Care Huddles and Critical Conversations

[vc_row type=”in_container” full_screen_row_position=”middle” column_margin=”default” column_direction=”default” column_direction_tablet=”default” column_direction_phone=”default” scene_position=”center” text_color=”dark” text_align=”left” row_border_radius=”none” row_border_radius_applies=”bg” overlay_strength=”0.3″ gradient_direction=”left_to_right” shape_divider_position=”bottom” bg_image_animation=”none”][vc_column column_padding=”no-extra-padding” column_padding_tablet=”inherit” column_padding_phone=”inherit” column_padding_position=”all” background_color_opacity=”1″ background_hover_color_opacity=”1″ column_shadow=”none” column_border_radius=”none” column_link_target=”_self” gradient_direction=”left_to_right” overlay_strength=”0.3″ width=”1/1″ tablet_width_inherit=”default” tablet_text_alignment=”default” phone_text_alignment=”default” column_border_width=”none” column_border_style=”solid” bg_image_animation=”none”][vc_column_text]We all know that effective communication in any work environment is critical. In a residential aged care environment, effective communication can make the difference between a positive experience for a resident supporting dignity and self-esteem to an environment where stress emerges for staff because of communication chaos and a negative consequence for residents and others.

Every day, we experience a range of communication methods; informal and formal, written and verbal. Providing the right forum for communication to take place between work teams is just as important as the message that needs to be portrayed in that communication.

What ways are your staff involved in communicating with their co-workers?

Does it need to be formalised for it to be effective?

Effective communication is an art form, that is, it takes skills, guidance and support to be expressive in a way that is understood, to be engaged and to pay attention to others, to understand another person’s perspective and to listen actively through clarifying, reflecting and paraphrasing. Therefore, there is a need for some formalised method to be established with staff involved in a routine to communicate with their co-workers.

A Care Huddle may be referred to by some organisations as a “10 minutes at 10am” discussion with staff. The Care Huddle draws people together to overcome the barriers of effective and positive communication: stress, elevated negative emotions and lack of focus. 

Under the model of a Care Huddle, the meeting is a brief stand up meeting, 10 to 15 minutes long and held every day, if practical, twice a day. It is a meeting held on the floor and in an appropriate location to maintain privacy. It is held with a collection of co-workers; the focus will be carers and lifestyle workers but will also include any staff available on the floor such as cleaners, catering staff, allied health professionals may be invited including the maintenance officer. To begin with, the meeting may be facilitated by the lead registered nurse or a team leader.

The focus of the discussion is on immediate matters for the care and service delivery team and includes alerts and safety matters for residents, staff wellbeing and system or process supports and improvements.

The Care Huddle does not replace the comprehensive handover for resident care which is specific for the clinical care team and change in shifts.

The benefits:

• • Care huddles improve the communication of care and service delivery for residents.
  • Streamlines the verbal communication strategies.
  • There is improved communication and sharing of information between the broader care and services team.
  • The outcome is on the resident and the systems that support quality and safe care.
  •  The pulse check allows staff to express themselves to others and to navigate through tough days.
  •  There is an understanding of other people’s perspectives.
  • The Care Huddle provides an opportunity for the sharing of skills and process improvements amongst all team members in the environment in which they are working.
  • Fosters teamwork and enhances staff morale.
  •  Responds to emerging risks or changes and creates greater productivity.
  • Promotes an environment for staff to speak up about what is working and what is not working generating a learning and improvement culture.
  • The Care Huddle provides a structure for facilitating a productive communication meeting, supporting new team leaders to navigate the art form of effective communication.
  • There are innovative options for a care huddle. For example, a maintenance team adopted the format of the care huddle and improved their productivity and responsiveness to ad hoc maintenance requests. 

Timing

The timing of a Care Huddle needs to ensure that staff are aware that it occurs at least once a day and flexible to the events that may occur in the residential aged care home. Depending on the size and design of the residential aged care home, some team leaders will choose to hold more than one Care Huddle and will stagger the times for the various locations or will arrange to share the Care Huddle lead.

The process

Step 1:

The Team Leader (RN, Care Manager or Care Team Leader) will undertake a ‘pulse check’ for each team member. Create a safe environment for people to express how they are feeling. This is a quick check on a person’s mood, there is no need to explain the mood, just a statement. The rest of the team does not need to know why a person may be under stress but that it is important to know how someone in their team is feeling because it affects how that staff member should be treated during the shift. Ensure every staff member has a say.

If someone is overwhelmed or there are personal issues, check after the meeting if they require assistance or if there is something about a particular resident that was not known earlier in the day that requires additional support.

Step 2:

Ask about safety issues or successes from the previous day or identified in the morning, afternoon or evening when arriving on the floor.

Confirm safety issues for any resident that may not have been identified during handover. Many changes in resident care are observed post a shift handover and it is an opportunity to check in on any deterioration or increased risks that should be quickly controlled.

Confirm any resident appointments, referrals etc. Making sure staff are aware.

The leader should ask if there is anything the team needs to know to work effectively that shift. For example, someone is unwell that was not reported at handover. Complaints raised about breakfast,  or call bells were not managed well earlier. The leader needs to note these and ensure follow up and action is responded to that day. Even if the action is to record the maintenance issue or add to an improvement plan or bring it to a leadership and governance or other team  meeting – make sure this is explained to staff. Again, make sure you go through everyone in order, go around clockwise. 

Initially, this may take longer, once everyone is used to the routine, this step will be efficient and focussed. Try to minimise staff debate, the focus is about daily emerging events,  if a subject is contentious or about a process that is not functioning well, make a note and arrange to discuss at one of the more formalised meetings. Ensure staff are kept informed at the next meeting (as per Step 3) of the plans to resolve any raised issues.

Step 3:

Provide any updates on improvement activities or alerts. Refer to new procedures, policies and processes. Give a progress update on any issues that were raised by staff.

Step 4:

To wrap up the meeting:

Quick round check, confirm actions agreed – no need to check one by one for the wrap up. 

Check:

• • What worked?

• • What should we keep doing?

• • What do we need to change to keep improving? 

• • Always reflect on the relationship with the Aged Care Quality Standards.

Once established, get more staff engagement:

Ask two staff members in the team to observe something during the shift and share their findings at the next day’s care huddle. This can be reflective of the introduction of a new policy or process, a competency check in practice e.g. list the five steps in handwashing or the most common errors in medication management. This can be something that may have been identified in audits or a relationship to the standards. For example, observe how dignity is being demonstrated by members in the team or ask residents if they know how to raise a complaint and report this back to the next care huddle. An observation may be to observe colleagues and reflect examples of contribution to an improved working atmosphere. This is about building the team culture and helps to gain insight to staff practices that stick.

Manager / team leader reflection:

Use the Care Huddle steps as an Agenda to keep you on track. Make some brief notes of discussion points, this means the team can talk to you about what was raised at a previous Care Huddle if they missed out. It is also evidence to share. Your notes are also your evidence, and a tool to reflect on staff culture and progress of system improvements. It is useful to bring your notes with you to your other meeting forums as a reflection point.

Aim for a Care Huddle every day, but it is acknowledged that best plans may be interrupted. Plan to mark a calendar to track the days you succeeded in having the huddle. Leave room for notes of reasons for any missed days and why another staff member did not take the lead.

Reflective questions:

What can you do to make the huddle happen every day?

What can you do to cover the key points in 5 minutes? This will leave 5 minutes for staff input.

Remember, effective communication is an art form, therefore, reflecting on what you do yourself in this process is to:

• • stress check yourself; 
  • Improve your approach for the next Care Huddle; or
  • self-assess when to let others take the lead.

How to minimise staff debate.

When implementing Care Huddles, the huddle can be overwhelmed in some environments where there may be many things that are not working well or there is an underlying staff culture of long term frustration. Keep the focus on the Care Huddle steps. Empower and delegate to team members – enlist the assistance of team members to resolve issues and engage with the processes and systems themselves and have them report back to the team. Ensure you hold others accountable to report back within stated timeframes, Ensure you report back at each Care Huddle on completed actions, start with the easy to resolve ones, trust will continue with the team. Note and escalate any issues through your usual systems and communicate at the Care Huddle how you are escalating issues, such as:

• • Existing meeting structure – raise issues at the relevant meetings
  • Plan for continuous improvement – consult through your relevant structure and add any suggested improvement activities
  • Complaints – ensure resident or representative complaints are logged and addressed through your complaints system
  • Competencies, education and training requests – commit, consult and add to your organisation’s training plan
  • Policy and procedure compliance – provide feedback for system improvement or internal audit processes
  • WHS – ensure staff hazards and work related risks are managed through your WHS system
  • Aged Care Quality Standards – self-assessment processes

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Ingrid Fairlie

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