Teamwork:
Six included studies looked at the impact of huddles and quality improvement interventions on teamwork.33,35,36,38,39,41
Of 12 studies, only two were controlled trials.35,38Monash et al measured attending and trainee physicians’ perception of nursing involvement during morning rounds. The new structure of rounding introduced in the intervention arm incorporated a pre-round huddle. Level of agreement for a statement (e.g., I am satisfied with morning rounds) was measured on a continuous scale; 0 (far too little) to 100 (far too much), with 50 being ‘about right’. This was carried out using an electronic survey adapted from previously published work,42 however this is not a standardised, validated survey. They measured the standard mean of attending and trainee responses and found both groups in the intervention arm perceived a significantly higher level of nursing involvement during morning rounds than the control arm; (44.6 v 35.7 adjusted mean, p=0.032) and (45.2 v 37.7, p=0.006) respectively. It is likely that this extra involvement bolstered team dynamics and enhanced workflow and engagement, improving the teamwork of healthcare staff involved.43
Pannick et al measured the effect of introducing daily briefings with teams over a six-month period and found improvements in both teamwork attitudes and patient safety outcomes.38 With sustained implementation, the estimated marginal mean ‘teamwork score’ significantly improved (81.7 v 70.0, p=0.004). The teamwork score measures the perceived quality of collaboration between personnel.
Communication between members of a healthcare team has previously been shown to be one of the most important factors to improve teamwork and work engagement.44 Stapley et al conducted 76 semi-structured interviews with staff members on four wards four months after the intervention.40 Thematic analysis showed that the huddle helped to ‘increase their awareness of important issues … communication, teamwork, and encourage a culture of increased efficiency’. One nurse described that the daily huddle helped the team work better on the ward:
“I think it helps that boundary between medical staff and nursing staff, it sort of links them a little bit more.”
Rodriguez et al reported that huddles were described as an important mechanism to ensure member awareness of what each team member’s role is and improved communication between members.1 When one registered nurse was asked what she felt was the most important change implemented she said:
“To be honest, the huddle, because you’re communicating with each other, you know? And that’s key to everything. To have success for any relationship whether it’s with - for the patients’ benefits, when we’re getting it across and trying to solve problems, looking at it and tackling it.”
Scotten et al also showed that the daily brief helped to improve teamwork across the hospital by looking at the results of the TeamSTEPPS Teamwork Perceptions Questionnaire.39 This looked at the individuals’ perception of teamwork with a five-point Likert scale. The mean for teamwork rating improved by 14.1% post-intervention, p <0.05.
Goldenhar et al conducted semi-structured interviews and focus groups to obtain a deeper understanding of the huddle system and its outcomes as implemented in a large academic tertiary care children’s hospital.20 One of their five key themes was ‘sense of community’. Participants reported that they had a ‘deeper understanding of what their colleagues across the hospital deal with on a daily basis’ and that this makes them ‘feel more connected to their peers’. Another key theme reported was a ‘culture of collaboration/collegiality’. Since introduction of the huddle system, one participant commented that:
“Anti-competition, consideration, compassion -don’t assume that the unit is saying no because they don’t want to help, all have a better idea of what’s going on on other units and know that everyone is busy!”
The Canadian Interprofessional Health Collaborative National Interprofessional competency Framework45 was used by Hastings et al to develop staff surveys.33 They introduced a number of new processes including regular care-hub huddles. Perceptions were measured with a Likert scale and completed at baseline and post-intervention. Similar to the previous studies mentioned, responses increased significantly for ‘collaboration and communication’ post-introduction of a huddle (4.4 v 3.4; p <0.001).