Expanding clinic huddles to other staff members reduces burnout, identifies IT issues

While the idea of huddles has been utilized in primary care among clinicians and medical assistants for some time, recent research suggests that including other medical staff also yields positive results.

Opening up huddles to include more than just clinicians and medical assistants can enhance efficiency and lead to better connectivity which, in turn, can lower rates of physician burnout, a clinician told Healio Family Medicine.

“A huge part of physician burnout is due to inefficiencies in the system and getting bogged down in tasks that do not reflect what a clinician can do with his or her license,” Ann Tseng, MD, of the department of family medicine at Oregon Health and Science University, said in an interview. “What’s nice about huddles that include the support staff members is you can plan ahead, so the supporting staff members know how to assist you in tasks such as getting the appropriate paperwork and records. It really does help reduce some of the inefficiencies in the entire system and thus helps reduce burnout as well.”

Her practice utilizes four different types of huddles: 1) clinic leadership; 2) registered nurse care manager and clinician; 3) behavioral staff member and clinician; and 4) front desk staff member and clinician.

Tseng said she saw other benefits after implementing the changes. Notably, expanding the huddles increases engagement between all members of a practice or care unit, fostering stronger professional relationships and connectivity.

“While the medical assistants and primary care physicians were reporting very good teamwork in the care of patients, our front desk felt disconnected from that purpose. By including the front desk, our staff members feel more appreciated. Beyond that, the huddles ensure that patient care is given in the most efficient and effective ways,” she added.

Research published in the Journal of American Medical Informatics Association showed another potential benefit to expanding huddles beyond clinicians and medical assistants.

In this study, researchers obtained data from 249 ‘safety huddles’ among administrative, clinical, and information technology staff at a midsized tertiary-care hospital in the United States during a 1-year period to identify and learn about electronic health record-related safety concerns.

Dean F. Sittig

“To date, we have had very little luck getting users to report all but the most egregious errors. The huddles seemed like a ‘safe’ place for them to talk about these types of events,” Dean F. Sittig, PhD, School of Biomedical Informatics, University of Texas Health Science Center, told Healio Family Medicine.

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Sittig and colleagues identified 245 EHR-related safety concerns, with most (n = 102) involving ‘EHR technology working incorrectly,’ followed by ‘EHR technology not working at all’ (n = 63), identifying EHR technology that was missing or absent (N = 41) and concerns linked to user errors (n = 39).

“EHR-related safety issues are often overlooked and continue to lead to patient harm,” Sittig said. “Organizations need methods of identifying these types of errors and getting them fixed. The EHR can be a huge tool to improve safety if used completely and correctly. Safety huddles are a great method to keep everyone apprised of what is going on in the organization.”

To maximize the chances for huddle success regardless of reason, Elizabeth E. Stewart, PhD, and Barbara C. Johnson, PhD, suggested these steps in an article that appeared in Family Practice Management.

Get physician buy-in;
Agree to a consistent time to meet;
Try out different participants;
Capping huddle time to 7 minutes or less;
Conduct the huddle in a central location;
Have everyone stand the entire time;
Choose a huddle leader and put together a structured agenda; and
Identify a huddle champion who can provide discipline each day.

“Just as huddles are critical on the football field, huddles within your practice can play an important role. A quick, efficient meeting of the minds galvanizes practice-level thinking, they wrote. “The results? Big wins for both your practice and your patients.”

Tseng acknowledged that long-standing system change, such as using huddles, can be hard to implement, but also emphasized it is worth making the change.

“When I reflect on how we adopted some of these practices, I can’t imagine doing it the old way. As a physician, I didn’t realize how much of my time was being wasted in inefficiency until experiencing some of these new ways of doing things,” she said. “This can be hard to imagine when you’ve been doing something in a certain way for a very long time. But, the career of medicine is a marathon, 30 years or more for most of us, so when you look at the long game you have to play, you have to change to keep that joy in practice.” - by Janel Miller

References: Johnson BC, Stewart EE. Fam Pract Manag. 2007 Jun;14(6):27-29.

Menon S, et al. J Am Med Inform Assoc. 2016;doi:10.1093/jamia/ocw153.

Tseng A. Ann Fam Med. 2017;doi:10.1370/afm.2156.

Disclosures: None of the authors report any relevant financial disclosures.