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Safety huddles have become a cornerstone of Caring Safely at UHN, yet historically, physicians haven't been active participants.
"Everyone struggles to engage physicians in quality and patient safety," says Dr. Meiqi Guo, a physiatrist at Toronto Rehab. "It's not because they don't want to be involved. It's because the opportunities aren't always there to allow it."
At Toronto Rehab, huddles tend to take place in the morning when physicians round on patients before therapy begins.
There's also the question of relevance. With medical care playing a smaller role within rehab, items that matter to physicians may not impact the larger team.
Recognizing the need for physicians to contribute to UHN's safety culture, Dr. Guo evaluated a seven-month trial of Medical Safety Huddles within Toronto Rehab's Brain & Spinal Cord program.
The success of these physician-focused huddles not only inspired the program to make it permanent, but encouraged all programs across Toronto Rehab to implement one of their own.
Medical Safety Huddles work
During these weekly, 15-minute, lunchtime teleconferences, physicians address patient safety and quality issues generally relating to medical imaging, EPR, transitions of care, and hand-over.
Urgent issues, such as missing bloodwork, are immediately escalated, while less-urgent items, such as suggestions around process improvements, are raised in weekly medical leadership huddles, which are led by Toronto Rehab's Medical Director, Dr. Gaetan Tardif.
"Having a regular process for escalating issues to huddles among the medical leadership team, meant that within a few days most of these issues could be addressed," says Dr. Mark Bayley, Medical Director of the Brain and Spinal Cord rehab program, and leader of the program's Medical Safety Huddle.
While the habit of connecting with colleagues isn't new – physicians also participate in monthly update meetings – the frequency of huddles are more effective at dealing with actionable items.
During the trial, Dr. Guo found that on average three actions were taken after each huddle in response to anticipated safety issues, and incidences resulting in preventable harm dropped by one-third.
"Huddles allow issues to be addressed as they come up instead of dropping off the radar over the course of the month," says Dr. Guo, whose study was awarded Paper of the Year from the Canadian Association of Physical Medicine and Rehabilitation (CAPM&R).
"They also allow us to avoid the 'learned helplessness' trap where we say, "it happened three weeks ago – I can't do anything about that now, anyway.
If it's fresh on your mind, you're more willing to speak up about a safety issue."
A less visible benefit is physician burnout, says Dr. Guo.
"Burnout is related to a sense that you can't do anything to improve the system you're in. With these huddles, we're seeing that we can actually make things better for our patients and our practice."
The key to successful huddles
Huddles weren't immediately embraced by all physicians. But as the benefits became obvious, buy-in grew.
"I think the reason huddles have become so well-attended is because physicians realize they can actually get things done," Dr. Guo says. "If they bring up an issue people are going to hear it and do something about it."
She credits this to support from senior leadership who were visibly engaged and responsive.
"We knew in order to have consistent attendance and buy in from colleagues it was critical to be efficient with our use of time and resolve issues as quickly as possible," says Dr. Bayley.
The success of Medical Safety Huddles makes Dr. Guo feel hopeful. She says she'd like to do more studies and help other programs across UHN adopt them as well.
"People always identify physician engagement as a barrier to improving safety culture. What we've shown is that physicians do want to be engaged and they do have something to contribute."