/ HUSH Project Clinical Lead Safety Huddles: How can I make patient safety huddles work for my area? AC to lead this part. Dr Ali Cracknell Consultant in Medicine for Older People (Leeds Teaching Hospitals NHS Trust) / HUSH Project Clinical Lead

Agenda 14:15 – 14:25 Introduction to safety huddles 14:25 – 14:35   14:15 – 14:25 Introduction to safety huddles 14:25 – 14:35 What are huddles like in my area? Bradford District NHS Foundation Trust Yorkshire Ambulance Service Care homes Medical Ward, Leeds Teaching Hospitals NHS Trust 14:35 – 14:45 Practical session: How can a huddle work for you and your team?   14:45 – 14:55 Discussion: What is the plan for your huddle?  14:55 – 15:00 Summary and close Questions to above teams from Anna: How do huddles work in your area? What have been the barriers/challenges you have faced? What are you most proud of?

Why Safety huddles? Yorkshire Contributory Factors Framework Lawton et al BMJ Qual Saf 2012

Yorkshire huddle Journey One day One ward in Yorkshire 2013 IA Spread 2014-present:  1-3+ frontline teams in every Y&H Trust  over 150 frontline teams huddle daily: Calderdale, Hull, Bradford, Bradford District, Barnsley, Airedale, Scarborough, Sheffield, Harrogate, Pinderfields, Leeds, Mental Health, Barnsley At scale across whole organisations 2015-present: Barnsley, Leeds, Scarborough- 139 wards 5 more Trusts

Patient Safety Huddles Key Characteristics Informed by QI tools and visual feedback  Review of days since last harm Focused meeting about one or more agreed patient harm  Who are the patients most likely at risk of harm? Agreed actions  set of team/individual actions (aimed at reducing risk of patient harm) Multidisciplinary frontline team invited to attend  including non-clinical Senior clinical leadership  Non-judgemental environment and all team staff empowered to speak up Daily (Monday - Friday as minimum)  Predictable time and venue (appropriate to team and context)  Brief (5-15 minutes) Celebration and recognition of milestones

A Huddle example Focus on Falls How many days since our last fall?  Celebrate milestones e.g. 10,20, 30 days  If recent, what was the learning, could we have done anything differently? Who are we really worried about falling today? What are we going to do as a team to prevent the patient falling? Review the “bigger picture” – location of patients, staffing, cohorting Are there any other concerns today? How many days since our last fall?  Celebrate milestones e.g. 10,20, 30 days  If recent, what was the learning, could we have done anything differently? Who are we really worried about falling today? What are we going to do as a team to prevent the patient falling? Review the “bigger picture” – location of patients, staffing, cohorting Are there any other concerns today? Review the “bigger picture” – location of patients, staffing, cohorting Are there any other concerns

ignites a spirit of learning Making measurement visible The Safety Huddle… ignites a spirit of learning Making measurement visible “We are achieving results now, that none of us thought were possible 12 months ago” Consultant Medicine for Older People, LTHT

ignites a spirit of learning Brings the team together to act: The Safety Huddle…. ignites a spirit of learning Brings the team together to act: Own the data, own the actions and anticipate

ignites a spirit of learning Addressing teamwork & safety culture The Safety Huddle… ignites a spirit of learning Addressing teamwork & safety culture Wards where Teamwork and Safety Climate surveys have been repeated after reaching embedded huddles have shown overall patient safety ratings of ‘good/excellent’ progressed from 77% and 43.5% in the first survey to 95% and 79% at second survey, with an overall trend to more positive answers across the survey.

The Safety Huddle … ignites a spirit of learning *** Celebrating Success ***

Evidence of Impact Falls Average down from 1.1 falls pw to 0.4 (64% reduction) Average down from 1.2 falls pw to 0.4 (67% reduction)

Achieved over 1 year between calls (previous average 29 days) Evidence of Impact 2222 calls Achieved over 1 year between calls (previous average 29 days) Highest days between 2222 call after huddles = 124 days! (previous average 17 days)

Steps to starting a huddle Team engagement Flexibility on approach when starting huddles start with one harm and build in more harms once huddles established PDSA, one day one shift: Local adaptation by ward team Collaborative Access to ‘light touch’ coaching Support embedding the principles Data and certificates Measurement (‘days between’) board With celebration plans! Culture survey and feedback session

What are huddles like in my area? Lynn Pearl & Katie Eacret Bradford District NHS Foundation Trust Clare Ashby Yorkshire Ambulance Service Abimbola Olusoga Clinical Leadership Fellow, Huddles in Care Homes  Georgie Haigh and Jessica Farman Medical Ward, Leeds Teaching Hospitals NHS Questions to above teams from Anna: How do huddles work in your area? What have been the barriers/challenges you have faced? What are you most proud of?

How can a huddle work for you? AW

Ward ………………. Time Data visualisation or other tools required Location Roles & Leader Harm(s) discussed Ward ………………. Staff present Structure Target number of days without harm

Sharing your huddle plans AC

Summary Give it a go When led by frontline teams and supported throughout organisation safety huddles: Improve safety culture Improve patient safety Fun, rewarding, and makes what seems impossible into routine clinical practice We learn with every team Collaborate, share, mobilise, empower

Some of our Resources/contacts Available via: www.improvementacademy.org HUSH animated video Safety Huddles Overview Prompt sheets: Falls / Pressure Ulcers Teamwork & Safety Climate Survey Contact: a.cracknell@nhs.net For a copy of our HUSH Manual contact: Vicky.Padgett@yhahns.nhs.uk @HUSH_Safe