title: Health care huddles: managing complexity to achieve high reliability.
abstract: BACKGROUND
  Health care huddles are increasingly employed in a range of formats but theoretical mechanisms underlying huddles remain relatively uncharted.
  
  
  OBJECTIVE
  A complexity science view implies that essential managerial strategies for high-performing health care organizations include meaningful conversations, enhanced relationships, and a learning culture. These three dimensions informed our approach to studying huddles. We explore new theories for how and why huddles have been useful in health care organizations.
  
  
  METHODS
  We used a study design incorporating literature review, direct observation, and semistructured interviews. A complexity science framework guided data collection in three health care settings; we also incorporated theories on high-reliability organizations to analyze our observations and interpret huddle participants' perspectives.
  
  
  RESULTS
  We identify theoretical paths that could link huddles to improvement in patient safety outcomes. Huddles create time and space for conversations, enhance relationships, and strengthen a culture of safety. Huddles can be of particular value to health care organizations seeking or sustaining high reliability.
  
  
  CONCLUSIONS
  Achieving high reliability, the organizational capacity to deliver what is intended to be delivered every time is difficult in complex systems. Managers have potential to create conditions from which huddle outcomes that support high reliability are more likely to emerge. Huddles support efforts to improve patient safety when they afford opportunities for heedful interactions to take place among individuals caring for patients and embed mindfulness into the organization.
authors.affiliation: Shannon M. Provost, MBA, is PhD Student, Department of Information, Risk, & Operations Management, McCombs School of Business, The University of Texas at Austin. E-mail: shannon.provost@phd.mccombs.utexas.edu. Holly J. Lanham, PhD, MBA, is Assistant Professor, Department of Medicine, University of Texas Health Science Center at San Antonio, and Adjunct Assistant Professor, Department of Information, Risk, & Operations Management, McCombs School of Business, The University of Texas at Austin. Luci K. Leykum, MD, MBA, MSc, is Associate Professor, Department of Medicine, South Texas Veterans Health Care System, University of Texas Health Science Center at San Antonio. Reuben R. McDaniel Jr., EdD, is Charles and Elizabeth Prothro Regents Chair in Health Care Management, McCombs School of Business, The University of Texas at Austin. Jacqueline Pugh, MD, is Research Professor of Medicine, University of Texas Health Science Center at San Antonio, and Acting Associate Chief of Staff for Research, South Texas Veterans Health Care System.
authors.forename: Shannon M
authors.initials: SM
authors.lastname: Provost
authors.forename: Holly J
authors.initials: HJ
authors.lastname: Lanham
authors.forename: Luci K
authors.initials: LK
authors.lastname: Leykum
authors.forename: Reuben R
authors.initials: RR
authors.lastname: McDaniel
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Pugh
mesh_terms: D003142:Communication; D003695:Delivery of Health Care / Q000458:organization & administration*; D006126:Group Processes; D058016:Health Facility Administration / Q000379:methods*; D006801:Humans; D007407:Interviews as Topic; D015279:Organizational Culture; D061214:Patient Safety; D058996:Quality Improvement / Q000458:organization & administration