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Tiered daily huddles: the power of teamwork in managing large healthcare organisations
  1. Tomislav Mihaljevic
  1. Cleveland Clinic Foundation, Cleveland, Ohio, USA
  1. Correspondence to Dr Tomislav Mihaljevic, Cleveland Clinic Foundation, Cleveland, Ohio 44195-5243, USA; mihaljt{at}

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Successful management of large healthcare organisations has always been challenging but never more than today. We must all think, work and act differently to deliver the highest quality and safest patient care amidst the challenges of payment reform, regulatory requirements, expense growth and resource constraints.1 2 These problems are particularly challenging for non-profit academic medical centres given the need to balance financial demands with commitments to teaching, research and the communities we serve. We observed that in our large healthcare organisation (66 000 caregivers serving approximately 2 million unique patients annually), our leadership team holds immense responsibility but lacked daily insight into our performance, and as a result, took action in retrospect. In order to address this challenge we built a tiered huddle system across our hospitals and outpatient facilities that has produced significant learnings and rapid results. We now reflect and share what we have done and hope others can benefit from this simple, powerful practice.

Building a system

Our tiered huddle system was built on a cultural foundation of every caregiver capable, empowered and expected to make improvements every day. Core to our ‘culture of improvement’ is a strong team-based culture in which all caregivers feel safe and supported to solve problems. In addition, I valued the daily, hospital-wide huddles we used in some of our hospital locations, and sought the same level of daily operational awareness for leaders across a large system. Huddles are not new in healthcare. However, tiered huddles are uncommon in large organisations due to their novelty, complexity and an overall lack of current, actionable information.3 In early 2018 we developed our system of tiered daily huddles in order to improve our daily insight into our operations and empower caregivers and teams at all levels to identify and solve problems on a daily basis.

After …

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  • Contributors This is a single-authored manuscript. I certify that I (TM) have fully contributed to the creation, writing and critique of this manuscript.

  • 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 Data are included and additional data are available upon request.