The Exec: Hospitals Should Embrace Huddles to Boost Reliability

Hackensack University Medical Center CMO Lisa Tank says huddles at the hospital promote safety and quality.

Huddles should be held on every floor and in every unit to advance reliability, says Lisa Tank, MD, senior vice president and chief medical officer of Hackensack University Medical Center as well as CMO for the North Region of Hackensack Meridian Health.

Tank has served in several roles at Hackensack University Medical Center over the past two decades. Prior to her current positions, she was chief of the Division of Geriatrics at the hospital. In 2016, she was appointed vice president of medical affairs.

Tank says she faces several primary challenges as CMO of the hospital, including patient safety, clinician well-being, and staffing shortages. The best way to meet these challenges is to be a high-reliability healthcare organization, she says. CMOs have long viewed high reliability such as limiting hospital-acquired infections as a cornerstone of efforts to boost patient safety.

"First and foremost, you must educate every member of the staff about the high-reliability journey, then you must practice high reliability every day," Tank says.

One method for developing high reliability is through daily tiered huddles that involve staff from the frontlines to top executives. Huddles have been in place at the hospital for several years.

"Every floor and every unit have a huddle where the key stakeholders get together," she says. "They talk about the current safety issues, quality issues, and any current challenges that the team is having that impact patient care or team safety. Those huddles percolate throughout the entire day and the executives get involved."

The huddles follow key principles, Tank says. There is a preoccupation with addressing failures, and staff focus on why setbacks occur. Staff members look for opportunities to simplify care and processes. In addition, huddles focus on determining how to integrate clinical care with clinical operations.

For example, if a medication was stored in the wrong place, staff can use a huddle to find out why it was stored in the wrong place and what could be done better, she says.

"With that approach to the challenges, you can not only meet the challenges but also excel in moving forward," Tank says.

Lisa Tank, MD, senior vice president and chief medical officer of Hackensack University Medical Center as well as CMO for the North Region of Hackensack Meridian Health. Photo courtesy of Hackensack Meridian Health.

Leading development of clinical guidelines during the pandemic

Tank also led efforts to develop clinical guidelines during the pandemic. The hospital worked on the clinical guidelines for treating patients by learning from the experiences of clinical care teams with coronavirus in China, Europe, and New York, she says.

Beyond treatments, Tank and the hospital's clinical care teams developed guidelines for communication and caregiver behavior at the bedside.

"The main guidelines we developed were communication guidelines such as how best to communicate a patient's status with their loved ones," she says. "Those were isolating times. There were no visitors allowed. While we were treating the patients, a key component for us was providing empathy and compassion at the bedside, which was as critical as the intravenous medications and high-flow oxygen."

Tank and the clinical staff collaborated on using iPads for care teams to communicate with families and patients to communicate with family members, she says.

"The iPads helped us to communicate with the families about what was going on with their loved ones," Tank says. "It was a multipurpose tool, but the most important piece was allowing patients to communicate with their families."

Promoting value-based care

With the opening of the new tower on the hospital campus, one of the main value-based care initiatives at the hospital has been to create clear best practices, programs, and processes for operating rooms as well as disease-specific clinical pathways, Tank says. The hospital's leadership viewed the opening of the new tower and expansion of services as an opportunity to advance value-based care, she says.

"That has helped us create value and cost-effectiveness. At the same time, it has helped us deliver high-quality care," she says.

Clinical teams should be encouraged to identify opportunities for value-based care, Tank says. For example, in value-based care for orthopedics at the medical center, the frontline teams have come up with clear pathways for using the equipment they need and the kinds of anesthesia they need. They have streamlined the patient's stay in the hospital such as getting physical therapy early in the care process and trying to have patients discharged to home.

Succeeding in care coordination

To boost care coordination, the medical center has tried to create a "hospital without walls," so there is a seamless continuum of care, Tank says. Whether a patient is in the hospital, assisted living, a skilled nursing facility, or at home, the goal is to make sure there is clear communication between the care teams. The Epic electronic medical record helps the care teams communicate. Care coordination often requires a navigator to communicate with the patient and the family as well as the clinical teams to make sure that the patient has access to care. Warm handoffs make sure nothing gets missed.

Care coordination is essential between hospitals and skilled nursing facilities, but the need for care coordination between hospitals and home health service providers is an emerging trend, she says.

"There has been a paradigm shift away from skilled nursing," Tank says. "If we can get the patient home safely and have the right support in the home, that is the goal now."

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