Meeting slide deck from the May meeting. Contact dr98@le.ac.uk for further information

1. SAFETY HUDDLES
EAST MIDLANDS EMERGENCY & MATERNITY DEPARTMENTS
FORMING A COMMUNITY OF PRACTICE

2. AGENDA
• 0930-1000 NETWORKING/COFFEE
• 1000-1030 WHAT YOU THINK YOU ARE
HERE FOR
• 1030-1045 WHAT WE THINK WE ARE
HERE FOR
• 1045-1115 WHAT ARE YOU DOING,
WHAT PLANS THEY HAVE?
BREAK
• 1115-1145 DEFINING THE PROBLEM
• 1145-1215 WHO LEADS WHO?
LUNCH
• 1300-1400 LOCAL CHANGE FOR
LOCAL PEOPLE
• 1400-1500 PRESENTATIONS OF PLANS
• 1500 HOW DO WE TAKE THINGS
FORWARD?

4. WHY YOU THINK YOU ARE HERE?
• EACH INDIVIDUAL/TEAM TO DESCRIBE THEIR REASON FOR ATTENDING…

5. WHY WE THINK YOU ARE HERE?
• ORIGINAL PURPOSE
• WHAT HAS BEEN ACHIEVED SO FAR?

6. WHY ARE WE HERE TODAY?
Ineffective communication is one of the
leading causes of medical errors and patient
harm
Early recognition of deteriorating patients
significantly reduces hospital mortality rates

7. CONTEXT: DETERIORATION IN PATIENTS
• SUIS: FAILURE TO RECOGNISE AND RESPOND TO DETERIORATION IN PATIENTS
• LETHAL PROBLEM: UP TO 6000 PATIENTS A YEAR DYING AS A RESULT OF FAILURE TO
RECOGNISE EARLY WARNINGS OF DETERIORATION (RCP, 2012)
• DETERIORATION AS A RESULT OF FAILURE:
• TO MONITOR AND OBSERVE PATIENTS ADEQUATELY,
• TO RECOGNISE THE DETERIORATING PATIENT,
• OF HEALTHCARE TEAMS TO COMMUNICATE EFFECTIVELY,
• TO RESPOND CORRECTLY OR IN A TIMELY MANNER
(PEARSON, 2011; NATIONAL PATIENT SAFETY AGENCY, 2009)
Early recognition of deteriorating patients
significantly reduces hospital mortality
rates

8. CONTEXT: CAUSES OF FAILURES
• MULTI-FACTORIAL CAUSES
• NOT UNIQUE TO A SINGLE ENVIRONMENT
• COMMUNICATION AND SITUATIONAL AWARENESS
• APPROACHES TO SOLUTIONS INCLUDE TECHNOLOGICAL:
• (PAEDIATRIC) EARLY WARNING SCORES ((P)EWS)
• ELECTRONIC OBSERVATIONS
Ineffective communication is one of the
leading causes of medical errors and patient
harm

9. CONTEXT
• UHL NHS TRUST SOUGHT TO IMPROVE COMMUNICATION, SITUATIONAL AWARENESS
AND TEAM WORKING
• HUMAN FACTORS EXCHANGE, COOPERATION BETWEEN:
• HEALTH EDUCATION ENGLAND ACROSS THE EAST MIDLANDS,
• EAST MIDLANDS ACADEMIC HEALTH SCIENCE NETWORK,
• UNIVERSITIES OF LEICESTER, NOTTINGHAM, LOUGHBOROUGH AND UHL

10. • ALLOW ANTICIPATION
• EMPOWER STAFF
• BUILD A GREATER SENSE OF
COMMUNITY, TEAM WORKING
AND TRUST
• INCREASE RESPECT AND
APPRECIATION OF OTHERS
• SHARE LEARNING
• CELEBRATE SUCCESS
WHAT IS A SAFETY HUDDLE?

11. WHAT IS A SAFETY HUDDLE?
• HUDDLES ARE BRIEF MEETINGS OF KEY PEOPLE WHO
HAVE INFORMATION OR WHO CAN INFLUENCE TEAM
WORKING AND PATIENT FLOW
• PROVIDE FRONTLINE STAFF A MECHANISM TO STAY
INFORMED, REVIEW EVENTS, MAKE AND SHARE PLANS
TO ENABLE OPTIMALLY COORDINATED CARE
• TEAM LEARNING
DEVELOPMENT:
Perception
Comprehensio
n
Projectio
n

12. RESOURCES
http://pediatrics.aappublications.org/content/131/1/e298.full.html
http://qualitysafety.bmj.com/content/22/11/899

13. SAFETY HUDDLES
• MULTI-PROFESSIONAL, STRUCTURED, QUICK, TEAM OR
GROUP MEETINGS HELD IN THE WORKING ENVIRONMENT
• DISTINCT FROM WARD/BOARD ROUNDS & HANDOVER!
• IDENTIFIED AS A SOLUTION TO OVERCOME POOR
COMMUNICATION AND IMPROVE BOTH INDIVIDUAL AND TEAM
SITUATIONAL AWARENESS (GOLDENHAR ET AL, 2015)
• FOCUS SINCE MIGRATION FROM AVIATION (E.G. TAYLOR, 1990)
• SUCCESSFUL ADOPTION IN USA (GOLDENHAR ET AL, 2013)
• INSTITUTE FOR HEALTHCARE IMPROVEMENT (2016) AND
HEALTH FOUNDATION

14. SAFETY HUDDLES
• A SNAP SHOT OF
• WHAT IS GOING ON,
• WHAT IS NEEDED, AND
• WHAT COULD BE IMPROVED UPON
• PROVIDE THE OPPORTUNITY TO
• TAKE STOCK
• IDENTIFY ‘WATCHERS’ / PATIENTS WITH DETERIORATING
ACUITY
• REFLECT
• IMPROVE TEAM SITUATIONAL AWARENESS WHICH CAN
REDUCE HARM (PAUL ET AL, 2010)
• CONTRIBUTE TO A SAFETY SURVEILLANCE SYSTEM
Children's Hospital Safety Huddles
https://vimeo.com/157569622

15. SITUATIONAL AWARENESS
• AVIATION, NUCLEAR POWER AND THE OIL INDUSTRY
• WELL DEBATED CONSTRUCT (ENDSLEY, 2015)
• DEFINITION (SEE STANTON ET AL, 2010)
• MEASUREMENT (SEE SALMON ET AL, 2009 FOR A DISCUSSION, AND
EXAMPLES FOR MEASURING BOTH INDIVIDUAL AND TEAM SITUATIONAL
AWARENESS ACROSS TAYLOR, 1990; DURSO ET AL, 1998; GOLOMBEK ET AL,
2015; GOLDENHAR ET AL, 2015)
• IDENTITY ACROSS DISCIPLINES (SEE ENDSLEY, 2015 FOR A DISCUSSION
AND DANE, 2011 FOR AN EXAMPLE OF APPLICATION IN MANAGEMENT)
• LOTS OF ATTENTION IN HEALTHCARE

16. SITUATIONAL AWARENESS
Knowledge
• Medical
• Nursing
• Family
Experience
• Training
• Life Skills
Information
• History & Obs
• Conversation
• Technology

17. DOES AND
SHOULD YOUR
CLINICAL
ENVIRONMENT
CHANGE YOUR
HUDDLE?

18. Board
Round
Huddle
Other
(e.g. walk
round)
What can it
do?
What can’t
it do?

19. Within 3 months
95% of the time
a recipient will
receive a cup of
tea they are
satisfied with
(3+ on a score of 1-5)
Aim
Tea preference of recipient
(type of tea)Knowledge
Skill
Primary
Driver
Equipment
Secondary
Driver
Quality
Tea mix (temp/milk etc)
Service
Mix of tea with milk
Temperature of water
Quality of the tea bag
‘Feel’ of the porcelain
Time from brewing to
delivery to recipient
Brewing time

20. Aim
Confidence and Skills of
Doctor and Nurse-in-
charge
Leadership
Capacity/Flexibility
Drivers
Effective Patient
Escalation
Context
Capability/Skill Mix
Communicatio
n
Interaction of doctor and
nurse-in-charge
A reliable measure of
acuity or deterioration
Communication Tools
(SBAR etc)
Appropriate
response to
Triage/DPS scores
Staff Numbers
Patient Satisfaction
Staff skill mix
What are the
domains that
influence the
delivery of
safe care
during an ED
shift?

21. Aim
Utilisation
Leadership
Capacity/Flexibility
Primary
Driver
Patient Escalation
Secondary
Driver
Timeliness
Capability/Skill Mix
Communication
Observations as per acuity
Delivery of Personal Care
(Pressure sores/toileting
etc)
Sepsis Management
Communication Tools
(SBAR etc)
Appropriate
response to
Triage/DPS scores
Measur
e
% of staff
trained
% of
proformas
completed
% of
bundles
completed
Effective analgesia
Patient Satisfaction
% Patients
receiving
appropriate
analgesia
within 20
minutes
Minimum
safe
staffing met
95% of
time
Medication Safety
To deliver an
ED
-Huddle?
- Shift?
-Vision?
that is
consistently
safe.

22. Safety in the Emergency
Department
Staff
Skill
Mix
Patient
Acuity
Flow
(in and
out)

23. Safety in the Maternity
Unit?
Staff
Skill
Mix
Patient
Acuity
??

24. WHAT IS AN SAFETY HUDDLE?

25. WHAT IS A SAFETY HUDDLE?

26. WHAT ARE WE TRYING TO ACHIEVE?
• WHAT VISION ARE YOU TRYING TO CREATE IN YOUR
ORGANISATION?
• YOUR VOICE?
• OTHER VOICES?
• WHAT ABOUT MORE JUNIOR MEMBERS OF YOUR TEAM?
• WHAT DID WE LEARN?
• MISSING VOICES?
• PATIENTS?

27. BUILDING AN AIM/VISION
• HOW DO WE HEAR THE QUIETEST VOICES?
• BUILDING PSYCHOLOGICAL SAFETY
• WHO IS THIS FOR?
• WHAT DOES SUCCESS LOOK LIKE?
• HOW CAN WE STAY FLEXIBLE AND RESPONSIVE TO A CHANGING
ENVIRONMENT?

28. HOW DO WE MAKE AN
IMPROVEMENT?
• PERMISSION
• EMPOWERMENT
• OWNERSHIP
• LET GO
• UNCERTAINTY
Harry Burns’ model for change through ceding of power and co-production

29. COMMUNITY OF PRACTICE
• WHAT IS IT?
”A GROUP OF PEOPLE WHO SHARE A CONCERN OR A
PASSION FOR SOMETHING THEY DO, AND LEARN HOW TO
DO IT BETTER AS THEY INTERACT REGULARLY”
THIS DEFINITION REFLECTS THE FUNDAMENTALLY SOCIAL NATURE OF HUMAN LEARNING.

30. CREATING A MOVEMENT
• THE LONE NUT VIDEO ON TED TALKS

31. COMMUNITY OF PRACTICE
• PRACTICALLY
• GET PEOPLE INVOLVED
• LISTEN TO THEIR IDEAS
• TRY STUFF
• FAIL OFTEN
• TELEGRAM/WHATSAPP
• SHARE YOUR SUCCESSES AND FAILURES
• SITE VISITS
• OBSERVATION
• INTERVIEWS

32. CHALLENGES
• DO NOT FIX IT
• HOW CAN YOU KEEP IT EVOLVING?
• HOW CAN YOU LISTEN TO YOUR QUIETEST VOICES?
• WHO OWNS THE HUDDLE?
• WHAT INVISIBLE OBSTACLES ARE THERE TO EFFECTIVE COMMUNICATION?
• WHAT ARE YOU MISSING?
• WHAT ARE YOUR UNKNOWN UNKNOWNS?
• WHO ARE YOUR GREATEST CRITICS?
• HOW CAN YOU HEAR THEIR MESSAGE BETTER?

33. STAKEHOLDER MAPPING

34. STAKEHOLDER MAPPING

35. STAKEHOLDER MAPPING
• YOUR TURN…

36. LUNCH

37. LOCAL CHANGE FOR LOCAL PEOPLE
• NEXT STEPS…

38. DESIGNING THE HUDDLE
• MUST BE ADOPTED EFFECTIVELY
• NOT PERCEIVED TO BE TOP DOWN – COULD CAUSE RESENTMENT
• FIT FOR PURPOSE – NUANCED AND NOT OVER BURDENING THE
SYSTEM
• HEALTHCARE PRACTITIONERS PARTICIPATE IN THE DESIGN,
PRODUCTION AND DIRECT ADOPTION
• STRENGTHEN TEAM MEMBERS COLLABORATION, OVERCOME
HISTORIC POWER DYNAMICS

39. OUR HUDDLE DESIGN JOURNEY
• HUMAN CENTRED DESIGN: PARTICIPATORY APPROACH ‘FOR AND WITH’ THE END USER
(EASON, 1995)
• TECHNICAL KNOWLEDGE OF HUDDLES REQUIRED TO STRUCTURE SAFETY HUDDLES
• ACKNOWLEDGING THE SOCIO-POLITICAL ENVIRONMENT
• NEED TO ENGAGE WITH TEAMS TO GIVE OWNERSHIP
• PERCEIVED AUTONOMY, E.G. WHEN AND WHERE
• HEALTHCARE PRACTITIONERS INPUT AND INTERVIEWS (N-17)
• INFORMAL GROUP MEETINGS
• ASYNCHRONOUS COMMUNICATION VIA EVERNOTE AND TELEGRAM
• ENABLED CONTINUOUS COMMUNICATION WHICH TRANSCENDED 9-5 WORKING HOURS
• ITERATIVE, E.G. FIRST HUDDLE AND INFORMATION REQUIRED
• TOOLKIT TO REFLECT AND SELF EVALUATE

40. SAFETY HUDDLE TOOLKIT
• THREE ELEMENTS:
• PART 1: EXPLAINING HUDDLES
• PART 2: HUDDLE ITERATIVE DESIGN
• CLINICAL PROMPTS ADAPTED FROM SAFE (RCPCH, 2016) AND (BRADY ET AL, 2013)
• WITHOUT PERIODIC REINFORCEMENT, DANGER THAT HISTORICAL BARRIERS TO
MEMBERSHIP AROUND PROFESSIONS WOULD CREEP IN (MICHIE ET AL, 2008)
• PART 3: EVALUATING SAFETY HUDDLES

41. SAFETY HUDDLE TOOLKIT
• THREE ELEMENTS:
• PART 1: EXPLAINING HUDDLES
• PART 2: HUDDLE ITERATIVE DESIGN
• REFLECTION FOR ITERATIVE IMPROVEMENTS
• PART 3: EVALUATING SAFETY HUDDLES

42. IMPACT
• SAFETY HUDDLES
• STAFF COULD MORE EFFECTIVELY ANTICIPATE
PATIENTS LIKELY TO DETERIORATE
• THE SICKEST PATIENTS WERE MORE WIDELY KNOWN
TO ALL STAFF
• I.E. MORE PAIRS OF EYES
• AMPLIFICATION OF ANY CONCERNS RAISED
• PARENTAL CONCERNS GIVEN A GREATER VOICE
• JUNIOR/QUIETER STAFF ‘HEARD BETTER’ AT A MORE
SENIOR LEVEL
• SHARED LANGUAGE
• REPORTED IMPROVED TEAM WORKING AND CULTURE

43. FINDINGS
• 49 OF THE 50 TEAMS WHO HAVE USED THE TOOLKIT FIND IT TO BE USEFUL
• “VERY USEFUL PROCESS FOR THE WARD TO HELP FOCUS CARE GOALS THE TEAM
HAVE FOR PATIENTS IF THEY ARE UNSTABLE AND HELPS THE OVERALL
ORGANISATION OF THE WARD, THE HUDDLE IS SUCCESSFUL IN MY OPINION”;
• “FIRST TIME TAKING PART IN WARD 12 HUDDLE.
FOUND IT USEFUL IN TERMS OF KNOWING A BRIEF
OVERVIEW OF THE WARD AND PLANS FOR THE DAY”

44. FINDINGS AND DISCUSSION
• “FOUND THE HUDDLE TO BE VERY HELPFUL IN MAKING ALL MEMBERS
OF THE TEAM AWARE OF ANY CONCERNS OR SITUATIONS THAT
OTHER MEMBERS MAY HAVE. TRY TO GET EVERYONE IN THE SAME
PLACE AT THE SAME TIME”;
• “GOOD FOR NURSES TO HIGHLIGHT WHO DOCTORS NEED TO SEE
FIRST, LIKE WATCHER.”
• ADOPTION OF THE TOOLKIT CONTINUED EIGHT MONTHS AFTER THIS
PROJECT ENDED.
• SUCCESS: A RESULT OF HUMAN CENTRED DESIGN FOR AND WITH
USERS; PERCEIVED AUTONOMY; CONTROL; BELIEF; CULTURALLY
SENSITIVE DESIGN.

45. LOCAL CHANGE FOR LOCAL PEOPLE
• WHAT ARE YOUR NEXT STEPS…
• WORK IN YOUR DEPARTMENTAL GROUPS

46. PRESENTATION OF PLANS
• WHAT ARE YOUR NEXT STEPS…

47. SAFETY HUDDLES
• WHAT NEXT???
• HOW DO WE TAKE THIS FORWARDS?