They Call It a “Huddle” or Leitungsbesprechung!

Marshall Ritchey can be contacted at Marshall.Ritchey@tenethealth.com.

Andy Griffith, of North Carolina fame, taught us about American football in his story about “What it was, was football.” I cannot compete with such a master of storytelling, but I would like to tell you some stories and change your thinking about a huddle. If you would be so kind as to open your mind and put aside your previously conceived notions about a huddle, I would like to present my suggestions. It may help you communicate with coworkers and coordinate your day. A huddle can be a tool to increase patient care and efficiency in the cath lab.

Now you may associate the term “huddle” with American football games. However, huddles are done in many different sports and even in other aspects of the world’s activities. Some of you may already be familiar with your hospital leadership having a huddle each morning. Some of you may even participate in huddles every morning in your department. I am here to promote and encourage this behavior. First, here is what I found out about a huddle.

The origin of the word is from the 1570’s, “to heap or crowd together,” probably from Low German word hudern “to cover, to shelter,” or from Middle Low German word huden “to cover up,”; also the Middle English word hoderen “heap together, huddle” (c.1300). The noun dates from 1580’s. Its use in U.S. football dates from 1928.¹

The term huddle and its application as we know it today came to life in the 1800’s, when Carl Clausewitz developed the idea and term for the concept of synchronization and coordination strategies. Clausewitz’s business was fighting, as he was a Prussian general and a military theorist. A huddle (or as the Prussians called it, a Leitungsbesprechung) was a new idea for the 1800’s. Clausewitz would get his team together before and after a battle to appraise the situation, and learn from the successes and failures on the field. Clausewitz even wrote a book on this and other theories, called On War.  This book continues to be read and referred to even in the 21st century.

 “Leitungsbesprechung” is a German word that is a direct descendant from Clausewitz and is still used today in Germany. Looking up “leitungsbesprechung” in the Linquee Dictionary², I found the following words and expressions associated with “leitungsbesprechung”:

Leitung f management n direction n leadership n conduct n line n guidance n supervision n head n administration n cable n pipe n wire n conductor n charge n control n pipeline n conduction n main n conduit n cord n conductorship n aegis n circuit n transmission line n controllership n cords pl pilotage n 

Besprechung f meeting n · discussion n  review n conference n talk n informal meeting n criticism n critique n powwow n ^[colloq.] 

You may, by now, get the idea that I am aiming for something more than a group of boys in circle planning a “Statue of Liberty” play like Johnny Unitas in the 1970’s.  

Looking at all those words associated with “leitungsbesprechung,” you can see how much emphasis is on management having a two-way transmission line in a powwow. A huddle is a sharing of information face-to-face. You are making contact up close and personal. There is an interaction for the common good of all involved and those they serve. The goals are communication and coordination. 

This gathering of the minds is important on many levels. None of us is as smart as all of us. When the day is beginning, and the list of outpatients and inpatients lies before you, surely you want everyone on the same page. When one patient needs this, and one physician has that concern, you want everyone to know. Just as important is everyone knowing when supplies are low and equipment is not working quite right; now you have communication and coordination.

There is more than one right answer to most questions. In a huddle, you should hear more than one possible solution. Knowing what options are available is strategically important; the decision of what is the best answer can be decided later. Don’t get bogged down with discussions in a huddle. Quick, concise discussion should be the course of action. 

Remember, you need to know what you are up against before you start the fight. Therefore, getting your staff and coworkers together in a huddle in the cardiac cath, electrophysiology, and special procedures lab in the morning before the battle begins is a great idea. Plan your day; work your plan.

Gather your troops together in the morning before the start of cases, before stocking the rooms (which should have been stocked before everyone left the night before), and before grabbing a drink or snack (which we shouldn’t have in the control room anyway). Get everyone together at the same time and place. 

The ideal meeting spot for a huddle is in front of the scheduling board or screen.  Eliminate chairs or places to rest, and the temptation to get too comfortable. The idea is to keep this meeting to the point of the attack. Keep it short and sweet. No long dialogue! This communication should be structured to keep you on target. A standard format for the huddle will help keep you focused. Figure 2 shows a suggested agenda sheet.

You may modify this agenda to your own needs and wants.  You will get more from such a form if everyone contributes their thoughts and suggestions.  Ownership harvests a greater bounty. 

• Complete your form as much as you can before the huddle. 
• Read out to your coworkers the order of battle.
• Tell them what they are facing for the day.
• Delegate the responsibilities.
• Document all concerns. Don’t try to answer them unless it is a quick answer.  
• Applaud recognitions.  
• Give them an idea of what tomorrow and the rest of the week holds for them.

Take notes during and after the huddle. If you don’t document it, it never happened. Try to have everyone participate in the huddle. Remember the goal is communication and coordination for everyone. Make it a conversation, not a monologue. Go around the room and engage them all in your plan of battle. Keep this limited to a five- to ten-minute session. 

When you have twenty or more staff members, this may be untimely and unmanageable. You may wish to break into smaller teams, which can form their own huddle. Then team leaders then meet to exchange information they learned in their huddle.

Currently at Piedmont Medical Center, the cardiac cath lab has a team huddle at 7:00 am. This is followed by a bed board meeting at 8:00 am, which is then followed by an administrative team huddle at 8:15 am. The information flows up and down the chain of command. These are short meetings, and following, there may be some breakout meetings for longer discussions. Keep it short and sweet. Keep them standing. No one wants to stand longer than ten minutes. Keep everyone engaged in the strategies, synchronization and coordination. This is a good thing!

I guarantee you one hundred percent that having a huddle is not the answer to all your problems. In fact, you may discover you have more problems than you knew or expected. However, you have a good chance at improving morale, as everyone has an opportunity to speak their piece. There may be more peace, because there is more communication and understanding of what you are all facing. Armed with the understanding of the why and wherefore of some decisions, your staff may feel more empowered. With this ownership, they may become more engaged in their work.  

Another suggestion would be to have a huddle before you retire to the locker room at the end of the day. You see, we do have some things that are in common with football. There are some days when I wish I wore a helmet and some padding to protect me from the bumps and bruises of managing a cardiac cath lab as I run for the goal. Piedmont Medical Center’s goal is to deliver exceptional healthcare to every person we have the privilege to serve. Remind your staff of your mission or goal.

The battle rages on with heart disease. Gather your troops, synchronize, and coordinate your daily attacks. Ben Franklin noted, “Those who fail to plan, plan to fail.” I encourage you to make your own game plan or huddle sheet, and then to huddle with your team every morning. Be the winning team at the end of the day.  Be strong and of good courage! 

Carpe diem – pluck the day!

References

1. Huddle. (n.d.). Online Etymology Dictionary. Retrieved February 24, 2015, from Dictionary.com website. Available online at: https://dictionary.reference.com/browse/huddle.
2. Leitungsbesprechung. Linguee German-English translation, Retrieved February 24, 2015, from Linquee.com. Available online at: https://www.linguee.com/german-english/translation/leitungsbesprechung.html.