Quality Update - May 2020
Radiology Tier 3 Huddles: Problem Solving and Communication Across the System
by Marta Heilbrun, MD, MSCI; Pratik Rachh, MD, MBA; Susan Reich, MHA, RDMS, CLSSBB; Amit Saindane, MD, MBA
Now matter how unprecedented the times are, the Quality Team at Emory Radiology goes above and beyond to respond and prepare.
The Radiology Tier 3 huddle was in planning prior to COVID-19 but was jumpstarted into existence as our response to the crisis began. In previous situations of inclement weather, ad hoc leadership calls provided a forum for clinical divisions and sites to report their status and discuss acute issues. With a more uncertain, complex, and prolonged road ahead, Emory Radiology leadership recognized the need for a systematic approach to situational awareness and problem escalation/resolution. The team leveraged the foundation the Quality Team established in Emory’s EmPower initiative, the existing Tier 1 and 2 huddles within Radiology, and best practices from system-level virtual huddles to set up the Radiology Tier 3 huddle for COVID-19.
This 30-minute huddle initially took place twice daily (7:30 am and 12:00 pm) starting Monday, March 16th. Weekend huddles later were moved to a single huddle at 9:00 am and the weekday 12:00 pm huddle was ended April 23rd after we had stabilized many processes. The huddles included department executive committee leadership, clinical division directors, EHC, Grady, and CHOA hospital radiology chiefs of service, advanced practice provider leaders, the radiology residency program director and chief residents, and our hospital and outpatient facility imaging directors. Over time backups for leaders, members of our quality and informatics teams, our departmental data analyst, and other key individuals were added to the daily huddles resulting in over 50 departmental leaders participating.
The huddles run on Microsoft Teams, a platform actively leveraged department-wide to improve communication. A team consisting of the leaders listed above was created, along with the Tier 3 huddle board, an issue tracker, and a central repository for key documents related to staffing, clinical operations, personal protective equipment (PPE), and infection control best-practices related to COVID-19.
The huddle board contains columns for kudos and announcements and situational awareness using the SMESS format, and contains rows for the individual clinical divisions and operating units. As leaders on the huddle board sign in, they indicate if all is as “green” for their group or enter content for awareness or discussion. System-level updates from Dr. Meltzer and Greg Hill kick off each Tier 3 huddle call. As the COVID-19 crisis evolved we incorporated into the huddle board visual trackers for staffing levels, including a recognition of counts COVID infections in our staff, PPE availability, home workstation deployment, and operational data reflecting daily patient census and imaging volumes from EHC, Grady, and CHOA. These visual management tools facilitate an efficient and informative process for huddle and allow the group to focus time on problem solving and consensus building rather than on reporting.
by Marta Heilbrun, MD, MSCI; Pratik Rachh, MD, MBA; Susan Reich, MHA, RDMS, CLSSBB; Amit Saindane, MD, MBA
Now matter how unprecedented the times are, the Quality Team at Emory Radiology goes above and beyond to respond and prepare.
The Radiology Tier 3 huddle was in planning prior to COVID-19 but was jumpstarted into existence as our response to the crisis began. In previous situations of inclement weather, ad hoc leadership calls provided a forum for clinical divisions and sites to report their status and discuss acute issues. With a more uncertain, complex, and prolonged road ahead, Emory Radiology leadership recognized the need for a systematic approach to situational awareness and problem escalation/resolution. The team leveraged the foundation the Quality Team established in Emory’s EmPower initiative, the existing Tier 1 and 2 huddles within Radiology, and best practices from system-level virtual huddles to set up the Radiology Tier 3 huddle for COVID-19.
This 30-minute huddle initially took place twice daily (7:30 am and 12:00 pm) starting Monday, March 16th. Weekend huddles later were moved to a single huddle at 9:00 am and the weekday 12:00 pm huddle was ended April 23rd after we had stabilized many processes. The huddles included department executive committee leadership, clinical division directors, EHC, Grady, and CHOA hospital radiology chiefs of service, advanced practice provider leaders, the radiology residency program director and chief residents, and our hospital and outpatient facility imaging directors. Over time backups for leaders, members of our quality and informatics teams, our departmental data analyst, and other key individuals were added to the daily huddles resulting in over 50 departmental leaders participating.
The huddles run on Microsoft Teams, a platform actively leveraged department-wide to improve communication. A team consisting of the leaders listed above was created, along with the Tier 3 huddle board, an issue tracker, and a central repository for key documents related to staffing, clinical operations, personal protective equipment (PPE), and infection control best-practices related to COVID-19.
The huddle board contains columns for kudos and announcements and situational awareness using the SMESS format, and contains rows for the individual clinical divisions and operating units. As leaders on the huddle board sign in, they indicate if all is as “green” for their group or enter content for awareness or discussion. System-level updates from Dr. Meltzer and Greg Hill kick off each Tier 3 huddle call. As the COVID-19 crisis evolved we incorporated into the huddle board visual trackers for staffing levels, including a recognition of counts COVID infections in our staff, PPE availability, home workstation deployment, and operational data reflecting daily patient census and imaging volumes from EHC, Grady, and CHOA. These visual management tools facilitate an efficient and informative process for huddle and allow the group to focus time on problem solving and consensus building rather than on reporting.
As the COVID-19 crisis rapidly unfolded in March, the new information and guidance released nearly daily created local variation on practices related to PPE, room cleaning, and clinical workflows for patients under investigation (PUI) and COVID-19 positive patients. The Radiology Tier 3 huddles provided a forum to quickly understand, develop, and disseminate best practices within the department. When necessary, topics could be escalated to Emory Healthcare system leadership for input or resolution, and the results could be quickly brought back to the Radiology leadership team on a subsequent huddle call.
New standard operating procedures, policies, and guidelines were developed to assist our team with navigating through the uncertainty of this crisis. Examples include the distribution of PPE, MR imaging on COVID-19 ventilated patients, roll-out of N95 mask re-use cleaning strategies, approaches to the use of IV contrast and US, among many other issues.
An area currently receiving considerable attention is working through a standardized approach to manage an outpatient who presents with signs or symptoms of a COVID-19 infection, but needs their imaging study to determine how to manage their underlying disease conditions. Operational data for the huddle board continue to be used to plan for staffing and to prepare for surge conditions and recovery planning.
The Radiology Tier 3 huddle has proven to be crucial platform to escalate and resolve complex issues in a complex environment comprising diverse geographic locations, modalities, personnel and clinical practice. Post-COVID, the Quality Team will continue the Radiology Tier 3 huddle to support daily management within the department. While COVID-19 has presented a specific focus for the daily Tier 3 huddles, there are many issues within the department that have historically taken excessive time to detect, escalate, and resolve. The team’s experience with EmPower in Tier 1 and Tier 2 huddles, and now our experience with a Tier 3 Radiology huddle during COVID-19 makes the resolution of issues more expeditious and the solutions more robust. The team hopes to continue building on what we have learned from EmPower to continuously improve the effectiveness of huddles to best serve team members within the department and to improve the care we provide to our patients and their families.
New standard operating procedures, policies, and guidelines were developed to assist our team with navigating through the uncertainty of this crisis. Examples include the distribution of PPE, MR imaging on COVID-19 ventilated patients, roll-out of N95 mask re-use cleaning strategies, approaches to the use of IV contrast and US, among many other issues.
An area currently receiving considerable attention is working through a standardized approach to manage an outpatient who presents with signs or symptoms of a COVID-19 infection, but needs their imaging study to determine how to manage their underlying disease conditions. Operational data for the huddle board continue to be used to plan for staffing and to prepare for surge conditions and recovery planning.
The Radiology Tier 3 huddle has proven to be crucial platform to escalate and resolve complex issues in a complex environment comprising diverse geographic locations, modalities, personnel and clinical practice. Post-COVID, the Quality Team will continue the Radiology Tier 3 huddle to support daily management within the department. While COVID-19 has presented a specific focus for the daily Tier 3 huddles, there are many issues within the department that have historically taken excessive time to detect, escalate, and resolve. The team’s experience with EmPower in Tier 1 and Tier 2 huddles, and now our experience with a Tier 3 Radiology huddle during COVID-19 makes the resolution of issues more expeditious and the solutions more robust. The team hopes to continue building on what we have learned from EmPower to continuously improve the effectiveness of huddles to best serve team members within the department and to improve the care we provide to our patients and their families.
The Quality Team in conjunction with Radiology leaders and staff is leveraging what we have learned and implemented through our responses to this crisis to set the foundation for the next phases of our EmPower journey and Lean Operating system deployment. By establishing a custom of daily communications and systems, we are making ongoing progress to being an organization that delivers extraordinary patient care by providing perfect value to our "customers" through a perfect value process that continuously strives for zero waste. We are implementing the components of a Lean Operating System as a vehicle that enables us to better execute on improved patient and team experience with better outcomes and lower costs. These principles and practices are essential as we further transform care in the face of our new normal.
