Job Satisfaction:
Monash et al’s randomised controlled trial measured attending and trainees job satisfaction as a secondary outcome.35This was carried out using an electronic survey adapted from previously published work,42 however this is not a standardised, validated survey. The efficiency of the new style of rounds incorporating a huddle was assessed against normal rounding practices and it found that trainees found the rounding less efficient (60.5 v 72.3, intervention v control; p=0.008). Trainees reported that it increased workload for the rest of the day and gave them less autonomy. The opposite was reported for attending physicians. Jain et alreported that the ‘day’s flow’ improved dramatically after huddle implementation in a surgical environment (median rating increased from 5 to 9, with 10 being the best).34 The average number of unexpected delays also decreased post-implementation (15 v 4). This was a much smaller study however, with only three surgeons surveyed.
Dingley et al analysed 495 discrete communication events pre and post-huddle implementation.32 Trained data collectors were used to record communication processes within the health system by using a standard form and asking nurses their perception of communication events. Comparison of pre- and post-intervention positive resolution of communication/issue (nursing staff’s perception of resolution of the patient’s issue following an interaction/communication with medical staff) and satisfaction scores revealed a significant increase in positive resolution scores (p =0.04), and a difference in satisfaction scores approaching significance (p =0.08) in the Medical Intensive Care Unit and nonsignificant increases in resolution and satisfaction scores (p =0.13, p =0.53, respectively) in the Acute Care Unit. Positive responses to both the resolution and satisfaction questions in the post-intervention period increased.
Turnover intention has been shown to be a reliable indicator of job satisfaction.15,16 Hastings et al examined intent to leave within the next twelve months. This was conducted using staff interviews (n=15) and staff surveys (n=25) and showed those that implemented team huddles were significantly less likely to plan to leave after implementation than they were before the new model was introduced (20% at final evaluation vs. 48% at baseline).33This included nursing staff, allied health professionals, managers, and physicians. Of note, there were multiple changes to the organisation including comfort rounds, bedside shift reports, patient whiteboards, rapid rounds, and team huddles.
Newman et al similarly found improved job satisfaction across all provider groups (cardiologist, resident, nursing staff).36 Job satisfaction was measured using an electronic survey that was piloted to twelve senior staff members to establish validity. Pre-post intervention surveys asking if staff had a positive overall experience working in the unit resulted in (20 v 25 residents agree/strongly agree (n=26 pre) (n=25 post); p=0.001), (8 v 16 cardiologists agree/strongly agree (n=14 pre) (n=17 post); p=0.005), (3 v 13 nursing staff agree/strongly agree (n=14 pre) (n=15 post); p < 0.001).
The job satisfaction ratings post-huddle implementation were also higher in Rodriguez et al’s study. They measured differences in ‘huddlers’ and ‘non-huddlers’ by using a survey that included the experiences of teamwork and practice climate.1 Those who implemented daily huddles in their practice were found to have higher satisfaction with their teams (83.1% v 51.7% satisfied; p <0.001), higher psychological safety (61.7% v 46.0%; p <0.001), and better experiences of practice communication (60.9% v 48.1%; p <0.01). However, 42% (n=174) of those surveyed indicated they found huddles ‘not very helpful’ when asked. Psychological safety in the workplace has been strongly linked to improved job satisfaction in the literature.46
As previously mentioned communication between team members has been shown to be a specific intervention that improves interdisciplinary teamwork21 O’Malley et al similarly reported that huddles played a role in improved communication among healthcare professionals and that this improved communication resulted in higher job satisfaction.37 23 out 27 practices mentioned that huddles were ‘key to maintaining structured communication within teams’ . Participants who adopted new forms of delegations such as huddles reported improved provider satisfaction and productivity.
However, it was also found that not all teams found the huddle was required to improve work engagement, teamwork, or job satisfaction. Rodriguez et al reported that some teams that did not choose to partake in daily huddles “have positive experiences of teamwork and indicated daily huddling was not necessary once team norms were firmly established and roles and responsibilities were very clear”.1 It is noted however that a greater proportion of non-huddlers interviewed described “challenging interpersonal dynamics among team members”.