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Fostering a Culture of Safety: The OR Huddle
PATIENT SAFETY FIRST
Fostering a Culture of Safety: The OR Huddle THERESA CRISCITELLI, EdD, RN, CNOR
T
he Joint Commission reports that more than two-thirds of all adverse events in the OR are a result of poor communication.1 Over the past decade, efforts have been made to improve the communication of health care workers, especially during surgical procedures. The World Health Organization promoted the use of the surgical checklist worldwide to decrease surgical patients’ morbidity and mortality.2 AORN further supported these efforts by offering resources such as AORN’s Correct Site Surgery Tool Kit to assist health care professionals in implementing best practices and to promote correct site surgery.3 Some facilities, however, may need to improve compliance with the use of the surgical checklist or the tool kit and to educate surgical team members as to the benefits of surgical checklists.4 The use of OR huddles has emerged as an effective form of communication with a proven track record of high reliability in reducing errors.5
BASIC HUDDLE CONCEPTS In health care, huddles are usually a quick meeting of a group to share pertinent information before engaging in a task. They can be considered a microsystem type of meeting and must have structure and an operational focus with the basic aim of communication and patient safety and care. Huddles originated from the concept of the football huddle.6 Approximately every 25 seconds, football team members come together for a brief period to plan the strategy and the execution of the next play. In business, team members have taken a page from the proverbial football playbook and use huddles during regular business hours to communicate a shared vision, provide clarity, and demonstrate unity.7 Business coaches advocate huddles in the workplace to help employees see the “big picture.”8 The Harvard Business Review strongly endorses the concepts of the team huddle for learning to discuss and debate business concepts and for use in the hospital setting.9 The Wharton Business School Alumni Association has http://dx.doi.org/10.1016/j.aorn.2015.10.002 ª AORN, Inc, 2015
656 j AORN Journal
www.aornjournal.org
December 2015, Vol. 102, No. 6
created a Social Enterprise Greenhouse huddle program to support collaboration with other alumni associations.10 Huddles in the health care setting are intended to improve communication and increase workflow and are used when a longer meeting would inhibit the required work. In the OR, there are preprocedural and unit level/staff member huddles. Team members engaged in a preprocedural huddle should focus on the care of one patient, his or her immediate care, and unique requests that may be necessary to perform the procedure (eg, equipment, implants, sutures, blood products). The surgical team caring for that patient would participate in this type of huddle. The unit level/staff member huddle focuses on the “big picture” in the department and the workflow of the day. Clinical leaders, nurses, certified surgical technologists, and anesthesia professionals would participate in this type of huddle. The unit level/staff member type of huddle can assist personnel in gaining an overview of the operational side of the OR, a different aspect of the perioperative environment that clinical staff members may not understand.
What Huddles Accomplish Unit level/staff member huddles can help improve an array of communication issues within the department, such as inoperable equipment or patient care issues, and can provide a forum for team members to review the daily schedule and plan for possible variations or potential problems. Huddles promote information sharing, which can include relevant messages of the day, information from a staff meeting that requires dissemination, or other departmental issues. Team members can review care processes and system issues and remind staff members of important issues. Preprocedural huddles provide a brief check-in time before the surgical team (ie, the RN circulator, surgeon, anesthesia professional, surgical technologist) begins a surgical procedure. The huddle is used to compare relevant information, discuss concerns, and identify needs and requests pertaining to the planned procedure. Most importantly, these huddles provide another opportunity to confirm the identity of the patient, the type of procedure planned, and its location or laterality, all of which help reduce errors.
Benefits of Huddles The health care literature supports the use of huddles to facilitate care coordination11; allow for increased and integrated participation of clinical staff members; promote team thinking; and improve team communication, patient care, and safety.12 Huddles have also been shown to reduce errors and
www.aornjournal.org
The OR Huddle
untoward events.13,14 Jain et al4 performed a pilot study in the OR involving the implementation of a daily preoperative huddle for orthopedic procedures. The result was an improvement of the flow of the procedures and surgeons’ experiences and satisfaction. This study demonstrated a direct decrease in the number of interruptions and delays, which can be correlated with an increase in patient safety. Einav et al14 found that the implementation of preoperative huddles showed a measurable reduction in the incidence of near-misses and untoward events in the OR. Other research indicated that preoperative huddles have led to improved outcomes relative to administration of prophylactic antibiotics and deep venous thrombosis prophylaxis.15 Another study showed an increase in on-time antibiotic administration before surgery.13 Therefore, a goal of implementing huddles in the OR will help to not only increase efficiency and communication but also improve patient outcomes.
EFFECTIVE HUDDLES An effective huddle should follow policies and procedures outlining its use and format. In general, facilities should
make the huddle mandatory, create a limited agenda for the huddle, limit the time of the huddle, identify a consistent time each day for huddles to occur or dictate that huddles occur before the patient is transported to the OR, and create a predictable structure for the huddle. Huddles also should be interdisciplinary and conducted in a convenient location for all team members. Literature supports that team members stand rather than sit to increase engagement and brevity.16 These key guidelines make huddles more efficient.
Implementing Huddles When newly implementing the huddle practice, nurse managers and clinical educators should set effective team-based guidelines and teach staff members how to conduct a huddle. This involves teaching staff members about conflict resolution skills, active listening skills, and negotiation tactics. Because huddles need structure, it is imperative for team members to agree on specifics such as time, location, and leader and to choose a checklist that outlines what should be addressed in the huddle. The team also must determine the duration of the huddle. The literature supports seven minutes as the optimum duration for most huddles. Huddles should never exceed 15 minutes to ensure that huddles can be AORN Journal j 657
Criscitelli
supported and sustained in the fast-paced environment of health care.12,16,17 The Institute for Healthcare Improvement recommends the use of a Plan-Do-Study-Act (PDSA) cycle to make progress toward instituting changes more rapidly because the PDSA model can quickly implement improvements.17 The use of the PDSA model when implementing changes in the clinical setting can indicate high reliability concepts, meaning that what is intended to happen occurs the majority of the time. High reliability concepts are tools that will create a culture and establish processes that can reduce system failures. The Joint Commission and the Agency for Healthcare Research and Quality recommend that hospitals become high reliability organizations by changing systems and processes to increase reliability that is higher than the present levels.18,19 This will help ensure the best possible quality of care each and every time. Other, more formal ways to implement huddles are by using a huddle coaching program that focuses on structuring the huddle process via scheduling, checklists, and designated huddle coaches.11 The San Francisco Veterans Affairs Medical Center is one such organization that has successfully implemented a formal and extensive interprofessional huddle coaching program.20 These types of programs can be worthwhile when making changes in large organizations. The TeamSTEPPS framework also endorses the use of brief team huddles to increase communication between team members and promote patient safety, and this process can help the transition of staff members to the huddle practice.21
Results of Effective Huddles The current literature indicates that daily team huddles at the start of shifts result in fewer interruptions during the day and can provide immediate clarification of issues.12 The use of preoperative huddles has been shown to increase the number of surgeries starting on time22 and to create a better flow for patients, families, and the surgical team.23 A study by Toussaint and Berry showed that huddles are able to increase patient satisfaction scores.23 These results demonstrate that huddles can increase the satisfaction of patients and providers as well as perioperative nurses. Huddles have also proven to affect patient outcomes by a reduction in the incidence of near-misses and untoward events in the OR,14 an increase in on-time administration of prophylactic antibiotics, and an increase in deep venous thrombosis prophylaxis.15 Huddles provide team members with a fixed time when all team members’ attention is focused on the issues being
658 j AORN Journal
December 2015, Vol. 102, No. 6
discussed and help them use that time efficiently and effectively. Huddles are useful for a team to quickly assess changes in the clinical workload, identify the relevant issues of the day, and provide a means to prioritize care. Preoperative huddles offer another chance to clarify patient needs or care issues and ensure that equipment and other needs are met, thus helping to ensure positive patient outcomes. In a very short time, members of a care team can be “on the same page” for the day or the procedure and can be assured that relevant issues are being addressed. Huddles have led to staff members gaining a sense of team cohesiveness, which can increase their satisfaction and increase patient safety and patient satisfaction.
CONCLUSION Health care professionals should not underestimate the power of huddles. Huddles make communication in the OR easier and more productive; staff members who engage in the huddle process help reduce errors and ensure a better functioning department. Choosing parameters for huddles is important so that they remain concise and effective and do not impede the workflow process. In addition to time outs, checklists, and other routine periods of reviewing important surgical patient information, huddles allow team members to discuss issues face to face and thus improve patient care and reduce errors.
Editor’s note: TeamSTEPPS is a registered trademark of the Agency for Healthcare Research and Quality, Rockville, MD.
References 1. Weaver SJ, Rosen MA, Diaz Granados D, et al. Does teamwork improve performance in the operating room? A multilevel evaluation. Jt Comm J Qual Patient Saf. 2010;36(3):133-142. 2. World Alliance for Patient Safety. Implementation Manual: Surgical Safety Checklist. Geneva, Switzerland: World Health Organization Press; 2008. 3. Correct Site Surgery Tool Kit. AORN, Inc. http://www.aorn.org/ toolkits/correctsite/. Accessed August 31, 2015. 4. Jain AL, Jones KC, Simon J, Patterson MD. The impact of a daily pre-operative surgical huddle on interruptions, delays, and surgeon satisfaction in an orthopedic operating room: a prospective study. Patient Saf Surg. 2015;9(1):8. 5. Provost SM, Lanham HJ, Leykum LK, McDaniel RR Jr, Pugh J. Health care huddles: managing complexity to achieve high reliability. Health Care Manage Rev. 2015;40(1):2-12. 6. Glymph DC, Olenick M, Barbera S, Brown EL, Prestianni L, Miller C. Healthcare utilizing deliberate discussion linking events (HUDDLE): a systematic review. AANA J. 2015;83(3):183. 7. Three Essential Elements for Powerful Workplace Team Huddles. Enviable Workplace. http://enviableworkplace.com/essential -elements-effective-workplace-team-huddles/ Accessed August 31, 2015.
www.aornjournal.org
December 2015, Vol. 102, No. 6 8. Gardella A. The verdict on business huddles. April 5, 2012. The New York Times. http://boss.blogs.nytimes.com/2012/04/05/the -verdict-on-business-huddles/?_r¼0. Accessed August 31, 2015. 9. Sikka R, Kovich K, Sacks L. How every hospital should start the day. December 5, 2014. Harvard Business Review. https://hbr .org/2014/12/how-every-hospital-should-start-the-day. Accessed August 31, 2015. 10. Huddle. SE Greenhouse. http://segreenhouse.org/services/accelerate -your-enterprise/huddle. Accessed August 31, 2015. 11. Shunk R, Dulay M, Chou CL, Janson S, O’Brien BC. Huddlecoaching: a dynamic intervention for trainees and staff to support team-based care. Acad Med. 2014;89(2):244-250. 12. Dingley C, Daugherty K, Derieg MK, Persing R. Improving patient safety through provider communication strategy enhancements. In: Advances in Patient Safety: New Directions and Alternative Approaches, Volume 3: Performance and Tools. Rockville, MD: Agency for Healthcare Research and Quality; 2008. 13. Lingard L, Regehr G, Cartmill C, et al. Evaluation of a preoperative team briefing: a new communication routine results in improved clinical practice. BMJ Qual Saf. 2011;20(6):475-482. 14. Einav Y, Gopher D, Karla I, et al. Preoperative briefing in the operating room: shared cognition, teamwork and patient safety. Chest. 2010;137(2):443-449. 15. Award SS, Fagan SP, Bellows C, et al. Bridging the communication gap in the operating room with medical team training. Am J Surg. 2005;190(5):770-774. 16. Stewart EE, Johnson BC. Improve office efficiency in mere minutes. Fam Pract Manag. 2007;14(6):27-29. 17. Huddles. Meeting Tools. Cambridge, MA: Institute for Healthcare Improvement; 2004. 18. Hines S, Luna K, Lofthus J, et al. Becoming a High Reliability Organization: Operational Advice for Hospital Leaders. AHRQ Publication No. 08-0022. Rockville, MD: Agency for Healthcare Research and Quality; 2008, http://www.ahrq.gov/professionals/ quality-patient-safety/quality-resources/tools/hroadvice/hroadvice1 .html. Accessed August 31, 2015.
www.aornjournal.org
The OR Huddle 19. Joint Commission Center for Transforming Healthcare. SCHA collaborate on high-reliability program. Bull Am Coll Surg. 2013; 98(4):65. 20. Progress and Promise: Profiles in Interprofessional Health Training to Deliver Patient-Centered Primary Care. PatientCentered Primary Care Collaborative; 2014. https://www.pcpcc .org/resource/progress-and-promise-profiles-interprofessional -health-training-deliver-patient-centered. Accessed September 14, 2015. 21. Tibbs SM, Moss J. Promoting teamwork and surgical optimization: combining TeamSTEPPS with a specialty team protocol. AORN J. 2014;100(5):477-488. 22. Scalea TM, Carco D, Reece M, Fouche YL, Pollak AN, Nagarkatti SS. Effect of a novel financial incentive program on operating room efficiency. JAMA Surg. 2014;149(9):920-924. 23. Toussaint JS, Berry LL. The promise of Lean in health care. Mayo Clin Proc. 2013;88(1):74-82.
Theresa Criscitelli, EdD, RN, CNOR, is the assistant vice president of Administration, Perioperative, and Procedural Services at Winthrop University Hospital, Mineola, NY. Dr Criscitelli has no declared affiliation that could be perceived as posing a potential conflict of interest in the publication of this article.
AORN Journal j 659
Fostering a Culture of Safety: The OR Huddle THERESA CRISCITELLI, EdD, RN, CNOR
T
he Joint Commission reports that more than two-thirds of all adverse events in the OR are a result of poor communication.1 Over the past decade, efforts have been made to improve the communication of health care workers, especially during surgical procedures. The World Health Organization promoted the use of the surgical checklist worldwide to decrease surgical patients’ morbidity and mortality.2 AORN further supported these efforts by offering resources such as AORN’s Correct Site Surgery Tool Kit to assist health care professionals in implementing best practices and to promote correct site surgery.3 Some facilities, however, may need to improve compliance with the use of the surgical checklist or the tool kit and to educate surgical team members as to the benefits of surgical checklists.4 The use of OR huddles has emerged as an effective form of communication with a proven track record of high reliability in reducing errors.5
BASIC HUDDLE CONCEPTS In health care, huddles are usually a quick meeting of a group to share pertinent information before engaging in a task. They can be considered a microsystem type of meeting and must have structure and an operational focus with the basic aim of communication and patient safety and care. Huddles originated from the concept of the football huddle.6 Approximately every 25 seconds, football team members come together for a brief period to plan the strategy and the execution of the next play. In business, team members have taken a page from the proverbial football playbook and use huddles during regular business hours to communicate a shared vision, provide clarity, and demonstrate unity.7 Business coaches advocate huddles in the workplace to help employees see the “big picture.”8 The Harvard Business Review strongly endorses the concepts of the team huddle for learning to discuss and debate business concepts and for use in the hospital setting.9 The Wharton Business School Alumni Association has http://dx.doi.org/10.1016/j.aorn.2015.10.002 ª AORN, Inc, 2015
656 j AORN Journal
www.aornjournal.org
December 2015, Vol. 102, No. 6
created a Social Enterprise Greenhouse huddle program to support collaboration with other alumni associations.10 Huddles in the health care setting are intended to improve communication and increase workflow and are used when a longer meeting would inhibit the required work. In the OR, there are preprocedural and unit level/staff member huddles. Team members engaged in a preprocedural huddle should focus on the care of one patient, his or her immediate care, and unique requests that may be necessary to perform the procedure (eg, equipment, implants, sutures, blood products). The surgical team caring for that patient would participate in this type of huddle. The unit level/staff member huddle focuses on the “big picture” in the department and the workflow of the day. Clinical leaders, nurses, certified surgical technologists, and anesthesia professionals would participate in this type of huddle. The unit level/staff member type of huddle can assist personnel in gaining an overview of the operational side of the OR, a different aspect of the perioperative environment that clinical staff members may not understand.
What Huddles Accomplish Unit level/staff member huddles can help improve an array of communication issues within the department, such as inoperable equipment or patient care issues, and can provide a forum for team members to review the daily schedule and plan for possible variations or potential problems. Huddles promote information sharing, which can include relevant messages of the day, information from a staff meeting that requires dissemination, or other departmental issues. Team members can review care processes and system issues and remind staff members of important issues. Preprocedural huddles provide a brief check-in time before the surgical team (ie, the RN circulator, surgeon, anesthesia professional, surgical technologist) begins a surgical procedure. The huddle is used to compare relevant information, discuss concerns, and identify needs and requests pertaining to the planned procedure. Most importantly, these huddles provide another opportunity to confirm the identity of the patient, the type of procedure planned, and its location or laterality, all of which help reduce errors.
Benefits of Huddles The health care literature supports the use of huddles to facilitate care coordination11; allow for increased and integrated participation of clinical staff members; promote team thinking; and improve team communication, patient care, and safety.12 Huddles have also been shown to reduce errors and
www.aornjournal.org
The OR Huddle
untoward events.13,14 Jain et al4 performed a pilot study in the OR involving the implementation of a daily preoperative huddle for orthopedic procedures. The result was an improvement of the flow of the procedures and surgeons’ experiences and satisfaction. This study demonstrated a direct decrease in the number of interruptions and delays, which can be correlated with an increase in patient safety. Einav et al14 found that the implementation of preoperative huddles showed a measurable reduction in the incidence of near-misses and untoward events in the OR. Other research indicated that preoperative huddles have led to improved outcomes relative to administration of prophylactic antibiotics and deep venous thrombosis prophylaxis.15 Another study showed an increase in on-time antibiotic administration before surgery.13 Therefore, a goal of implementing huddles in the OR will help to not only increase efficiency and communication but also improve patient outcomes.
EFFECTIVE HUDDLES An effective huddle should follow policies and procedures outlining its use and format. In general, facilities should
make the huddle mandatory, create a limited agenda for the huddle, limit the time of the huddle, identify a consistent time each day for huddles to occur or dictate that huddles occur before the patient is transported to the OR, and create a predictable structure for the huddle. Huddles also should be interdisciplinary and conducted in a convenient location for all team members. Literature supports that team members stand rather than sit to increase engagement and brevity.16 These key guidelines make huddles more efficient.
Implementing Huddles When newly implementing the huddle practice, nurse managers and clinical educators should set effective team-based guidelines and teach staff members how to conduct a huddle. This involves teaching staff members about conflict resolution skills, active listening skills, and negotiation tactics. Because huddles need structure, it is imperative for team members to agree on specifics such as time, location, and leader and to choose a checklist that outlines what should be addressed in the huddle. The team also must determine the duration of the huddle. The literature supports seven minutes as the optimum duration for most huddles. Huddles should never exceed 15 minutes to ensure that huddles can be AORN Journal j 657
Criscitelli
supported and sustained in the fast-paced environment of health care.12,16,17 The Institute for Healthcare Improvement recommends the use of a Plan-Do-Study-Act (PDSA) cycle to make progress toward instituting changes more rapidly because the PDSA model can quickly implement improvements.17 The use of the PDSA model when implementing changes in the clinical setting can indicate high reliability concepts, meaning that what is intended to happen occurs the majority of the time. High reliability concepts are tools that will create a culture and establish processes that can reduce system failures. The Joint Commission and the Agency for Healthcare Research and Quality recommend that hospitals become high reliability organizations by changing systems and processes to increase reliability that is higher than the present levels.18,19 This will help ensure the best possible quality of care each and every time. Other, more formal ways to implement huddles are by using a huddle coaching program that focuses on structuring the huddle process via scheduling, checklists, and designated huddle coaches.11 The San Francisco Veterans Affairs Medical Center is one such organization that has successfully implemented a formal and extensive interprofessional huddle coaching program.20 These types of programs can be worthwhile when making changes in large organizations. The TeamSTEPPS framework also endorses the use of brief team huddles to increase communication between team members and promote patient safety, and this process can help the transition of staff members to the huddle practice.21
Results of Effective Huddles The current literature indicates that daily team huddles at the start of shifts result in fewer interruptions during the day and can provide immediate clarification of issues.12 The use of preoperative huddles has been shown to increase the number of surgeries starting on time22 and to create a better flow for patients, families, and the surgical team.23 A study by Toussaint and Berry showed that huddles are able to increase patient satisfaction scores.23 These results demonstrate that huddles can increase the satisfaction of patients and providers as well as perioperative nurses. Huddles have also proven to affect patient outcomes by a reduction in the incidence of near-misses and untoward events in the OR,14 an increase in on-time administration of prophylactic antibiotics, and an increase in deep venous thrombosis prophylaxis.15 Huddles provide team members with a fixed time when all team members’ attention is focused on the issues being
658 j AORN Journal
December 2015, Vol. 102, No. 6
discussed and help them use that time efficiently and effectively. Huddles are useful for a team to quickly assess changes in the clinical workload, identify the relevant issues of the day, and provide a means to prioritize care. Preoperative huddles offer another chance to clarify patient needs or care issues and ensure that equipment and other needs are met, thus helping to ensure positive patient outcomes. In a very short time, members of a care team can be “on the same page” for the day or the procedure and can be assured that relevant issues are being addressed. Huddles have led to staff members gaining a sense of team cohesiveness, which can increase their satisfaction and increase patient safety and patient satisfaction.
CONCLUSION Health care professionals should not underestimate the power of huddles. Huddles make communication in the OR easier and more productive; staff members who engage in the huddle process help reduce errors and ensure a better functioning department. Choosing parameters for huddles is important so that they remain concise and effective and do not impede the workflow process. In addition to time outs, checklists, and other routine periods of reviewing important surgical patient information, huddles allow team members to discuss issues face to face and thus improve patient care and reduce errors.
Editor’s note: TeamSTEPPS is a registered trademark of the Agency for Healthcare Research and Quality, Rockville, MD.
References 1. Weaver SJ, Rosen MA, Diaz Granados D, et al. Does teamwork improve performance in the operating room? A multilevel evaluation. Jt Comm J Qual Patient Saf. 2010;36(3):133-142. 2. World Alliance for Patient Safety. Implementation Manual: Surgical Safety Checklist. Geneva, Switzerland: World Health Organization Press; 2008. 3. Correct Site Surgery Tool Kit. AORN, Inc. http://www.aorn.org/ toolkits/correctsite/. Accessed August 31, 2015. 4. Jain AL, Jones KC, Simon J, Patterson MD. The impact of a daily pre-operative surgical huddle on interruptions, delays, and surgeon satisfaction in an orthopedic operating room: a prospective study. Patient Saf Surg. 2015;9(1):8. 5. Provost SM, Lanham HJ, Leykum LK, McDaniel RR Jr, Pugh J. Health care huddles: managing complexity to achieve high reliability. Health Care Manage Rev. 2015;40(1):2-12. 6. Glymph DC, Olenick M, Barbera S, Brown EL, Prestianni L, Miller C. Healthcare utilizing deliberate discussion linking events (HUDDLE): a systematic review. AANA J. 2015;83(3):183. 7. Three Essential Elements for Powerful Workplace Team Huddles. Enviable Workplace. http://enviableworkplace.com/essential -elements-effective-workplace-team-huddles/ Accessed August 31, 2015.
www.aornjournal.org
December 2015, Vol. 102, No. 6 8. Gardella A. The verdict on business huddles. April 5, 2012. The New York Times. http://boss.blogs.nytimes.com/2012/04/05/the -verdict-on-business-huddles/?_r¼0. Accessed August 31, 2015. 9. Sikka R, Kovich K, Sacks L. How every hospital should start the day. December 5, 2014. Harvard Business Review. https://hbr .org/2014/12/how-every-hospital-should-start-the-day. Accessed August 31, 2015. 10. Huddle. SE Greenhouse. http://segreenhouse.org/services/accelerate -your-enterprise/huddle. Accessed August 31, 2015. 11. Shunk R, Dulay M, Chou CL, Janson S, O’Brien BC. Huddlecoaching: a dynamic intervention for trainees and staff to support team-based care. Acad Med. 2014;89(2):244-250. 12. Dingley C, Daugherty K, Derieg MK, Persing R. Improving patient safety through provider communication strategy enhancements. In: Advances in Patient Safety: New Directions and Alternative Approaches, Volume 3: Performance and Tools. Rockville, MD: Agency for Healthcare Research and Quality; 2008. 13. Lingard L, Regehr G, Cartmill C, et al. Evaluation of a preoperative team briefing: a new communication routine results in improved clinical practice. BMJ Qual Saf. 2011;20(6):475-482. 14. Einav Y, Gopher D, Karla I, et al. Preoperative briefing in the operating room: shared cognition, teamwork and patient safety. Chest. 2010;137(2):443-449. 15. Award SS, Fagan SP, Bellows C, et al. Bridging the communication gap in the operating room with medical team training. Am J Surg. 2005;190(5):770-774. 16. Stewart EE, Johnson BC. Improve office efficiency in mere minutes. Fam Pract Manag. 2007;14(6):27-29. 17. Huddles. Meeting Tools. Cambridge, MA: Institute for Healthcare Improvement; 2004. 18. Hines S, Luna K, Lofthus J, et al. Becoming a High Reliability Organization: Operational Advice for Hospital Leaders. AHRQ Publication No. 08-0022. Rockville, MD: Agency for Healthcare Research and Quality; 2008, http://www.ahrq.gov/professionals/ quality-patient-safety/quality-resources/tools/hroadvice/hroadvice1 .html. Accessed August 31, 2015.
www.aornjournal.org
The OR Huddle 19. Joint Commission Center for Transforming Healthcare. SCHA collaborate on high-reliability program. Bull Am Coll Surg. 2013; 98(4):65. 20. Progress and Promise: Profiles in Interprofessional Health Training to Deliver Patient-Centered Primary Care. PatientCentered Primary Care Collaborative; 2014. https://www.pcpcc .org/resource/progress-and-promise-profiles-interprofessional -health-training-deliver-patient-centered. Accessed September 14, 2015. 21. Tibbs SM, Moss J. Promoting teamwork and surgical optimization: combining TeamSTEPPS with a specialty team protocol. AORN J. 2014;100(5):477-488. 22. Scalea TM, Carco D, Reece M, Fouche YL, Pollak AN, Nagarkatti SS. Effect of a novel financial incentive program on operating room efficiency. JAMA Surg. 2014;149(9):920-924. 23. Toussaint JS, Berry LL. The promise of Lean in health care. Mayo Clin Proc. 2013;88(1):74-82.
Theresa Criscitelli, EdD, RN, CNOR, is the assistant vice president of Administration, Perioperative, and Procedural Services at Winthrop University Hospital, Mineola, NY. Dr Criscitelli has no declared affiliation that could be perceived as posing a potential conflict of interest in the publication of this article.
AORN Journal j 659