- Consider inviting others to observe and participate in the huddle periodically, from board members to physicians to front-line staff. Welcoming others is a tremendous opportunity for everyone in the organization to gain awareness of the importance of resolving safety risks as soon as they arise. Incorporate observation of the huddle into your orientation programs to communicate the importance of quality and safety for your organization’s high-reliability journey.
Are We Getting the Information That We Need to Address Patient and Staff Safety Risks?
- As a team, ask yourselves: What have we learned about safety risks in the last year? Are we getting the information that we need from the huddle? What are the barriers to getting the information that we need? In many organizations, “nothing to report” or “no issues or concerns” are frequent comments in daily huddles, which may mean that managers do not have a good understanding of what is a potential concern that should be shared. Organizations that have successfully implemented effective huddles are educating and coaching front-line managers about what to verbalize in a huddle. This may take working with the individual leader to identify meaningful potential risks specific to that department that can be shared.
- It is important to track safety risks that are shared so that you can identify trends. Ask yourself: Why do we keep hearing about the same risk? Hasn’t this happened before? Briefings provide an opportunity to get a wealth of data, which can then be used to strengthen safety systems. Using data on trends helps to prioritize unsafe conditions and near-misses that need a deeper dive, using root-cause analysis, failure mode and effects analysis.
Are We Holding Ourselves Accountable for Loop Closure?
- The organizational safety huddle is typically not the forum to actually resolve the problem, but it is the opportunity to manage accountability for resolution. One of the key huddle agenda items is the follow-up on issues identified the previous day and setting a date for resolution of longer-term items. White boards in huddle meeting space or in administrative offices can be used to track items and demonstrate transparency and accountability. You can also track the number of risks identified and resolved as a metric of effectiveness.
- When risks are identified and resolved, it is important to have a structured approach to get this critical information back to the people that need it most—the front-line workers. This may be through a hospitalwide email blast, an alert on the EHR or a midday huddle with managers. This effort helps to keep safety front and center in everyone’s mind throughout the day. Senior leaders can also address loop closure during their safety rounds.
Do We Routinely Look for Opportunities to Improve and Celebrate Our Successes?
- Evaluate your daily safety briefing on a consistent basis, which will help keep it fresh and provide opportunities to ask what can be improved. Consider a survey of participants to get their feedback and ideas on what could keep the process meaningful.
- Use the briefing time to share safety stories and lessons learned, and reflect on what is going well. Being intentional about this practice will help to break down siloes. Your briefing is a great opportunity to celebrate milestones you have achieved with key quality and safety metrics, which fosters camaraderie with your team.
The daily safety huddle is one of the most effective team-building and quality-improvement resources in our toolbox, especially when we commit to careful analysis and open conversation about the best way to use this valuable approach.
LuAnn Vis, RN, is associate director, High Reliability Initiatives, Joint Commission Center for Transforming Healthcare (lvis@jointcommission.org).