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Huddle-Coaching: A Dynamic Intervention for Trainees and Staff to Support Team-Based Care

Shunk, Rebecca MD; Dulay, Maya MD; Chou, Calvin L. MD, PhD; Janson, Susan PhD, RN, ANP; O’Brien, Bridget C. PhD

doi: 10.1097/ACM.0000000000000104
Articles

Many outpatient clinics where health professionals train will transition to a team-based medical home model over the next several years. Therefore, training programs need innovative approaches to prepare and incorporate trainees into team-based delivery systems. To address this need, educators at the San Francisco Veterans Affairs (VA) Medical Center included trainees in preclinic team “huddles,” or briefing meetings to facilitate care coordination, and developed an interprofessional huddle-coaching program for nurse practitioner students and internal medicine residents who function as primary providers for patient panels in VA outpatient primary care clinics. The program aimed to support trainees’ partnerships with staff and full participation in the VA’s Patient Aligned Care Teams. The huddle-coaching program focuses on structuring the huddle process via scheduling, checklists, and designated huddle coaches; building relationships among team members through team-building activities; and teaching core skills to support collaborative practice. A multifaceted evaluation of the program showed positive results. Participants rated training sessions and team-building activities favorably. In interviews, trainees valued their team members and identified improvements in efficiency and quality of patient care as a result of the team-based approach. Huddle checklists and scores on the Team Development Measure indicated progress in team processes and relationships as the year progressed. These findings suggest that the huddle-coaching program was a worthwhile investment in trainee development that also supported the clinic’s larger mission to deliver team-based, patient-aligned care. As more training sites shift to team-based care, the huddle-coaching program offers a strategy for successfully incorporating trainees.

Dr. Shunk is associate professor, Department of Medicine, San Francisco VA Medical Center and University of California, San Francisco, San Francisco, California.

Dr. Dulay is assistant professor, Department of Medicine, San Francisco VA Medical Center and University of California, San Francisco, San Francisco, California.

Dr. Chou is professor, Department of Medicine, San Francisco VA Medical Center and University of California, San Francisco, San Francisco, California.

Dr. Janson is professor, Department of Community Health Systems, School of Nursing, and Department of Medicine, University of California, San Francisco, San Francisco, California.

Dr. O’Brien is assistant professor, Department of Medicine and Office of Research and Development in Medical Education, University of California, San Francisco, San Francisco, California.

Funding/Support: The Centers of Excellence in Primary Care Education of the Office of Academic Affiliations, U.S. Department of Veterans Affairs Office of Academic Affiliations; San Francisco Veterans Affairs Medical Center; University of California, San Francisco (UCSF).

Other disclosures: None reported.

Ethical approval: The study was reviewed for ethical approval and deemed exempt by the UCSF committee on human research and SFVAMC research and development committee.

Previous presentations: A much earlier version of the manuscript was presented as a poster at the annual meeting of the Society for General Internal Medicine, Orlando, Florida, May 2012, and at the UCSF Medical Education Day in April 2012.

Correspondence should be addressed to Dr. Shunk, San Francisco VA Medical Center, 4150 Clement St., San Francisco, CA 94121; telephone: (415) 221-4810 ext. 4878; fax: (415) 750-6919; e-mail: rebecca.shunk@va.gov.

© 2014 by the Association of American Medical Colleges