Table 1

Cincinnati Children's Hospital Medical Center huddle development and implementation timeline

YearHuddle-related activities
2005–2006 Pre implementationBegan speaking with people in other high-reliability organisations (HROs)
Concentrated learning about principles of HRO and situation awareness (SA)
Joined Agency for Healthcare Research and Quality HRO Learning Network
Initiated serious safety event (SSE) reduction across entire organisation
2007–2008Flow office began 8:00 bed huddles—focus on patient flow and staffing, run by Manager of Patient Services
Invited inpatient, emergency department (ED) and post-anaesthesia care unit directors—changed to charge nurses (more frontline)
Started conducting data analysis of ED and community admissions
Attended Institute for Healthcare Improvement conference. Informed initial format of HRO and SA enhanced huddles and three-tiered organisational huddle structure
Studied trend data and identified SA failures related to SSEs
Invited outside SA experts to consult
2009Four diverse units piloted methods to improve SA; focused on improving perception and comprehension
Created safety officers of the day (SOD) role (started with one, expanded to four within 1 year)
Began developing and testing standardised data identification and collection tools
2010Expanded focus of bed huddle beyond four pilot units
Expanded SA focus to include prediction (eg, the need for rapid response team)
Charge nurse in other units trained on SA and HRO principles
Expanded to afternoon and night rounding for 6–12 months to coach and reinforce methods to all charge nurses
Added 4:30 huddle to replace afternoon rounding
Started night huddles (‘night talks’) to replace rounding
Began weekday organisational huddle (named: daily operational brief)
2011Emphasised robust mitigation plans
Invited representatives from family relations, protective services, social services, and facilities to 8:00 bed huddle
Began tracking SA concerns in electronic health record
2012Began midnight huddles
Began weekend daily operational brief
Began new pilot to enhance structure and standardisation of unit huddles