Daily Huddles - 2 Setting the Stage for Organizational Learning

In the first post on daily huddles, I described the way supervisors at two ambulatory surgical centers have tested an agenda and some of the benefits they’ve reported.

Daily huddles also look like one way to promote organizational learning, as described by Tucker et al. in their article “When problem-solving prevents organizational learning” (Journal of Organizational Change Management, 15, 2, 2002, 122-137).

Tucker and her co-authors report on 190 observation hours of nurses in two hospitals, summarizing lessons and implications in the ways the nurses solved problems.

They describe two types of problem solving. (The authors define a problem as an “undesirable gap between an expected and an observed state.” p. 124).

“First-order problem solving allows work to continue but does nothing to prevent a similar problem from occurring….Second-order problem solving, in contrast, investigates and seeks to change underlying causes.” (p. 124).

Of the 120 problem-solving events in the 190 hours observations, the researchers characterized 110 (92%) as first-order.

As the authors note, if staff only engage in first order problem solving, then the problems will continue unabated, changing only in detail, day after day.

Of course second-order problem solving is preferred—but the data showed that first-order problem solving dominated nursing practice.

The authors describe factors to explain their observations. They then offer several fundamental principles to move an organization from first-order to second-order problem solving (pp. 134-135):

(1) Second-order problem-solving must “…be an explicit part of [front-line staff’s] job and enough time allocated for improvement efforts.”

(2) There must be “…frequent opportunities for communicating about problems with individuals who are responsible for supplying front line workers with materials or information.”

(3) “…when the signal is given that there is a problem, proper attention must be paid to it. We must recognize communication as a valid step in the direction of improvement.”

(4) The organization has “…a dedicated person to serve as a system improvement resource.” 

Daily huddles by themselves are not sufficient to move an organization to second-order problem solving. To practice second-order problem solving, the unit supervisor needs skill in process analysis and observation, help from quality improvement specialists to learn and use data tools, and support from the supervisor’s supervisor. The unit supervisor and team members will need additional time outside the huddle to analyze causes and think about countermeasures that then need testing. (principle (1))

Nonetheless, the daily huddle opens the door to second-order problem solving, especially if the organization agrees that the unit supervisor is the immediate “system improvement resource” who aims to help his or her people to do a better job. (principle (4)).

The daily huddle provides time every day for a unit team and supervisor to identify problems--gaps between desired state and actual states. The huddle fosters communication between staff and supervisor, the first-line system improvement resource. Thus the daily huddle begins to operationalize principles (2) and (3).

In our initial experience with ambulatory surgical centers, the daily huddle looks like a solid platform for maintenance of desired protocols and second-order problem solving, helping supervisors and unit teams to reduce gaps between actual and desired performance.

Prevent the PDSA Wheel from Rolling Back Down the Improvement Hill

Prevent the PDSA Wheel from Rolling Back Down the Improvement Hill

Daily Huddles-I: Helping People Do a Better Job

Daily Huddles-I: Helping People Do a Better Job