What Can the Dallas Cowboys Teach Us?

by Marianne Ramey, Senior Partner, PhoenixMed
Published on Nov 10, 2016

A morning huddle is probably the single most effective meeting that physicians and care team members can have. The key lies in the purpose of the team huddle. The goal is to check in with team members about what the day will look like. An effective morning huddle is chance for team members to share information with each other and check on progression-of-care status.

When it comes to efficiency and teamwork, football players (yes, football players!) offer care managers, nurses and hospitalists a valuable lesson:  A quick huddle can ensure that everyone is on the same page.  Only in football does a team, every 24 seconds, gather to plot their offensive attack. The plotting is done in the huddle, in a brief five to ten seconds, with players looking each other in the eye and their leader, the quarterback, taking signals from the sideline, providing instructions and an execution plan. In the huddle there is no time for a conversation, deep reflection and discussion.

Daily huddles in the hospital help address a number of critical issues and is successful for many reasons.  First and foremost it is direct personal person to person contact.  It is a powerful way to unite a group of people., It is instructive with each team member knowing his or her role and how to follow through with it.  Huddles allow the team to plan for changes in the daily workflow based on patient priorities, manage crisies before they arrive and make adjustments that impove patients' progression-of-care.  Huddles work because they demand rapid team formation and preparation at the practice level. Perhaps best of all, huddles can become part of the daily routine almost overnight once each member perceives value in the shared information.  

Huddles are not unique; they've been around for many years and take many forms.  Around the turn of the century, huddles typically took place mid-morning on patient units. Timing was staggered to promote attendance by the hospitalists who moved from unit to unit depending on the location of their patients. Many of us can remember rushing from unit to unit to meet the 30 minute allowance for each unit meeting.  Soon after, we began to see huddles taking place early morning at the time of the hospitalist hand-off. There were many variations of this model, but most began with a report from the nocturnist about any new admissions or problems during the night. The lead hospitalist would then assign the new patients to one of the physicians and then 'run the list' of all the hospitalist patients.  A well organized hand-off huddle took about 45 mins (depending upon volume of patients) and was attended by the pharmacist, PT, nurse leaders, SW and Care Managers. But the real value was that opportunities to streamline patient care and facilitate timely discharge were identified and accomplished right there around the table (eg: change IV to po; write script for discharge meds; or consult to specialist) so that when the huddle dispersed, everyone knew their priorities.  By the time the hospitalist made rounds, many of the progression-of-care activities had already been put into action,

The next step in huddle evolution, is the move to hospitalist regionalization and the adoption of structured bedside rounds. These are prevalent in accountable care units and many hospitalists champion this model.  We've seen it work in one mid-sized community hospital with regionalized hospitalists and patient comments evidence their approval and appreciation in being part of the conversation about their plan of care.           

Is any one model best for every facility?  Of course not.  But we can all learn from these innovations as the industry continues its turbulent march to total transformation.