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Huddle Up: A Brief Morning Meeting Can Lead to Stress-Free Day

Improving communications with your team can lead to increased productivity, higher patient satisfaction, and improved team morale.

The practice I discuss in this case study is productive and successful, with patients flocking through the door to receive high-quality service and care. Last year, the doctor reached his patient-loadWhat we've got here is failure to communicate threshold. Up to this point, we did everything we could think of to maximize his productivity and manage the practice growth. We added treatment rooms and medical assistants, re-engineered the infrastructure, and added an administrator to the management team.

However, the practice just kept growing and demand continued to increase. The doctor was booked out for many months and could not accept new patients. The simple solution appeared to be to recruit another high-quality physician to join this single-physician practice in order to better meet the needs of the patients. Sounds like a piece-of-cake solution, right?.

Integration Challenges

Integrating the new physician into the practice has proven to be a major challenge. Moving forward a year, the practice should now be past the growing pains and operating like a well-oiled machine. Unfortunately, the gears started squeaking more loudly and stress fractures began to appear in the framework. A major "check-up" was needed before the engine seized.

The physician-integration challenges were not totally unexpected but everyone really needed to know what the "real" issues were. Similar to most people, the staff did not like change and needed some coaching and hand-holding through the process. We tried to set the expectation that there would be some challenges and reinforced the importance of working together as a team to ensure a successful integration.

In order to diagnose the problems, we needed to first gather information. One of the best ways to analyze an internal practice situation is to go directly to the source of the conflict with objective measurement tools. Consequently, we initiated a patient satisfaction survey and an employee job satisfaction survey.

Using Surveys

The first step was to conduct the patient satisfaction survey. We handed out 200 surveys for each physician. We started on a Monday morning and gave one to every patient that received a service from the practice. Human nature sometimes tempts us to "forget" to hand out a survey to someone who is in obvious distress. However, that is the patient we really need to hear from, so it was important to coach our check-out person to give the survey to everyone. This survey measured each of the major "patient contact points" and followed the normal progression of the patient's flow through the practice. Questions were asked pertaining to check-in, rooming, quality of care by physician and support staff, check-out, and billing.

The second source of information was the employee team. An employee job satisfaction survey usually works best if you have an anonymous data gathering mechanism administered by a third party. The survey covered a series of topics that were broad in scope, including satisfaction with the compensation plan, benefits, workload distribution, morale, management effectiveness, and the amount of time the physician spends with patients.

Survey Results

This was not the first time we had administered these surveys and the scores were just as high as always, with the exception of one area. The results of both surveys were consistent in identifying the major area of opportunity, which turned out to be a vicious patient flow cycle.

Patients were unhappy because of the long wait times, the staff was unhappy because the patients were taking out their wait-related frustration on them, and the doctor wasn't happy because he had to spend extra time with the patients to calm them down. The more time he spent with the patients getting them to a happy place, the further it put him behind schedule. The further he got behind on the schedule, the longer the wait time. So the doctor expressed his displeasure directly to the staff, the staff was demoralized and stressed, which directly affected their level of customer service. This vicious cycle made the staff miserable and the practice a very unhappy place to be. As an observer, I saw this as a textbook definition of medical practice insanity.

When discussing the survey results with the staff and the physicians (separately), no one wanted to take ownership of the problem. The staff blamed the doctor for taking too much time with the patients and not staying on schedule. The doctor blamed the staff for poor scheduling and slow rooming. It was difficult to determine who was "right" in this situation, but right or wrong really did not matter in this instance. Given the circumstances, everyone was probably a "little bit right." The challenge I faced as a consultant was to get both parties to find a solution, agree to work together, and get the practice back up to the high standards expected by patients.

Huddle and Communicate

The starting point for conflict resolution usually begins with improved communication. It is imperative to improve the communication between physician and staff by creating a vehicle that allows this.

I recently attended the Cosmetic Bootcamp where I met Dr. Marguerite Germain who is in private practice in Mt. Pleasant, SC. She and I discussed many issues and she shared with me several very effective activities she has incorporated into her daily schedule that have had excellent results. One of the most effective activities is the morning meeting – they call it a "huddle." Every day before the first patient is roomed, they "Huddle up". This made an impact on me for several reasons. The primary reason is that it was such a simple solution to a problem that I see consistently. Secondly, it works and does not require any major behavioral changes. Lastly, it can lead to strong team cohesion that is critical to practice success.

This is a very simple starting point to begin elevating the practice's performance and opening up the communication lines. It is also critical that the staff understand why they are having the huddle. It is a forum in which everyone has the opportunity to provide input as a team. It isn't a debate or gripe session. It is a daily strategy discussion based on a gathering of respected professionals.

During the huddle, everyone receives a copy of the day's patient schedule, which is reviewed in depth. Participants identify and call out any situations that might affect patient flow. A huddle should take no more than five to 10 minutes. It is not meant to take the place of regularly scheduled staff meetings.

One of the most important components of the huddle process is that everyone has the opportunity to be a part of the solution rather than part of the problem. Over time, this will help build a stronger team. It also will lead to the best possible office experience for the patient, who will then become practice advocates.

A Sample Huddle Agenda

While the huddle will be brief, everyone will benefit if there is some kind of an agenda. The agenda items might include.

  • Any special needs for particular appointments/patients.
  • Possible "log-jams" in the schedule.
  • Challenging patients or situations.
  • VIP's (may be the same as #3).
  • "Work in" slots for emergencies.
  • Identification of mis-categorized appointments, i.e., a long visit in a short visit time slot or 10 new patients back to back.
  • Anything pertinent to the patient flow and office efficiency for the current day, i.e., someone working a half day.
Who should be involved in the huddle?

It is important to include as many staff members as possible in this huddle/discussion. Participants should include:

  • Physician or Medical Provider: May or may not be the discussion leader.
  • Manager/Administrator: This person should be the motivational speaker when appropriate, mediator if needed, and enforcer if required.
  • Medical Assistants/Nursing Staff: They understand how prepare the rooms in advance.
  • Scheduler: Available to answer specific schedule questions. This person can also observe the importance of proper scheduling. They will be held accountable for scheduling mishaps and praised for well-organized schedules that affect patient flow.
  • Check-in staff: Always a possible bottle-neck for patient flow, this person or group is the patient's first "live" contact with the practice. The gatekeeper can make or break the overall rhythm and set the tone for the visit.
  • Check-out staff: This is another possible traffic bottle-neck. This team can also serve as valuable observers in gauging the quality of care and customer service provided during the office visit.
Huddle Up for Success

The huddle will save time and effort every day. It should result in higher productivity, improved practice efficiency, and decreased wait times. It will also help get you out of the office on time, which is always a popular result. The goal the team needs to have in mind is to improve customer service. With excellent customer service, you can achieve high patient satisfaction levels, which lead to patient advocates for your practice. Setting expectations for the day and planning accordingly will help you minimize the "surprises." Use the "huddle" to create a plan for the day and try to stick to it. Keep in mind, however, that surprises will occur. It is important to remain flexible and manage the situation using a team approach. Lastly, please remember to provide positive reinforcement and celebrate the success with your team.