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Impact of multidisciplinary team huddles on patient safety: a systematic review and proposed taxonomy
  1. Brian J Franklin1,2,
  2. Tejal K Gandhi3,
  3. David W Bates4,5,
  4. Nadia Huancahuari5,6,
  5. Charles A Morris4,5,
  6. Madelyn Pearson7,
  7. Michelle Beth Bass8,
  8. Eric Goralnick6,9
  1. 1 University of Michigan Medical School, Ann Arbor, Michigan, USA
  2. 2 Harvard Business School, Boston, Massachusetts, USA
  3. 3 Press Ganey Associates LLC, Boston, Massachusetts, USA
  4. 4 Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, Massachusetts, USA
  5. 5 Harvard Medical School, Boston, Massachusetts, USA
  6. 6 Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
  7. 7 Brigham and Women's Hospital, Boston, Massachusetts, USA
  8. 8 Countway Library of Medicine, Harvard Medical School, Boston, Massachusetts, USA
  9. 9 Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
  1. Correspondence to Brian J Franklin, University of Michigan Medical School, Ann Arbor, MI 48109, USA; BrianJFr{at}


Background Despite significant advances, patient safety remains a critical public health concern. Daily huddles—discussions to identify and respond to safety risks—have been credited with enhancing safety culture in operationally complex industries including aviation and nuclear power. More recently, huddles have been endorsed as a mechanism to improve patient safety in healthcare. This review synthesises the literature related to the impact of hospital-based safety huddles.

Methods We conducted a systematic review of peer-reviewed literature related to scheduled, multidisciplinary, hospital-based safety huddles through December 2019. We screened for studies (1) in which huddles were the primary intervention being assessed and (2) that measured the huddle programme’s apparent impact using at least one quantitative metric.

Results We identified 1034 articles; 24 met our criteria for review, of which 19 reflected unit-based huddles and 5 reflected hospital-wide or multiunit huddles. Of the 24 included articles, uncontrolled pre–post comparison was the prevailing study design; we identified only two controlled studies. Among the 12 unit-based studies that provided complete measures of statistical significance for reported outcomes, 11 reported statistically significant improvement among some or all outcomes. The objectives of huddle programmes and the language used to describe them varied widely across the studies we reviewed.

Conclusion While anecdotal accounts of successful huddle programmes abound and the evidence we reviewed appears favourable overall, high-quality peer-reviewed evidence regarding the effectiveness of hospital-based safety huddles, particularly at the hospital-wide level, is in its earliest stages. Additional rigorous research—especially focused on huddle programme design and implementation fidelity—would enhance the collective understanding of how huddles impact patient safety and other targeted outcomes. We propose a taxonomy and standardised reporting measures for future huddle-related studies to enhance comparability and evidence quality.

  • healthcare quality improvement
  • communication
  • lean management
  • patient safety
  • teamwork

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  • Twitter @BrianJFranklin1, @EricGoralnick

  • Contributors EG conceived of and led the project. MBB, BJF and EG developed the comprehensive search strategy. BJF and EG screened articles for inclusion. BJF executed the data extraction and initial drafting of the manuscript. All authors assisted with analysis and interpretation of the data, as well as provided critical feedback related to the research and manuscript revision.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information.