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Huddle up!: The adoption and use of structured team communication for VA medical home implementation
Hector P Rodriguez1, Lisa S Meredith, Alison B Hamilton
1Hector P. Rodriguez, PhD, MPH, is Associate Professor of Health Policy and Management and Associate Director, Center for Healthcare Organizational and Innovation Research, School of Public Health, University of California, Berkeley. E-mail: hrod@berkeley.edu. Lisa S. Meredith, PhD, is Senior Behavioral Scientist and Co-Director, Behavioral and Policy Sciences Research Department, RAND Corporation, Santa Monica, California. Alison B. Hamilton, PhD, MPH, is Research Health Scientist, HSR&D Center for the Study of Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Health Care System, North Hills, California, and Associate Research Anthropologist, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles. Elizabeth M. Yano, PhD, MSPH, is VA Career Research Scientist and Director, HSR&D Center for the Study of Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Health Care System, North Hills, California, and Adjunct Professor of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles. Lisa V. Rubenstein, MD, MSPH, is Director, Center for Implementation Practice and Research Support, North Hills, California, and Professor of Medicine, David Geffen School of Medicine and Fielding School of Public Health, University of California, Los Angeles.
Background:
Daily clinical team meetings (i.e., "huddles") may be helpful in implementing new roles and responsibilities for patient care because they provide a regular opportunity for member learning and feedback.
Purposes:
We examined how huddles were implemented in the context of the VA patient-centered medical home (PCMH) transformation, including assessing barriers and facilitators to regular huddling among small teams ("teamlets"). We assessed the extent to which teamlet members that huddled had higher self-efficacy for PCMH changes, reported better teamwork experiences, and perceived more supportive practice environments.
Methodology/Approach:
We used a convergent mixed-methods approach to analyze 79 teamlet member interviews from six VA primary care practices and 418 clinician and staff PCMH survey responses from the six interviewed practices and 13 additional practices in the same region.
Findings:
Most members reported participating in teamlet huddles when asked in surveys (85%). A minority of interview participants, however, described routine huddling focused on previsit planning that included all members. When members reported routine teamlet huddling, activities included (a) previsit planning, (b) strategizing treatment plans for patients with special or complex needs, (c) addressing daily workflow and communication issues through collective problem solving, and (d) ensuring awareness of what team members do and what actions are happening on the teamlet and in the practice. Primary care providers (PCPs) were least likely to report routine huddling. PCP huddlers reported greater self-efficacy for implementing PCMH changes. All huddlers, irrespective of role, reported better teamwork and more supportive practice climates. The most common barriers to teamlet huddling were limited time and operational constraints.
Practice Implications:
In order to improve the impact of huddles on patient care, practice leaders should clearly communicate the goals, requirements, and benefits of huddling and provide adequate time and resources to ensure that frontline teams use huddle time to improve patient care.
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