A few years ago, I semi-retired as the manager of a clinical engineering department in a large teaching hospital in California. When the subsequent manager retired this past summer, I became the interim manager during the long search for a replacement. That led to my first experience with healthcare “huddles.” At first, I thought huddles were just another management fad. But I soon learned how important they can be to hospital operations.
The Institute for Healthcare Improvement defines a huddle as “a short, stand-up meeting … that is typically used once at the start of each workday in a clinical setting.” The daily huddle “gives teams a way to actively manage quality and safety, including a review of important standard work such as checklists” and “enable[s] teams to look back to review performance and to look ahead to flag concerns proactively.” According to that definition, huddles typically focus on identifying problems—not necessarily solving them.
In my new role as interim manager, I saw that these short meetings, typically near the beginning of shifts, involved several different formats and participants ranging from daily huddles of individual groups within departments, to quality and safety huddles on the nursing floors, to a daily leadership huddle that my boss “asked” me to join. After seeing the first few leadership huddles, I realized its importance. The huddle—large, agenda-focused, and only about 30 minutes—really did succeed in focusing everyone’s attention. This one focused on improving the safety and efficiency of patient care and particularly on patient throughput, which is critical to efficient day-to-day hospital operations.
How does all of this affect healthcare technology management? Engineering and medical equipment issues come up in the huddle primarily in two categories: downtime of critical equipment that impacts patient throughput (e.g. a down CT, MRI, cardiac cath lab) or impacts to patient care (e.g. problems with a telemetry central station). Occasionally, the huddle will discuss medical device-related incident reports.
In these structured huddles, various departments (primarily in imaging) report on the impact of critical equipment that is not operational and impacts patient care and/or patient throughput. Clinical engineering is working with several departments to better define “critical equipment.” And it has been proposed that clinical engineering take responsibility for providing the leadership huddle with a daily “critical system down” slid—our 30 seconds of fame or infamy. Other clinical engineering staff are included in huddles that are used for quality and safety rounds and intradepartmental huddles for staff communication. The intradepartmental huddles are particularly important to help make implemented process improvement changes stick.
All of these frequent huddle interactions, at multiple levels of the organization, are helpful in improving communication. Huddles have also shown me the importance of moving from monthly, quarterly, and annual reporting of key performance metrics to daily or even real-time dashboards. Critical equipment down, work order backlogs, specific critical-equipment problems that need escalation, and more, are all metrics and information that are very useful at different levels of huddles.
I encourage you to peruse the Institute for Healthcare Improvement website to see if huddles may be able to help your department. Also, work with your CMMS (computerized maintenance management system) vendor and report writers to consider moving key operational performance metrics to real-time dashboards.
Ted Cohen, MS, CCE FACCE, is a clinical engineering consultant who has worked in the HTM field for 40 years. He is the co-author of the AAMI-published book, Computerized Maintenance Management Systems , and is a member of the BI&T editorial board.