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).