Team huddles - Time well spent

This is article fifteen in an RCVS Knowledge series of features on patient safety, clinical human factors, and the principles and associated themes of Quality Improvement (QI).

Fiona strode into the prep room, chuffed that she had navigated a morning surgery full of challenging cases. She was pleased to see that she was working with Esther, the deputy head nurse, although less pleased that her initials were by both the cat dentals. Esther was super organised and fun to work with. “Joanna’s on first ops, isn’t she?” Fiona asked, “I’ll see where she’s got to and if there’s anything I need to know.” “She was straight into theatre first thing, haven’t seen her since, you know she likes to crack on and be efficient- I say we leave her to it!” said Esther.

Joanna was elbow deep in a particularly large bitch spay, “All under control here… I’ll do most of the list, given you the dentals… sorry!”

As Fiona finished the first dental, she heard Joanna shouting into prep for someone to set up the second theatre. Esther’s smiley face dropped, “what’s wrong?” Fiona asked. “She can’t use theatre 2 – there’s a water leak. I tried to tell her this morning, but she was so intent on getting started with ops that she wouldn’t stop for two minutes to listen.” At this moment, Joanna stormed into the dental room, “Why didn’t you tell me about the water leak, I’ve planned my whole morning thinking I could use both theatres…there’s no way I’ll get through everything now. Jane says you knew about this yesterday. It’s a total disaster.”

Fiona could see Esther start to panic, “I didn’t want to disturb you this morning, I’m so sorry.” Joanna turned to walk out of dental, “Hang on,” Fiona said, “I’m pretty much finished with this dental, why don’t you grab a cup of tea, and when I’m done, we can plan how we get through the rest of the work?” “No time,” Joanna snapped back, “I’ll just have to sort it out myself.”

Having handed the now recovering cat over to Greg, the inpatient nurse, Esther surveyed the prep room, the staff were running around like headless chickens and there appeared to be kit and bandages on every available surface. Fiona noticed her disapproving stare. “Right,” said Fiona, “I really think we need to take five minutes and regroup”.

We’ve probably all been in a similar situation, where it feels like everything is going wrong, and we are under so much time pressure that we don’t have time to stop and plan. But these are the times that we really need to. There’s a huge amount of evidence demonstrating the role of communication failures as causes of inadvertent patient harm¹, and it seems common sense that this is the case. However, it is so easy to get caught up in the moment and not take the time to stop and allow all teams members to speak up about concerns or potential problems. In this case, a quick morning briefing, a strategy session conducted at the start of the op or shift, might have allowed Esther to mention that theatre two was out of action, allowing a plan to be put in place. This briefing might contain the following²:

• A reminder that any team member can speak up if they have concerns.
• A plan for the day, and who will be doing what.
• What potential problems might arise and who is responsible for taking action.
• How to intervene if something does not seem right.

In our scenario, Joanna felt she was too busy to start her ops shift with a brief, leading to her starting without all the information she needed. Luckily when things began going wrong, Fiona intervened with an impromptu huddle. An impromptu huddle is an ad hoc meeting held when problems arise or a change in plan is needed.

In this huddle, the team met at the ops board and took a few minutes to talk through the remaining procedures. Fiona made sure that she gave everyone a chance to voice their concerns, aware of their role in patient safety³. To do this, Fiona aimed to do the following:

• Make herself approachable: using her actions and words to show that she welcomed contributions from everyone and was willing to stop or change the plan if anyone had a concern.
• Invite everyone into the conversation: Fiona made sure she acknowledged everyone in the room and told them that they were welcome to ask questions or voice concerns at any time.
• Establish shared goals: Fiona led a discussion of how they would finish the ops list- and what everyone could do together to ensure it went well.

In the huddle, one of the nurses mentioned that she was worried they wouldn’t have enough staff to safely recover the patients over the lunch period, so she suggested that Fiona do the x-rays before she began her next dental, so the dog could be recovered sooner. Fiona was pleased to have a break from dentistry, and it gave her something to do while the dental room was being cleaned!

By working together, the team became more effective, by having a shared understanding of what needed to be done, and so being able to anticipate what might cause problems and work together to avoid them.

Checklist – what you can do next

• Listen to Pam Mosedale and Professor John Williams discuss how systems and meetings aid communication in practice.
• Read Mark Turner's previous feature to see why an environment that nurtures psychological safety, enabling everyone to speak up or ask for help, is so important.
• Read how compassion - at the heart of practice can directly impact the quality of care we provide.
• Read the BVA Policy Position on Good Veterinary Workplaces.
• Find out how good practice culture and job satisfaction can benefit everyone.
• Listen to Laura Playforth and Pam Mosedale discuss how incivility can increase errors and impact our patient care.
• Check the website Civility Saves Lives, run by healthcare professionals to raise awareness of the power of civility in medicine.
• Read Pam Mosedale's blog to find out what a successful practice feels like for a Practice Standards Assessor.

References

¹Leonard, M., Graham, S. and Bonacum, D. (2004) The human factor: the critical importance of effective teamwork and communication in providing safe care. BMJ Quality & Safety,13 (S1), i85–i90.  http://dx.doi.org/10.1136/qshc.2004.010033

²Brennan, P. A. et al. (2016) Good people who try their best can have problems: recognition of human factors and how to minimise error. British Journal of Oral and Maxillofacial Surgery, 54 (1), pp. 3–7. https://doi.org/10.1016/j.bjoms.2015.09.023 

³Brennan, P. A., Standring, S.M. and Wiseman, S.M. (eds.) (2019) Gray’s surgical anatomy. Amsterdam: Elsevier 

About the author 

Jenny Brown Bsc(Hons) BVM&S(dist) GPCert(FelPr) MANZCVS(Medicine of Cats)
MSc MRCVS

Jenny graduated from Edinburgh in 2004 and joined the Active Vetcare group in Berkshire, where she has been working in small animal first opinion practice ever since, now as a Senior Clinical Director. She has always been interested in feline medicine, gaining Membership of the Australia and New Zealand College of Veterinary Surgeons in Medicine of Cats in 2012 and RCVS Advanced Practitioner Status in Small Animal Medicine - Feline in 2018. More recently, she has developed an interest in anaesthesia and analgesia, gaining Advanced Practitioner status in Veterinary Anaesthesia and being awarding the degree of Master of Science in Veterinary Anaesthesia and Analgesia in 2021. Jenny enjoys all aspects of first opinion practice, including mentoring and supporting colleagues, clinical governance and minimising avoidable errors in clinical practice. Jenny joined RCVS Knowledge in 2020 as Clinical Lead for the National Audit for Post-operative Outcomes (NAPO), where she is working together with clinicians in practice to gain evidence to ensure the surgical journey is as safe as possible for the animals we treat.

Back to top