Patient safety huddles by Kimberley Salmon-Jamieson

Patient safety is at the heart of healthcare good governance. The ultimate aim of effective governance is to save lives and beyond that to improve the quality of patient care. It is why risk management is so crucial to the successful and strategic operation of any organisation.

Good governance must successfully blend dynamic elements such as culture, behaviour and mindset with harder static aspects like structures and processes.

In the right balance, these elements come together to deliver effective outcomes throughout the organisation. Warrington and Halton Teaching Hospitals provide a great example of this in practice. Kimberley Salmon Jamieson, the trust’s chief nurse and deputy chief executive, describes Warrington and Halton’s morning Safety Huddle, an ingrained part of her organisation’s heartbeat.

A huddle a day makes all the difference

I sometimes think it is the most important 10mins of our day. Everyone in the (virtual) room: status, issues, questions, and concerns at the ready – and we’re off! Welcome to the WHH safety huddle.

Senior nurse-led, we follow a four-point prescribed agenda that deals with the top safety issues of the morning, captured ably by our communications team and distributed to the entire organisation within the hour.

Used over the next 24-hours as a core part of shift handover and service briefings. This is cascade at its finest: quick, understandable, informative, and reassuring.

All are welcome to join from clinical to corporate staff and with strong attendance from our wards and services we see a really wide range of professionals in the room: Allied health professionals, medics, pharmacists, estates and facilities, nurses and midwives, clinical scientists.

Our huddle is always inclusive and key points are discussed and any issues resolved, supported, dispensed, or taken offline for deeper resolution and escalation. Pre-pandemic it was a few quick minutes to catch up with colleagues on the way in or the way out saving valuable time on phone calls and emails.

Huddling

It’s over four years since we launched our daily safety huddle and it is testament to the simple, punchy and effective format that it is more strongly supported than ever:

• Prompt: We start on the dot at 9:15 Monday to Friday and close at 9:30.
• Visual: The chair uses a whiteboard to capture key points – under our four key themes
• Inclusive: The chair always goes around the (virtual) room and asks for comments, escalations or just sharing
• Recorded: The topics and discussions are captured and templated for immediate circulation – with clear actions identified
• Relevant: Operational, safety and patient safety items are collated with a clear route and action to any required next steps
• Summarises: A round-robin AOB summarises and closes the meeting, actions remain on the white board ready for the next day to begin - and the cycle continues.

Four key themes set the tone for the huddle and we are vigilant in ensuring relevance – which has ensured its continued success. If it’s not safety related, find another channel.

Safety items

As a medium-sized acute hospital serving our community, we experience all the usual daily issues of any similar trust.

How’s patient flow this morning? Where is struggling? Who needs help? Any equipment outages? Patient falls – any key themes, have all actions been taken? Are there any safety alerts for us – changes to policies/SOPs, medication packaging changes, changes to patient transfer requirements? … the list is endless but so is keeping patients safe in our care.

This is a vibrant slot and staff praise the fact that they can escalate to senior staff in real time – in a big, multi-layered organisation the value of this cannot be underestimated – and flows straight to the organisation’s daily command-and-control ‘Silver’ lead.

HALT!

Is there anything that is going to stop us caring safely for our patients today? Call it out! What can we do to work around this while a fix or a solution devised? Halt moments are serious, will affect more than one ward or department and staff are fully familiar with these criteria. A leak which is pouring into the ward below, a lift block outage preventing patients being transferred to theatres or switchboard fault preventing in-and outgoing calls and paging.

We always learn from halt moments and the resolution is communicated by global email as soon as the situation develops, minimised or is resolved. It remains on the whiteboard ready to share learning at the next huddle.

Hot topic

Booked in advance – the subject specialist delivers a 3-5-minute briefing on a hot topic with these bite-sized topics running across the whole week with signposting to resources. There is a strong quality of care focus and both patient experience and patient safety initiatives are included and a really wide variety of topics describe a quality initiative, showcase key learning points and access of information or signposting. A really great learning tool – attendees learn in bites and take this back to their units to share.

Bright spots

A firm and popular favourite - we never miss an opportunity to recognise and celebrate good practice and achievements on the spot. Our bright spots are avidly read and contributed to across the trust, and many find their way into case studies, staff nominations or external awards. Many are escalated to me or the chief executive and all get a personal ‘well done’ in return.

Four years on, our huddle remains a key part of our day. Safety really is everyone’s business, and we never tire of hearing or talking about it in this open, supportive, and encouraging forum. It has been observed by others, audited, tweaked, gone virtual, actual and hybrid yet the same format lives on – impactful, informative, ingrained.

Even though attendances and topics have mushroomed (a note of caution for anyone who wishes to reproduce!) and there has been a danger of it becoming unwieldy or unmanageable – constant vigilance and adherence to our four-point timed model has seen us through.

We simply wouldn’t or couldn’t do without our daily huddle now.