Posted by: ayrshirehealth | July 23, 2014

The Power of the Collective! by @lozharvey

– Embedding the Hospital Daily Safety Huddle  – Committed to change 

The Institute for Healthcare Improvement (IHI) states that an organisation can only improve upon safety when its leaders are visibly committed to change, and that a culture of safety can only start to develop when they enable staff to openly share safety information. IHI

With this in mind, we set out on our own safety journey with “collective responsibility” on our mind – do we routinely share safety information across the complex systems that are our hospitals? Or, do we fiercely guard our own little areas of responsibility?

What does getting it right for every patient, every time actually mean – or is getting it right every time for “my patient” enough?

Hospital Daily Safety Huddle

NHS Scotland has seen a year on year increase in activity, and frontline services are under increasing pressure to deliver timely, safe and person centred care. ayr huddle1

In NHS Ayrshire & Arran, an exciting capital project to modernise how we deliver unscheduled care is underway – Building for Better Care – making this the ideal time to start to reconnect our front and back door, and to close the gap between the blunt and sharp ends of our system. xh huddle2One important quality improvement project, designed to make hospital performance everyone’s business is the Hospital Daily Safety Huddle.

Whilst our concept of a Hospital wide huddle is not new, the focus on safety and high reliability witnessed both here in Scotland and overseas (particularly in the States) made it an ideal vehicle upon which we could re- engage leaders and staff from all disciplines to increase their situational awareness of the hospital’s business and give them a quick and efficient way to take the pulse of the organisation.

Model for improvement

UHAUsing improvement methodology, we set out to use the Huddle format to measure improvement across our organisation. screen-capture-20Starting at University Hospital, Ayr we went live, using the PDSA format of rapid tests of change as we went, and spreading to University Hospital, Crosshouse within 1 week ( in true improvement style – by next Tuesday!)

Huddle Driver Diagram

With the help of our colleagues and a fellow “fellow” at the Royal Infirmary of Edinburgh (RIE), we set out with a “classic” huddle format in mind;

  • Looking Back –Rapid review of significant safety, quality and flow activity from the previous 24 hours
  • Looking Forward – Share predicted activity, anticipate safety or quality issues, and collectively support shared decision making
  • Follow up – Status report of issues identified previously and safety successes, and detailed reflection on previous day’s performance in a post huddle daily debrief meeting

All huddle contributors were provided with scripts to support consistent and concise information sharing, and every service and discipline of staff were encouraged to attend – to share relevant safety information, or to learn, from others, what was happening across the hospital.

Phone a friend

To demonstrate the commitment of the organisation’s leaders to the huddle, our Site Assistant Directors became Huddle Chairs, and members of the hospital management team were identified as the “go to” people should escalation of shared issues be required, referred to as “Phone a Friend” (shamelessly stolen from RIE’s Chair – Lyn McDonald!).

Although only two weeks in, the response to our huddle has been amazing. Attendance has been almost perfect from day one and feedback has been really positive. July 8th HuddleAlready we believe that the shift towards a true safety culture is beginning, and the collective responsibility we hope to develop across our system is almost palpable.

In just two short weeks, the wins are evident;

  • Nursing staff offering assistance to other areas
  • AHP staff sharing service issues
  • Estates staff taking early action in response to issues raised

Feedback has also been very positive;

July 22nd Huddle“The huddle is great! I don’t know why we didn’t think of it before – knowing at the very start of the day what is happening right across the hospital is invaluable and seeing all the managers and directors getting involved is brilliant” – Senior Charge Nurse, University Hospital, Ayr

“The hospital huddle has really inspired and motivated staff… it has also enhanced our cardiac arrest team huddle and increased situational awareness across the hospital” – Resuscitation Training Officer

“I truly believe you have given us a tool to improve safety, accountability and leadership and to be proud again of what we do – we have been given a lifeline and I’m amazed as what has been achieved already” – Senior Charge Nurse, University Hospital, Crosshouse

The safest organisation in Scotland

Change3All staff have embraced the huddle methodology and in many cases, have changed their working hours in order to contribute. The power of having 50-60 people in a room, sharing safety information has to be seen to be believed! Andrew and I, and the Huddle Chairs – Jean Hendry & Joanne Edwards would like to thank everyone for their positive contributions and huddle support.

So with a good start under our belt, our ultimate goal is the make NHSAAA the safest oPurposerganisation in Scotland. A bit ambitious? Our patients deserve nothing less.

Embedding our huddle is a fundamental part of our safety journey and already staff are feeling a deepened understanding of what we must do to provide the best possible care for our patients. We believe that the huddle is definitely capable of contributing to a culture that helps staff work together to do the right thing for every patient, every time

– because now we all can see that every patient IS “my patient”.

This week’s blog was by @lozharvey (Laura Harvey)  SPSP Fellow & @Andrew_AMD (Andrew Murray – Associate Medical Director) – Huddle Project Leads


  1. How wonderful and inspiring. Thank you Laura.

    • Thank you jenny. Been a great project to be Involved with as it has been so enthusiastically embraced by all

  2. Great work Laura well done to all involved.
    I have been hearing lots of positive feedback, great evidence of working together .

  3. Laura/Andrew, I love the ‘every patient is my patient’ quote and of course the challenge to be the safest organization in Scotland. The huddles have been a great example of straightforward improvement- costing nothing other than some time that is well invested- and that makes a real difference to people.

    • Thanks Fiona and Julie

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