The morning huddle

My wife and I have been getting our house ready to host a holiday party for my work team - this is only the second year in our current house, so we hope that this will become an annual tradition.  Anyway, I was running some "almost last minute" errands at our friendly neighborhood Kroger store this morning, when I heard an overhead page that said something like, "Good morning Kroger team, please send a representative from your department for the morning huddle." 

Wow!  I was impressed to hear that Kroger has a morning huddle.  It certainly makes sense though - just about every industry has embraced the concept of a morning huddle, a pre-shift huddle, or a daily operations briefing.  I don't know exactly where this started, but I know that the military started conducting morning reports or daily briefings a long time ago.   Perhaps the concept came from the sporting world - before every play in football, the offense gets together in a "huddle" and talks about the next play.

Look carefully the next time that you are out and about, and I think you will find that there are numerous examples of this practice.  Restaurants do it - the manager often will pull together all of the waiting staff together before a shift to tell them about the night's specials, how many guests are coming (and how busy they can expect to be), and any other last minute items of interest.  Ritz Carlton hotels are particular well-known for the huddle concept and call their version of it, "the daily line-up."  Who knows what our current President does, but historically the President of the United States receives a morning briefing of the overnight events every morning.

If everyone else is doing it, there must be something to the morning huddle, right?  As a matter of fact, there are a number of health care organizations that have embraced the concept.  Cincinnati Children's Hospital Medical Center was one of the early pioneers for what they called the "morning safety huddle".  The morning huddle started out as a staffing huddle between nursing leadership and charge nurses (the lead shift nurse) from each of the inpatient units in the hospital.  Borrowing concepts from United States Navy aircraft carrier operations, the hospital's Safety Officer, Steve Muething, MD and others restructured the morning staffing huddle, which occurred every single day of the year, to include a briefing of significant events that had occurred overnight, the current status of the inpatient unit (from a census, acuity, and staffing perspective), and any anticipated issues for the upcoming shift (from a patient safety, flow/capacity, staffing, employee safety, or patient/family experience perspective).  More importantly, Dr. Muething and his team made the huddle multidisciplinary with the addition of a Safety Officer of the Day (SOD), a senior physician who was assigned daily responsibility for working with the lead nurses to help identify and mitigate any problems throughout the day, as well representatives from other areas of the hospital, such as Social Work, Respiratory Therapy, Supply Chain, and the Patient and Family Relations department. 

The morning huddle at Cincinnati Children's was so successful that the organization started conducting a "Daily Safety Brief" following the huddle.  The "DSB" brought together (at first, by telephone but later in person) representatives from all of the major areas of the hospital - Inpatient, Outpatient, Peri-operative Services, Emergency Services, Mental Health Services, Pharmacy, Facilities, Supply Chain, Information Services, Security, Laboratory, Radiology, Occupational Safety, and others (about 17 different departments are represented) to raise awareness and communicate any concerns for the upcoming day's operations.  Each representative again reports significant events that occurred overnight, as well as predicted events for that day.  If a problem has been identified, the representative is expected to report how the problem was identified and mitigated.  In most cases, identified problems are fixed within 48 hours.  Problems that cannot be mitigated at the local level are escalated to hospital leadership.  The name has since been changed to the "Daily Operations Brief" or "DOB" in order to reflect the fact that the focus is not just on safety, but on hospital operations as a whole.

Conducting a morning or pre-shift huddle is now considered best practice in most industries, including health care.  It doesn't matter whether you are leading and managing a large academic medical center or a small, community-based physician practice, bringing your team together to discuss key items for the upcoming day is an important part of leading an effective team.  The Children's Hospital Association has published several key tips for implementing safety huddles, which are available here.  If it's good enough for Kroger, it must be good enough for health care!