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.