I love the UK, its wonderful architecture, stories of bygone days and cute accents. It is this very history which is so attractive and also makes so many beholden to the past. How does this impact healthcare?
In reality, I have not been here long enough to tell. What I have observed, is that even with a super innovative practice group, which has just been awarded one of 29 highly valued Vanguard contracts, there was less mention of team huddles. I have become used to hearing about the various models of huddling at many of the other sites visited so far so had assumed it would come up in Birmingham. So what is a huddle and why might it be missed?
Basically, it is a collection of the key team members involved in patient care to discuss who is coming in, what needs to be resolved, what the plan of attack is and how the work will be allocated. In the majority of sites this is a short collaboration at the beginning of a session, day or less often a week. In one instance, they took an hour at the beginning of the day for their huddle as all of their patients were over 65 and hence more complex.
The basics are pretty much always the same; stand up, stay on task, use a prompting agenda and list of patients, no hierarchy. Maybe it was this last point which has our English cousins a little puzzled? Sorry, the colonial girl was having a lapse…
The most numerous use of this process is between two doctors and the Medical Assistant or nurse who will be working with them for the session or day. Perhaps the most powerful examples involved panels of specialists and allied health linking in with the care team of a complex patient to case conference and engage in didactic learning as per the Project Echo model.
Most of the innovators seem to have something in the middle. Their rationale? When you have a Medical Home you bring in more people to the care team eg pharmacy, social work, psychology and/or psychiatry, nurses, GPs and some sort of case management staffing (plus or minus any other allied health which might be associated with your particular model if you are lucky). This means you need to link up to ensure that each part of the group is doing their bit for the most at risk patients planned for care that week or who need to be prompted for care that week.
The frequency of these discourses plus their very nature moves the GP away from being a legend in their own lunchbox (if that is how big your consultation room is) into being part of a wider team. This takes psychological adjustment and probably psychological fit. It also takes time. In Australia’s pay for volume funding model this means less income. It may also mean less care as our model is so geared to being re-active amongst a chaotic assortment of agents who use their professional judgement to do their best. Perhaps it would be best to use a system where the most expert in a particular aspect or the person with the best relationship to the patient or simply the collective breakthroughs which come when you spend time thinking, are applied to the patient need.
The most common phrases heard in corridors where this is common practice are “I feel I am not alone”, “We work as a team and share the load”, “the patient gets the best care as it is the right care delivered by the right person”, “things are not missed as often as many heads are better than one”, “patients have a real chance as at least one person on the team will have a good relationship or insight into them and can advocate for them”. Wouldn’t it be great to have more of this in our practices? We will need to change more than our funding streams to make it happen. It will involve creating spaces where this sort of exchange can occur. We will also need training to do it well and an insight into our colleagues so that we can harness their insights no matter their role or personality. I suspect bullying may be less of an issue in healthcare facilities which do this as the process itself works against one person dominating. So with an eye to the media in Melbourne, an ear to colleagues who feel overwhelmed, and a heart for patients…why not try and get a foot in the door for a fistful of dollars to make this sort of work arrangement possible? We need bigger and enriched teams, spaces, capability and will. We can do it, everyone else is!
Tracey Johnson, General Manager, Inala Primary Care