Factors to consider in the introduction of huddles on clinical wards: Perceptions of staff on the SAFE programme

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Abstract

Objectives: To explore paediatric hospital staff members’ perceptions of the emerging benefits and challenges of the huddle, a new safety improvement initiative, as well as the barriers and facilitators to its implementation.

Design: A qualitative study was conducted using semi-structured interviews to explore staff perspectives and experiences.

Setting: Situation Awareness For Everyone (SAFE), a safety improvement programme, was implemented on a sample of National Health Service (NHS) paediatric wards from September 2014 to June 2016. Previously untested in England, the huddle was a central component of the programme.

Participants: Semi-structured interviews were conducted with 76 staff members on four wards ~4 months after the start of the programme.

Results: A thematic analysis showed that staff perceived the huddle as helping to increase their awareness of important issues, improve communication, facilitate teamwork, and encourage a culture of increased efficiency, anticipation and planning on the ward. Challenges of the huddle included added pressure on staff time and workload, and the potential for junior nurses to be excluded from involvement, thus perhaps inadvertently reinforcing medical hierarchies. Staff also identified several barriers and facilitators to the huddle process, including the importance of senior nursing and medical staff leadership and managing staff time and capacity issues.

Conclusions: The findings point towards the potential efficacy of the huddle as a way of improving hospital staff members’ working environments and clinical practice, with important implications for other sites seeking to implement such safety improvement initiative