A hospital achieved significant safety improvements by instituting a system of safety huddles. Staff and physicians meet regularly to alert one another to issues that have arisen or may arise in the next 24 hours.
- Safety huddles increased incident and event reporting by 51% over baseline from previous years.
- The huddles are intended to convey information, not be an opportunity for discussion.
- Participants Raised More Than 1,500 Issues In One Year.
Leaders at Bassett Medical Center in Cooperstown, NY, worried in 2014 that its culture of safety could be improved, particularly the length of time it took to resolve known safety issues. When a review of data revealed a decline in staff reporting actual and near-miss events, the vice president for patient safety and performance improvement called for the development of a safety huddle policy.
After a year of regular safety huddles, reporting of incidents has increased 51%, and participants reported more than 1,500 issues of concern.
Safety huddles were known to the leaders and staff at Bassett, but they had a reputation as one of those ideas that caused people to get excited initially but then lose interest, says Ronette Wiley, RN, MHSA, CPPS, vice president of performance improvement at the hospital.
“We heard from a number of people that safety huddles were useful until they fizzled out,” she says. “One of the things that made ours successful was that we developed monitoring and tracking tools to help hold people accountable. We also had a great champion for the safety huddles in our CEO, who tries to attend every safety huddle.”
The team designed a daily leadership safety huddle to promote awareness of issues within the previous 24 hours plus any issues that may arise in the next 24 hours. Leaders from 31 departments meet at 8 a.m. each day, which means that they must round on their units or otherwise contact their staff to be aware of any developments or concerns. There was some initial concern about that requirement being too onerous, so Wiley asked members to commit to only a 30-day trial period with the possibility of altering the time or frequency.
At the end of the 30 days, huddle participants reported that the meeting was ingrained in their workdays and should remain unchanged. Some members did ask for a call-in number so they could attend by phone, but that request was denied.
“We felt that was detrimental to the important face-to-face connection,” Wiley says. “We also wanted to resist our natural tendency to multitask as we’re driving or looking at something better on the computer.”
Six Rules for Huddles
Some departments were added to the original huddle team as the first year continued. The team leaders added the human resources and biomedical departments to the huddles when they realized that those departments often were copied or consulted on issues that arose.
Wiley says these are the key rules for making their safety huddles successful:
- Arrive on time.
- Plan ahead, and appoint a substitute if you cannot attend. Participants will sign in at each huddle so that attendance can be monitored.
- Give yourself enough time to meet with staff before the huddle so that you are well informed.
- Be prepared to present your information in a clear and concise way.
- Stick to the facts. If there is nothing to report, the participant will state that fact, and the huddle moves on to the next person.
- Do not discuss issues and potential solutions. The huddle is intended only to make others aware of issues; problem solving happens in a different venue.
In addition, Wiley says the success of the safety huddles can be attributed to the visibility of the CEO and senior administrative and medical staff at the daily huddles. It also is important to recognize participation, so each month Overlake presents each safety huddle participant with a small gift and a message of thanks. Anyone responsible for a “good catch” or providing outstanding care receives a signed certificate of appreciation.
Supervisors also bring staff members to the huddle to recognize them for doing something especially noteworthy.
Incident and event reporting increased 51% during the first year that huddles were implemented, and near-miss reports increased 86%. There were several concrete improvements from information reported at the safety huddles, Wiley says. (See the stories enclosed in this issue for more information on the results of the safety huddles.)
“One example is what we call ‘code grays,’ which is patient behavior escalating toward violence,” she says. “Last year we had a significant uptick that we learned about in the safety huddles, and after instituting a more robust de-escalation program, we’re now seeing a 60% reduction in those incidents.”
- Ronette Wiley, RN, MHSA, CPPS, Vice President of Performance Improvement, Bassett Medical Center, Cooperstown, NY. Email: firstname.lastname@example.org.