In 15 minutes, by 9:30 a.m., what was once thought impossible has become possible. This is the time it takes Saskatoon Health Region’s senior leadership team to know the daily pulse of our organization.

“You know, I was skeptical,” says Jackie Mann, one of the Region’s vice-presidents. “We often came together as a senior team, problem solved, and had good results. But this is every day. Every day from 9 to 9:15, we learn about the state of our Region and are doing cross-functional (across departments) problem solving.”This is the Region’s new cascading huddle in action, a concept created during the 14 day Challenge and implemented during 90 Days of Innovation: Ready Every RR-2015-06-04-dailypulsecheckDay by Team 3: Information and Decision Support.

At the beginning of the day, teams at the point of care have their daily huddle with their manager, this is followed by managers calling in or meeting  with their  operational directors for the Region. They are to report on two things in their areas – safety concerns and the capacity of their area’s units.

“There is a fine line between being too rigid and facilitating the right discussion. Because when you have over 30 people who report in, you can’t have small talk,” explains Mann. “One of the most interesting aspects was coaching people to know it was okay to be ‘green’ (meaning no issues or concerns for that day), and just say ‘My area is green’.”

In the past, directors would spend significant time trying to track down their counterparts in order to raise and resolve critical issues affecting their areas of responsibility, and ultimately their front-line staff. Now, if an issue is critical, the director can flag it on the call and the expectation is that right after the call colleagues are connecting to find resolution.

The huddle after the huddle

From 9:15 to 9:30 am, the Region’s senior team meets to discuss what they heard and comes up with their support plan for the organization for that day. The senior team consists of the Region’s vice-presidents, and president and CEO.

Sometimes, the call signals a pending crisis, which in the past, might have been handled through incident command, which is an emergency response mechanism. Now, it’s handled quickly and efficiently by senior leaders taking immediate action. For example, on Friday May 22, the senior team heard of major capacity concerns across key areas. Leaders signalled a post-long weekend surge in demand was taking its toll and many units listed their status as “red”.

“When we huddled as a senior leadership team, Dan said ‘It’s all hands on deck today’. And we decided what we were going to do, and who was going to do what. Everyone pushed out to support their team to try and improve flow, get us through the surge and help remove barriers,” says Mann. The result was a reprieve in the surge and improved flow of patients out of emergency to the unit.

Other times, the call suggests trends that need further investigation.

“For example, we are seeing through this that the flow of information on when there is harm is inconsistent,” says Mann. “Our safety department is reporting, but so are the directors. We are seeing our directors don’t always have the information when a staff member in their area was hurt, even though the incident was reported to our safety department. So, now we are trying to figure out why. What is wrong with the system? One of the vice-presidents has been assigned to lead and find the root cause so we can then problem solve.”

But the story of success comes when the huddle works up, down and across

The real power of the huddles happens when everyone works across departments and participates right from the front-line up to the highest levels.

“We had this small device in lab used for blood collection on children,” explains Mann. “The Region’s lab staff huddles daily, over the phone, across sites. During that ‘virtual’ huddle, one staff member raised an incident they had with this device saying it had  failed for no apparent reason. Upon hearing that, a staff member at a different site said they had had the same thing happen. That raised the alarm bell because there is a risk we might have to re-poke patients to get another sample, plus there is the risk of blood and body fluid exposure to our staff.”

The labs then immediately put a plan in place where they would report and monitor any incidents across all the sites with this device over the next 24 hours. Based on that monitoring, they soon realized there might be an issue with the device itself.

“So, that safety concern got reported up the next day on our director-senior team huddle,” says Mann. “The right actions were being taken and the lab was working with supply chain management, who was contacting the supplier and investigating the concern.”

Mann says during the senior team huddle, they had questioned if we should stop using the product while the investigation was underway. Mann took the day’s assignment to look into this further.

“I contacted the director for supply chain and went to the Test Centre at Royal University Hospital, and looked at the equipment. More importantly, I spoke with the manager and staff about the steps they had taken so far,” says Mann. “It was awesome. As we talked through this, staff were concerned this device might be a larger issue than just a few one-offs. They developed a work standard right then and there to say, ‘We are going to check every one of these to make sure they are not cracked before use,’ which seemed to be a common issue when the product failed.”

From that, staff decided to pull the lots when they found a cracked piece within the same order to ensure they were minimizing the risks while the investigation into this equipment is underway.

“When I reported back to our senior huddle the next morning, we discussed the need to issue a provincial alert on the potential failure of this product and did that,” says Mann. “It was an amazing process and reinforces that our role, as leaders, is to support the people who do the work. It’s not about supporting them over the phone. It’s about listening, following up and going to them to actually see and talk about what is happening so we can truly understand what is going on.”

And the learning hasn’t stopped.

The next phase of the cascading huddles is to determine how to loop back what the senior team has done with the concerns raised to them by the organization, so that information can cascade back  to the staff who are doing the work.

“It’s a gap,” says Mann. “We are a month into using this process and we working to make it better each day and stay connected to the over 14,000 people within our organization.”

See more stories about Region improvements at