From hospital-system sprawl to e-health screen staring, today’s modes of healthcare delivery often end up keeping radiology-department members and stakeholders from collaborating with one another in person. At Texas Children’s Hospital in Houston, the imaging department is defying these currents: Each morning the team gathers to plan out its day in a low-tech, high-attendance “readiness huddle.”
Lane Donnelly, MD, the hospital’s chief quality officer of hospital-based services as well as its associate radiologist-in-chief, describes the effort in an article published online in Current Problems in Diagnostic Radiology.
Donnelly stresses that the daily readiness huddle (DRH) is more than just a pep rally. By incorporating the gathering into the department’s daily routine, the team has seen itself become better able to rapidly identify and solve issues, he writes, adding that the exercise has also helped build a sense of teamwork both among the radiologists and between the rads and the non-physician staff.
As a management technique, this type of huddle started in industry with companies like Toyota and is on the rise in medicine, Donnelly points out. In its detailing of the particulars at Texas Children’s, Donnelly’s material suggests a number of tips for other radiology departments or practices looking to launch a DRH of their own. These include:
1. Use no-tech white boards. These are inexpensive and allow for easy changes and updates using tape, markers and dry erasers, Donnelly writes. “For huddle processes that involve staff at remote sites, screen sharing of electronic documents can also work well,” he adds. However, the in-person aspect of the meeting “is highly valuable, so if there is a way to bring people together briefly from nearby locations, it is worth the effort.”
2. Keep DRH sessions short—10 to 20 minutes—and conduct them with everyone standing. To optimize “huddle flow,” have two people run the huddle, Donnelly recommends. One person acts as the moderator, leading the discussion, while the other serves as scribe. “This helps keep up the pace of the huddle,” Donnelly writes. “When the same person is trying to both write and conduct the meeting, the cadence of the meeting can be awkward and slow.”
3. Invite all radiology department members as well as guest stakeholders from other departments. At Texas Children’s, these include directors, managers, front-line staff who have expressed concerns, representatives from support services (informatics services, biomedical engineering) and virtual representatives from off-site locations (by phone).
4. Schedule a regular daily time for the DRH and stick to it, and use a strategically accessible site. The Texas Children’s team is there at 9 a.m. each day in an area near to leadership offices and the largest radiology reading room. The scheduled time allows for managers and radiologists to report to their areas of work, assess their area and identify any issues that need to be discussed.
5. Follow a standardized process so the huddle can be run by various people. “Currently, the ‘host’ rotates between 10 physician and administrative leaders,” Donnelly explains, adding that a quality coach helps write newly identified items on the board. “An electronic summary of each DRH is emailed daily to all associates and physicians in radiology. This way even those not in attendance are aware of the issues discussed.”
6. Begin each DRH with a review of metrics and goals. The metrics and goals reviewed in the huddle, rather than in other regular meetings, are those that benefit most by daily review, Donnelly writes. Current metrics that are part of the DRH at Texas Children’s include days since the last radiology-related serious safety event, days since the last wrong patient/wrong procedure event, days since the last MRI safety policy violation/event, first-case start times in MRI and interventional radiology, open staffing positions, and number of MRI and CT examinations needing to be protocoled.
7. When reviewing imaging volumes in the DRH, organize items by modality and location performed the prior day and scheduled for the current day. At Texas Children’s, these numbers are benchmarked against studies budgeted per day for that month. The team then discusses the outliers—the volumes that are either extraordinarily high or low. “Most common areas of concern in our department relate to high volumes in MRI, interventional radiology and cases requiring anesthesia.”
8. Follow up the volume review with a readiness assessment. The team categorizes areas to eyeball using the acronym S-MESA. This stands for safety, methods, equipment, supplies and associates. Each of these categories has readiness questions associated with it, and the DRH host runs through these in a standardized way. “Obviously, there are other categories that can be used to perform a readiness assessment, depending upon the nature of the services offered and size and complexity of the department,” Donnelly writes.
9. If your radiology department seems too large for one “everybody-in” DRH, consider a tiered huddle system. Issues likely to resist resolution at, for example, the modality level can be brought to a radiology-wide DRH, Donnelly notes. Likewise, tiered huddling “may be helpful in some geographically spread-out radiology systems where locations have a DRH” of their own, while issues that have system implications are escalated to a system-wide radiology DRH. “We currently have DRH processes for multiple modalities and locations. These meetings occur prior to the overall radiology DRH,” Donnelly writes. “We also have an institutional process referred to as the Daily Operational Brief to which issues in radiology that need to be escalated are brought.”
10. Let your DRH serve as a simple yet effective “daily touchpoint.” Ideally, this huddle will come to be anticipated and even enjoyed as a time and place where, as Donnelly puts it, “everyone knows that they will be able to see and touch base with those with whom they need to communicate.”