Cincinnati Children's Hospital Medical Center huddle development and implementation timeline
| Year | Huddle-related activities |
|---|---|
| 2005–2006 Pre implementation | Began 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 |
| 2007–2008 | Flow 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 |
| 2009 | Four 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 |
| 2010 | Expanded 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) |
| 2011 | Emphasised 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 |
| 2012 | Began midnight huddles Began weekend daily operational brief Began new pilot to enhance structure and standardisation of unit huddles |