1 Aldawood F, et al. BMJ Open Quality 2020;9:e000753. doi:10.1136/bmjoq-2019-000753 Open access Enhancing teamwork communication and patient safety responsiveness in a paediatric intensive care unit using the daily safety huddle tool Fatima Aldawood , 1 Yasser Kazzaz , 2,3,4 Ali AlShehri, 2,3,4 Hamza Alali, 3,4 Khaled Al-Surimi 5,6 To cite: Aldawood F, Kazzaz Y, AlShehri A, et al. Enhancing teamwork communication and patient safety responsiveness in a paediatric intensive care unit using the daily safety huddle tool. BMJ Open Quality 2020;9:e000753. doi:10.1136/ bmjoq-2019-000753 Received 15 June 2019 Revised 23 January 2020 Accepted 11 February 2020 1 Nursing Services, Ministry of National Guard Health Affairs, Riyadh, Central, Saudi Arabia 2 College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia 3 King Abdullah International Medical Research Center, Riyadh, Saudi Arabia 4 Department of Pediatric, King Abdulaziz Medical City, Riyadh, Saudi Arabia 5 College of Public Health and Health Informatics, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia 6 Primary Care and Public Health Department, School of Public Health, Imperial College London, London, UK Correspondence to Ms Fatima Aldawood; dawood.fatima@outlook.com Quality improvement report © Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. ABSTRACT Background Open communication between leadership and frontline staff at the unit level is vital in promoting safe hospital culture. Our hospital staff culture survey identifed the failure to address safety issues as one of the areas where staff felt unable to express their concerns openly. Thus, this improvement project using the daily safety huddle tool has been developed to enhance teamwork communication and respond effectively to patient safety issues identifed in a paediatric intensive care unit. Methods We used the TeamSTEPPS quality approach. TeamSTEPPS is an evidence-based set of teamwork tools developed by the US Agency of Healthcare Research and Quality to enhance teamwork and communication. We applied TeamSTEPPS using a tool called the Daily Safety Huddle, aiming at improving communication and interaction between healthcare workers and building trust by acting immediately when there is any patient safety issue or concern at the unit level. Results During the period from April to December 2017, the interaction between frontline staff and unit leadership increased through compliance with the daily safety huddle. Initially, compliance was at 73%, but it increased to 97%, with a total of 340 safety issues addressed. The majority of these safety issues pertained to infection control and medication errors (109; 32.05%), followed by communication (83; 24.41%), documentation (59; 17.35%), other issues (37; 10.88%), procedure (20; 5.88%), patient fow (16; 4.7%) and equipment and supplies (16; 4.7%). Conclusions Systematic use of daily safety huddle is a powerful tool to create an equitable environment where frontline staff can speak up freely about daily patient safety concerns. The huddle leads to a more open and active discussion with unit leadership and to the ability to perform the right action at the right time. INTRODUCTION Problem assessment In 2014, MNGHA (Ministry of National Guard - Health Affairs) conducted an institution- wide culture survey. The results from the paediatric intensive care unit (PICU) showed weakness in the domain of safety climate. The majority of staff claimed that they did not receive proper feedback about their performance, and they expressed fear of and difficulty in discussing errors. Moreover, some staff felt the culture of the unit did not promote learning from errors. In order to better understand the problem and select an appropriate intervention, the quality and patient safety department conducted a meeting involving frontline staff and unit leadership (division head, unit-based quality steering committee, nurse manager, clinical resource nurses and nurse coordinators). The meeting revealed the need for transparency in order for staff to address and report safety issues. In addition, leaders acknowledged the need for dedicated time with staff to develop trust and provide constant feedback. Staff and leaders realised that errors could be due to human factors like poor teamwork and poor communication rather than individual mistakes. Background Open communication between leadership and staff at the unit level is vital in promoting safe hospital culture. 1 Daily quick meetings are proven to improve a team’s dynamics through sharing knowledge and discussing safety issues. 2 Moreover, a timely leadership response to frontline staff’s concerns builds trust and brings the team together, which is positively reflected in the care provided to patients and their families. 2 Therefore, the US Institute for Healthcare Improvement (IHI) and the UK National Health Service (NHS) recommend the use of the daily safety huddle in clinical settings. 3 4 Conversations that take place in the huddle between individuals who might not other- wise interact may help to combat the perpet- uation of unconstructive communication norms. For example, staff working in high- reliability organisations should be aware of what is known as ‘the fallacy of centrality: the on June 25, 2020 by guest. 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