This play was developed by the Institute for Healthcare Improvement (IHI) based on their work in the Better Health and Lower Costs for People with Complex Needs collaborative, which ran from 2014-2017.
Establishing regular huddles as a part of a complex care program is a strategy to actively manage quality by allowing care teams to work and problem solve together. They also help teams track whether they are meeting program performance expectations and goals. For teams that work together on a daily basis, a daily huddle can be used to review the day ahead, orchestrate tasks, and to collectively strategize how to best handle complicated issues. For teams that come together less frequently, regular huddles can still help them keep programs on track, share lessons learned, and solve or escalate general program issues.
The goal of daily huddles is to manage the implementation of your enhanced care program.
- Develop a standard schedule and format for the huddle, including who will attend, a regular time when they will occur, who will lead the huddle, how long the huddle will last, and how decisions will be made and documented. Consider starting with this agenda:
- Concerns and problems from the day before, including with patients, physicians, and staff
- Anticipated issues for today
- Review of tracked problems (follow-up on past issues)
- Input from staff
- Create a huddle board with key information on the team’s work, including the names of patients with active issues being addressed, items marked for follow-up from previous discussions, notation of new tasks, and an overview of the team’s active workload.
- Each day, assemble the team for a huddle and follow a huddle agenda. Update the huddle board with the latest information at the end of each huddle.
- At regular intervals, discuss the effectiveness of the huddles with the team to keep staff engaged and continue improving the process.
- Huddles are helpful in fully integrated, centralized teams working with the same set of patients. In a complex care program, this may be the complex care team or the primary care team, if the care coordinator is embedded in primary care.
- For huddles to be sustainable, team members need to experience them as an effective use of time. Like any work process, someone, usually in the program leadership, needs to attend to continuous process improvement for the huddles themselves.
- Most frequently, huddles will focus on the daily work ahead. Less often, the discussion will focus on solving problems, escalating problems that can't be solved by frontline teams to the next level of management, and sharing lessons learned. Consider setting a regular time to check in on these issues.
- Huddles can focus on different issues at different times, depending on what the team is working on. Keeping the huddle board up to date, as a reminder is key for this to be effective.
- While huddles focus on the frontline team’s work, higher-level managers in the organization should also actively manage quality, including setting time aside to resolve problems escalated by frontline teams.
- Managers may or may not participate in huddles. When they do, their goal should be to support the team, not to take a punitive approach to quality issues. Huddles are working well when the team sees value in conducting them even when a manager is unavailable.
- While most huddles focus on tasks at hand, they can also be used for case reviews to help the program understand where it is being most effective (and might want to increase efforts) as well as where it is being least effective (and might want to refocus or change its approach.) Working on the program is as important as working in the program.
For more information
- View a printable PDF of this Play.
- Learn more about IHI's complex care efforts.
- Review slides on Active Daily Management, an approach from Lean management that includes huddles, from Stanford Coordinated Care.
- Read the Sustaining Improvement white paper from IHI for an in-depth discussion of the use of Visual Management for quality control, which includes huddle boards.
- Download the free IHI tool on how to implement daily huddles for quality and safety.
- Review slides from the IHI program Sustaining Improvement, including examples of a huddle agenda and huddle board.