Trust in collaboration develops a huddle programme to improve safety culture, empowering staff to confidently speak up about patient safety concerns, thereby reducing patient harm incidents

* Please describe the challenges or problems your solution set out to solve.

Despite efforts to prevent falls, pressure ulcers and recognise deterioration, clinical incidents were still occurring and patients were suffering harm. This was also demoralising for staff and had financial impacts due to litigation. We wanted to address this and improve staff morale, empowering staff to speak up about patient safety issues.

We were committed to bring fun back to the workplace, strengthening teamwork and safety culture. Although there is limited evidence for safety huddles in UK healthcare; they are widely used in high reliability organisations. We wanted to learn if they could be adapted to frontline ward-teams focused on safety.

* Please describe the actions you took to achieve your result.

Early testing of safety huddles on two wards in Leeds involved bringing the multidisciplinary team together to focus on “who are we worried about falling today?” and “what we could do as a team to prevent this?”

Using QI methodology the huddles evolved and we learnt what were the key principles, other teams observed the success and this spread to 10 other teams covering additional harms; statistically significant reductions in harm and improved safety culture followed.

In partnership with the Improvement Academy and supported by The Health Foundation we established “HUSH” and have scaled up safety huddles throughout 5 hospitals: including Leeds, Barnsley and Scarborough over 30 months (123 wards) and to other teams e.g. Leeds Porters. 88% of these wards have embedded huddles into their daily ward routine, with 41% of these achieving step-reductions in falls and cardiac arrests (on SPC charts). We have undertaken teamwork and safety climate surveys of multidisciplinary staff, and fed-back results to staff before and after implementation of huddles.

A positive shift in safety culture has been observed on wards and across organisations; preliminary results indicating an increase in staff rating overall patient safety ‘good/excellent’ from 60% to 87% after implementation.

In qualitative interviews, staff stated they felt empowered and more confident in the huddle to speak up about patient safety concerns. In addition, non-clinical staff e.g. housekeepers reported increased job satisfaction and a sense of feeling part of the wider multi-disciplinary team.

Early return on Investment (ROI) studies by the York Health Economics Consortium, has indicated a highly positive ROI for safety huddles. Coordinated by our Patient and Public Involvement lead we have tested how we can bring the patient voice into a huddle, with some teams utilising ward volunteers to ensure patient concerns can be raised in the huddle. We have learnt the art of coaching teams to adapt huddles in their world and identified the principles to successful ‘huddling’, these are described in our video.

Celebration is a key ingredient. In the past, 7 days between falls on an elderly care ward was rare, now we are celebrating 20, 30 and even 56 days between falls on these wards. Our executives enjoy recognising teams achieving significant milestones by awarding certificates. Team ownership of ward data is another crucial ingredient, monitoring days between harm and regularly reviewing SPC charts. Huddles have reduced patient harm, boosted staff morale and transformed our organisation.

* Please list the most significant results

• We surpassed our goal: 91% wards in Leeds are huddling and 45% have achieved a statistically significant step-reduction in harm e.g. falls (thus reducing patient safety incidents/litigation).

• LTHT has had organisation level impact with step-reduction in cardiac arrests of 25% and step-reduction in falls of 34% (Data attached: hsjvalue2018_patientsafety_huddles_data.docx

• Across Yorkshire there has been significant reductions in harm; teams huddling in Barnsley and Scarborough have achieved step-reductions in harm on 33% and 50% of wards respectively.

• Huddles lead to a positive shift in teamwork and safety culture, we have observed a highly positive ROI for huddles focusing on falls (388%).

* Describe how your project has spread to other teams, departments or organisations

We have developed resources to help spread huddles (hsjvalue2018_patientsafety_huddles_booklet.pdf), our successes/failures and case studies are detailed in our video, HUSH webpage and twitter account. We have supported spread of huddles across Yorkshire, they have been implemented in >30 organisations including 14 acute trusts, 4 mental health trusts, Yorkshire Ambulance Service, Care homes and the LTHT Portering services (the first huddle of its kind in the UK). Huddles are spreading nationally and the Improvement Academy are coaching teams from organisations across the UK. We have recently hosted a UK Improvement Alliance visit and have shared best practice with NHS Improvement