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Want to increase your hospital's operational efficiency and cohesiveness? Huddle up, says Intermountain Healthcare's CEO

Marc Harrison said the escalation process, which includes daily huddles with all levels of staff, has provided operational clarity, improved safety.

Beth Jones Sanborn, Managing Editor

Daily huddles at every level of staff that form a chain of escalation and information yield big operational gains in safety, quality and efficiency but you'll need to focus on trends, tracking of issues, accountability and overall goals. That's what the Intermountain Healthcare CEO Marc Harrison said in an article he penned for Harvard Business Review.

Harrison said the escalation process, which includes daily huddles with all levels of staff wherein issues not able to be resolved at that level are escalated up to the next level of staff, has provided improved clarity around operations, including the discovery of opportunities for staffing procedure improvements and reducing interruption of services. Through this, the system has been able to improve its international shipping processes for replacement parts for imaging equipment with two large vendors.

Thus far, 365 unique issues were tackled yielding 22 systemwide safety alerts to caregivers, organizational awareness of 15 pharmaceutical and supply shortages, faster communication for potential formulary alternatives when supplies become limited, and the improved processes around patient transfers. Staff also pinpointed and resolved training gaps.

Harrison cited an example of the success from earlier this year, when a community-wide outbreak of hepatitis B occurred. "Our clinics reported the early development of the disease in huddles. That enabled Intermountain to prepare guidance for all clinics and ensure that staffing levels were appropriate and that increased dosages of needed drugs were on hand," Harrison said.

Starting at the ground level, each huddle is 15 minutes and has a leader, data recorder and designated participants. Four fundamentals of extraordinary care i.e. safety, quality, access, and stewardship of resources are covered and across those fundamentals, eight key topics are reported daily including serious safety events and caregiver injuries. If an issue can be solved at its base level, it does not escalate to higher level huddles. Issues that can not be resolved at inception level move up to the next staff level huddle.

Huddles are held with a sort of ripple effect in mind. That is to say, care teams and managers in hospitals and clinics gather in "Tier 1" huddles first at 8:45 each morning. Then at 9 a.m., their reporting is discussed in Tier 2 huddles with hospital and clinic directors. Tiers 3,4,5 and 6 huddles continue in that pattern with increasing levels of system leadership and by 10 a.m., vital information has reached executive leadership, including the CEO and other executives.

Harrison also documented lessons learned from their huddle model. First, he wrote that it's important to track trends and address any identified issues. He said every quarter they analyze what issues were escalated and compare them against performance metrics. They then decide how to address those trends.

He also stressed the importance of accountability and tracking every action taken and the time frame in which it was resolved and making sure that the topics discussed are aligned with your organization's overall goals and mission.

"Every action that emerges, including those at Tier VI, is tracked, and the outcome is communicated back through all tiers, so participants know what has transpired and understand the value of their input...Continuous improvement is a constant quest. Escalation huddles offer enormous potential and striking results in that pursuit -- both in healthcare and beyond," Harrison wrote.

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Twitter: @BethJSanborn
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