Strengths and limitations:
An important strength of this review is that it has systematically collated evidence on the impact huddles can have on a healthcare team’s job satisfaction and teamwork. The lack of published data on the impact of the huddle on work engagement highlights the need for future research in this area. The review adopted broad inclusion criteria and interrogated five major research databases to identify as many relevant studies as possible. This review used two different appraisal tools to minimise bias and appraise the quality of included studies. Due to the fact surveys used in the studies identified tended to report more positive outcomes, the mixed methods approach of many of the studies included allowed us to see both sides more clearly, while simultaneously allowing the data specifically to the huddle to be extracted and reviewed.
The variability in intervention models and in the measurement tools used in the studies we reviewed reflects the lack of a standardised framework for huddle implementation and appraisal. Intervention models varied from entire new care processes that incorporated a huddle33to a night-shift interprofessional huddle.36 Within these, the comparable interventions were variously reported as ‘briefs’, ‘huddles’, or ‘pre-rounds’. This lack of common language makes synthesising data and comparing studies challenging. This has previously been documented in reviews related to huddles and patient handoffs.7,53 We would support the proposed taxonomy and standardisation of reporting measures for future huddle-related studies as proposed by Franklin et al,7 however we would also suggest that staff satisfaction is measured by a validated survey, such as the Satisfaction of Employees in Health Care survey (SEHC)54 or the Hospital Survey on Patient Safety Culture (HSOPSC)55 as part of the safety culture measures to support future comparability of studies.
However, a limitation of this review is that many studies implemented whole new care processes, rather than just introducing the huddle concept. This makes it challenging to isolate the impact of the huddle when part of a complex intervention. Additionally, the use of a validated common survey to evaluate outcomes was rare. Publication bias may result in successful huddle programme implementations being over-represented in the literature we identified. Finally, almost all the studies in our review were uncontrolled, pre-post studies, conducted in a single hospital/ward, in one country, with relatively small sample sizes, and a lack of rigorous study designs. All the studies included took place in the UK or the USA. We therefore cannot generalise the findings to other health service contexts, or to low and middle-income countries.