Huddle Up: Engage Staff for Meaningful Improvement

Guest blog



Mary Brickels, RTR, Lean Project Lead 1, New Hanover Regional Medical Center

Walk through any clinical (or even non-clinical) unit in a hospital and you’ll likely see a visual example of how that department highlights and tracks its progress. A popular continuous improvement tool, huddle boards help teams collaborate on the most important tasks and actions in order to provide the highest level of patient care. New Hanover Regional Medical Center is no different.

Designed to engage staff where they are—to be bottom up, not top down—the purpose of huddle boards is to engage staff at all levels; to provide a visual display of key measurements to help them succeed. Teams use huddle boards to proactively problem solve, uncover opportunities and recognize their peers for going above and beyond in their daily routine

A good start

Our original huddle board design was developed and introduced in the fall of 2012. As folks clamored for them, the more than 200 boards were thoughtfully cascaded throughout our health system over a one-year period. Over time, however, enthusiasm for the boards was only a distant memory and in some cases, they became just another tool for leaders to push information to the staff instead of soliciting information from them. Since the boards were no longer being used as originally intended, a request for improvement to the initial huddle board design was received and a rapid PDSA (plan, do, study, act) cycle was performed in late 2014. 

Did we validate that we had a problem? Yes! Did something go wrong? No. Had our staff obtained a Lean maturity that the previous board was unable to harness? No, not really, and the answer was surprisingly simple. Following leader standard work for rounding with “humble inquiry,” we learned that information on some of the boards was out of date and therefore posed no value for the staff. As leaders, we were able to glean responses from staff that included such things as they wanted a space on the board for safety and quality issues, and some wanted to move their huddle boards into areas visible to patients and visitors so they could participate in huddle activities as well. 

Taking another look

In the spirit of continuous improvement, a group was formed made up of members from the original team, along with fresh eyes from other areas to gain different perspectives. In February 2017, the group took a deeper dive, observing daily huddles on nursing units, physician offices, ancillary areas, and non-clinical areas such as maintenance and purchasing. What they validated was that the daily huddles were being run by leaders instead of staff members. They found outdated A3’s or A3’s that were on life support, continuously being revisited with no progress noted.

The group also found that staff wanted to be engaged but felt that they no longer had a visual management tool that was working in their favor. Staff openly shared that they wanted a huddle board that was proactive, transparent and allowed interactive, focused, daily problem-solving. The group then surveyed patients and visitors, openly sharing our problem-solving efforts to enhance their health care experience. They also wanted to give patients and visitors the opportunity to provide feedback on their care, recognize staff, and help them feel that they are part of the overall solution to improving care at NHRMC.

After reviewing all comments, the next step was obvious: deconstruct and redesign the huddle board. The group worked through multiple iterations of the layout and standard work before presenting a final board for trial. Two weeks later the board was refined and soon senior leadership and each group member’s department trialed the new version. They spent time observing each other’s huddles and regrouped to review observation data. With some modifications to the standard work, a new huddle board style was born.

Rolling out a new design

The organization-wide implementation plan was built with staff engagement as the highest priority and leadership support as the backbone. The team created an online learning module for all staff, helping identify the key components of the new huddle board and describing the standard work for leading a huddle. This was followed by multiple hands-on training sessions pairing two or more staff and one leader as superusers empowered to train others in each department. Hands-on training included standard work instruction, an opportunity to practice the mechanics in a safe environment, plus time for questions and answers. Attendees walked away with an understanding of how to navigate the new huddle board and a kit with the necessary items to transform their existing boards.

A follow-up plan to support coworkers as they transitioned to the new board was outlined and shared with all training attendees and leadership. Training sessions were held from Dec. 4, 2017 through May 9, 2018 and all areas were required to update their huddle boards to the new format within two weeks of their session. 

Where are we now? We continue to remain focused on supporting those who might need assistance with the changes in the standard work to lead a huddle, as well as rounding on those areas in their sphere of influence to coach and support their daily huddle efforts.

What have we learned from this process? We learned that staff wants to be involved and have a say in the work they do. They want to understand the organization’s long-range goals and identify together how they can support improvement efforts to reach those goals. We also learned how they would like to be recognized for their great work. 

Response to the new huddle boards has been positive. Still, we know the improvement process never ends, so we look forward to the next iteration of this particular visual management tool.

About the author. A radiologic technologist with more than 32 years of experience in diagnostic and interventional radiology, Mary Brickels has served as staff technologist, weekend coordinator, diagnostic site coordinator and as subject matter expert for diagnostic radiology. She obtained her Lean certification and joined the Lean Strategies department in 2016. Her current position as a project lead has allowed her to gain experience in many aspects of Lean methodology, including Kaizen, value stream mapping, A3 problem solving, 5S, standard work and staff training/coaching of Lean concepts.

New Hanover Regional Medical Center in Wilmington, NC has been on their Lean journey for more than seven years, and the Lean Strategies department is currently working to ensure that there is understanding and alignment of the organization’s strategic goals from the board of directors to frontline staff.

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