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Huddles: Improve Office Efficiency in Mere Minutes

When you are looking for efficiency and teamwork, football players (yes, football players)

offer family physicians a very important lesson: A quick huddle can make certain that

everyone is on a single page.

The practice enhancement facilitators at TransforMED, an AAFP initiative that’s working

together with practices around the world to test a new model of family medicine, have

realized that daily huddles can help address a number of critical issues. Huddles permit

the practice to plan for changes in the daily workflow, manage crises before they arise to

make adjustments that improve patients’ access and staff members’ quality lifestyle.

Huddles work given that they demand rapid team formation and preparation at the practice

level.

Perhaps additionally, huddles could become part of a practice’s routine almost overnight,

because the TransforMED practices discovered. This article shares what these practices

have discovered about huddles and will be offering advice based on how you can begin using

them in your practice. (For more information in regards to the TransforMED national

demonstration project, see “TransforMED Tries to Rebuild Family Medicine,” FPM, May 2007.)
You should huddle if …

Consider this scenario: It’s Monday morning at Healthy People Family Practice, and also

the phones are actually ringing. The doctors and the staff members have in mind the day is

going to be busy, so they really all focus their energy on beginning see patients straight

away. Although this strategy saves time at the start, bottlenecks develop in the hour. A

lab report is missing. One patient needs an interpreter. Two physicals are scheduled back

to back, however the physician needs to leave early for the meeting. By lunchtime, the

whole staff is frazzled and running behind.

Sound familiar? It’s a scene that had been playing repeatedly at lots of the TransforMED

practices, but it is rarely seen given that huddles are employed.

Huddles have helped to eliminate these situations:

Confusion about provider availability for scheduling;

Lack of understanding broken equipment or unavailable labs;

Lack of preparation for scheduled patients who require additional time and assistance;

Staff shortages due to illnesses, vacations and family emergencies;

Chaos because of last-minute schedule changes, whether brought on by patients

(cancellations or no-shows), providers (unexpected hospital visits), office systems

(computer network down) or external factors (traffic jams, late busses), etc.;

Lack of awareness of how everyone contributes on the practice’s smooth functioning.

Huddles will benefit practices from a size. In large practices that use multiple hallways

or pods, someone from each hallway can attend the huddle and take information and facts

back to their area. In small or solo practices, huddles prevent issues that can arise when

anyone assumes that everybody else in the office knows what’s happening.
How to huddle

Huddles are certainly not unique for the TransforMED practices; the theory has been

promoted widely from the Institute for Healthcare Improvement and others.1,2,3 The secrets

to successfully implementing huddles inside a medical practice are highlighted below:

1. Get physician buy-in. Regardless of whether problems attends the meeting, his / her

support of daily huddles is very important to their success.

2. Settle on an occasion to meet consistently. It’s important how the “huddle time”

becomes a a part of everyone’s daily routine. However, it could take some experimenting to

determine what the proper time should be. If the first time you pick doesn’t appear to be

working, don’t throw in the towel. Try another time. Early morning huddles have worked

well for a few TransforMED practices, while other groups prefer to meet after lunch or

late within the afternoon.

3. Experiment with different participants. The best huddle won’t necessarily involve

everyone inside practice. At a number of the TransforMED practices, the physicians attend.

In other practices, the medical assistant or registered nurse attends after which reports

back to the physician.

4. Limit huddles to seven minutes or less. This keeps the meeting focused and prevents

downline from becoming long-winded.

5. Hold the huddle in the central location. For example, you could possibly simply gather

in the hallway outside the nurse’s station.

6. Have everyone stand the whole time. This helps keep your meeting short so you can get

time for seeing patients.

Two additional guidelines can be disregarded after a few weeks if everything works

correctly:

7. Designate a huddle leader and hang together an arranged agenda. (See “A suggested

huddle agenda.”) After a few weeks, the huddle will run itself.

8. Identify a huddle champion who can provide daily discipline. It’s best when the

champion is a physician or office manager. Once the huddles gain momentum, the benefits

become self-evident with no extra effort is essential. In the TransforMED practices, this

has usually happened anywhere between two days and a couple weeks.
A SUGGESTED HUDDLE AGENDA

Check for patients around the schedule who might require more time and assistance due to

age, disability, personality or language barriers. Who can help?

Check for back-to-back lengthy appointments, for example physicals. How can they be worked

around to prevent backlog?

Check for openings that might be filled or chronic no-shows that could be anticipated. Any

special instructions for the scheduler?

Check provider and staff schedules. Does anyone need to leave early or break for any phone

call or meeting?

Ask whether lab results, test results and notes off their physicians are ready inside the

patient’s chart. What will probably be the handiest path of patient flow?

Success stories

Many from the TransforMED practices who have implemented huddles have a hard time

imagining a day without them now. “Huddles were a foreign idea to us initially, however

they are an integral section of the workday,” says Randall C. Rickard, MD, of Family

Practice Partners in Murfreesboro, Tenn.

Rickard’s practice is housed by 50 percent different buildings, creating some unique

communication challenges. Its TransforMED facilitator suggested daily huddles so that you

can bring everyone inside practice together to get a few minutes. “We now begin daily with

mini-meetings between our doctors, nurses and receptionist. Team members are empowered and

aimed day-specific goals to relieve wait times and improve efficiency.”

Hays Family Medicine, a TransforMED practice in Hays, Kan., uses huddles to coordinate the

scheduling needs of eight providers scattered in three hallways. “Our afternoon huddles

allow us to discuss available openings for that next day,” says nurse manager Karen

Threlkel, RN. The hospital that owns the Hays practice recently instructed all of its

other departments to begin with using huddles like a tool to strengthen communication and

improve customer support, citing the Hays practice as one example to emulate.
Try one today

Just as huddles are critical around the football field, huddles as part of your practice

can begin to play an important role. A quick, efficient meeting with the minds galvanizes

practice-level thinking. The results? Big wins for both your practice as well as your

patients.

E. Stewart, PhD, B. Johnson, PhD; Fam Pract Manag. 2007; Jun;14(6):27-29.