title: Huddling for high reliability and situation awareness.
abstract: BACKGROUND
  Studies show that implementing huddles in healthcare can improve a variety of outcomes. Yet little is known about the mechanisms through which huddles exert their effects. To help remedy this gap, our study objectives were to explore hospital administrator and frontline staff perspectives on the benefits and challenges of implementing a tiered huddle system; and propose a model based on our findings depicting the mediating pathways through which implementing a huddle system may reduce patient harm.
  
  
  METHODS
  Using qualitative methods, we conducted semi-structured interviews and focus groups to obtain a deeper understanding of the huddle system and its outcomes as implemented in an academic tertiary care children's hospital with 539 inpatient beds. We recruited healthcare providers representing all levels using a snowball sampling technique (10 interviews), and emails, flyers, and paper invitations (six focus groups). We transcribed recordings and analysed the data using established techniques.
  
  
  RESULTS
  Five themes emerged and provided the foundational constructs of our model. Specifically we propose that huddle implementation leads to improved efficiencies and quality of information sharing, increased levels of accountability, empowerment, and sense of community, which together create a culture of collaboration and collegiality that increases the staff's quality of collective awareness and enhanced capacity for eliminating patient harm.
  
  
  CONCLUSIONS
  While each construct in the proposed model is itself a beneficial outcome of implementing huddles, conceptualising the pathways by which they may work allows us to design ways to evaluate other huddle implementation efforts designed to help reduce failures and eliminate patient harm.
authors.affiliation: James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, , Cincinnati, Ohio, USA.
authors.forename: Linda M
authors.initials: LM
authors.lastname: Goldenhar
authors.forename: Patrick W
authors.initials: PW
authors.lastname: Brady
authors.forename: Kathleen M
authors.initials: KM
authors.lastname: Sutcliffe
authors.forename: Stephen E
authors.initials: SE
authors.lastname: Muething
mesh_terms: D001364:Awareness; D003299:Cooperative Behavior; D017598:Efficiency, Organizational; D005260:Female; D017144:Focus Groups; D006776:Hospitals, Pediatric / Q000458:organization & administration*; D006801:Humans; D033183:Interdisciplinary Communication; D007407:Interviews as Topic; D008297:Male; D017146:Models, Organizational; D061214:Patient Safety; D011209:Power, Psychological; D036301:Qualitative Research; D058996:Quality Improvement; D015203:Reproducibility of Results
keywords: Communication; Healthcare quality improvement; Qualitative research; Teamwork