Team huddles: the role of the primary care educator

Fogarty, Colleen T.; Schultz, Stephen

doi:10.1111/j.1743-498x.2010.00369.x

Cited by 23 publications

(20 citation statements)

References 5 publications

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“…To determine the conceptual framework on teamwork that best fit the themes and codes we had identified in this first phase, we used the list of available frameworks from our prior literature review 1,2,9,20 and settled on the Ghorob and Bodenheimer framework, 2,12 which identifies five key elements of team building: 1) Defined Goals, such as specific measurable operational objectives; 2) Systems, including the physical arrangement of team members and clinical systems (e.g., standing orders for common situations); 3) Division of Labor, including clear task definition and role assignment; 4) Training of team members on their functions; and 5) Communication, including communication structures (e.g., instant messaging and informal face-to-face gatherings of the clinical team known as "huddles" 21, 22 ) and processes (e.g., feedback, conflict resolution).…”

Section: Discussionmentioning

confidence: 99%

Overcoming Challenges to Teamwork in Patient-Centered Medical Homes: A Qualitative Study

et al. 2014

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BACKGROUND: There is emerging consensus that enhanced inter-professional teamwork is necessary for the effective and efficient delivery of primary care, but there is less practical information specific to primary care available to guide practices on how to better work as teams. OBJECTIVE: The purpose of this study was to describe how primary care practices have overcome challenges to providing team-based primary care and the implications for care delivery and policy. APPROACH: Practices for this qualitative study were selected from those recognized as patient-centered medical homes (PCMHs) via the most recent National Committee for Quality Assurance PCMH tool, which included a domain on practice teamwork. PARTICIPANTS: Sixty-three respondents, ranging from physicians to front-desk staff, were interviewed from May through December of 2013. Practice respondents came from 27 primary care practices ranging in size, type, geography, and population served. KEY RESULTS: Practices emphasizing teamwork overcame common challenges through the incremental delegation of non-clinical tasks away from physicians. The roles of medical assistants and nurses are expanding to include template-guided information collection from patients prior to the physician office visit as well as many other tasks. The inclusion of staff input in care workflow redesign and the use of data to demonstrate how team care process changes improved patient care were helpful in gaining staff buy-in. Team "huddles" guided by pre-visit planning were reported to assist in role delegation, consistency of information collected from patients, and structured communication among team members. Nurse care managers were found to be important team members in working with patients and their physicians on care plan design and execution. Most practices had not participated in formal teamwork training, but respondents expressed a desire for training for key team members, particularly if they could access it on-site (e.g., via practice coaches or the Internet). CONCLUSIONS: Participants who adopted new forms of delegation and care processes using teamwork approaches, and who were supported with resources, system support, and data feedback, reported improved provider satisfaction and productivity. There appears to be a need for more on-site teamwork training.

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Section: Discussionmentioning

confidence: 99%

Overcoming Challenges to Teamwork in Patient-Centered Medical Homes: A Qualitative Study

et al. 2014

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“…9,10 In addition, recognizing coaching as pedagogy for workplace learning that could provide teams insights and feedback on team processes • Trainee interviews (perceived impact on patient care) *Aims: 1 = Cohere as team members with interdependent tasks rather than as autonomous individuals completing independent tasks; 2 = Participate consistently in team huddles through physical presence as well as active contribution to discussions; 3 = Use skills such as distributive leadership, active listening, negotiation, and conflict resolution to support effective teamwork in the huddle and beyond. On trainees' first day in clinic together, we held an introductory session in which we reviewed "how to huddle" guidelines derived from the literature, then watched a video of a huddle and evaluated it according to the huddle guidelines.…”

Section: Program Descriptionmentioning

confidence: 99%

Huddle-Coaching

et al. 2014

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Many outpatient clinics where health professionals train will transition to a team-based medical home model over the next several years. Therefore, training programs need innovative approaches to prepare and incorporate trainees into team-based delivery systems. To address this need, educators at the San Francisco Veterans Affairs (VA) Medical Center included trainees in preclinic team "huddles," or briefing meetings to facilitate care coordination, and developed an interprofessional huddle-coaching program for nurse practitioner students and internal medicine residents who function as primary providers for patient panels in VA outpatient primary care clinics. The program aimed to support trainees' partnerships with staff and full participation in the VA's Patient Aligned Care Teams. The huddle-coaching program focuses on structuring the huddle process via scheduling, checklists, and designated huddle coaches; building relationships among team members through team-building activities; and teaching core skills to support collaborative practice. A multifaceted evaluation of the program showed positive results. Participants rated training sessions and team-building activities favorably. In interviews, trainees valued their team members and identified improvements in efficiency and quality of patient care as a result of the team-based approach. Huddle checklists and scores on the Team Development Measure indicated progress in team processes and relationships as the year progressed. These findings suggest that the huddle-coaching program was a worthwhile investment in trainee development that also supported the clinic's larger mission to deliver team-based, patient-aligned care. As more training sites shift to team-based care, the huddle-coaching program offers a strategy for successfully incorporating trainees.

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“…The direct effect of teamwork on readiness for change, however, was 2.9 times larger than the direct effect of team member availability on readiness for change, indicating that intervening directly to improve teamwork may be more effective in supporting change readiness than improving team structure. Recent structured team communication interventions, such as team huddles (Fogarty & Schultz, 2010) and other organizational supports for improving team communication, may facilitate important practice changes critical to patient-centered care because these communication structures can improve team member availability (Rodriguez, Meredith, et al, 2015). Our findings underscore how primary care teams with better teamwork might be better positioned to galvanize resources and collective efforts to overcome the disruptive changes sometimes experienced by clinicians and staff as part of PCMH implementation.…”

Section: Practice Implicationsmentioning

confidence: 98%

“…D eveloping a high-functioning interdisciplinary primary care workforce is widely considered a critical delivery system strategy for meeting the demands of an aging population with increasing needs for chronic illness care (Bodenheimer, 2006;Bodenheimer, Chen, & Bennett, 2009;Grumbach & Bodenheimer, 2004). An increased demand for primary care services and projected shortfalls in primary care physician supply under current delivery models necessitate greater involvement of nonphysician clinician and staff in patient care.…”

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confidence: 99%

Availability of primary care team members can improve teamwork and readiness for change

Rodríguez

Chen

Martínez

et al. 2016

Health Care Manage Rev

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Ensuring that members perceive that their teammates are routinely available to them may improve readiness for implementing organizational changes like adopting patient-centered medical home models. Given that better teamwork only partially explained the availability-readiness relationship, additional research to identify the mechanisms through which consistent team member availability increases change readiness could lend insight into how to more effectively support clinicians and staff undergoing complex organizational changes.

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Team huddles: the role of the primary care educator

Abstract: We review considerations in applying the team huddle to practice, and provide recommendations for ambulatory health care educators to teach this technique to trainees.

Cited by 23 publications

References 5 publications

Overcoming Challenges to Teamwork in Patient-Centered Medical Homes: A Qualitative Study

Overcoming Challenges to Teamwork in Patient-Centered Medical Homes: A Qualitative Study

Huddle-Coaching

Availability of primary care team members can improve teamwork and readiness for change

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