Brief “huddles” — rather than a barrage of emails and texts about safety and risk — may be the fastest and simplest way for hospital workers to avoid communication overload as they deal with the flood of COVID-19 cases, a Baylor University researcher says.
Even in normal times, hospitals are complex workplaces, with daily demands changing as staff treat patients, and prevent physical, biological and chemical risks to themselves. But amid the pandemic, health care providers must maintain physical distancing and follow new federal recommendations for increased electronic health communications — all while keeping up with rapid changes in communication technology.
Hospital efforts to increase safety can be stifled by — and even contribute to — information overload, according to a Baylor University study, published in the journal Health Communication.
“Simply inundating hospital workers with risk information isn’t likely to make for greater understanding. Technology offers unique advantages — being more connected and available — but there also is more pressure,” said lead author Ashley K. Barrett, Ph.D., assistant professor of communication studies at Baylor University.
“Workers have different capacities to process and apply information,” she said. “They can feel overwhelmed by new information technology and prefer to communicate face to face when possible, such as at the beginning and end of shifts, to give updates on patients and answer questions.”
Workers interviewed for the study offered feedback on communication challenges as well as some simple solutions increase their attention to safety and risk messages.
Interview Methods and Findings
For the study, researchers from Baylor and the University of Kansas interviewed 40 workers in two hospitals in the same network in the Midwest.
Researchers noted that recommendations from the Centers for Disease Control and Prevention include using telehealth services over face-to-face triage and visits, an approach that could become permanent for the health profession. Patient portals are being used widely for outpatient care. For inpatient care, physicians are using tablets, smartphones and video conferencing for “virtual rounds” while the rest of the care team participates from a conference room. Nurses maintain distance in patient rooms by using tablets.
Workers interviewed in the study reported using several face-to-face channels – including brief huddles and one-on-one conversations — as well as email, video conferencing, wearable mobile communication devices, paging, texting, electronic records, whiteboards and fliers.
The interviews revealed that:
- Many hospital workers questioned the effectiveness of email. Nurses said that they could not access email on the floor, so safety and risk information piled up in their inboxes. Many doctors said that emails on safety and risk were not useful and that they did not check their email at work because it competed with the time they spent with patients. “When you get done with a 14-hour workday, that doesn’t include time to read your emails,” one doctor said. “I’m exhausted when I go home. But if I don’t keep up with it everybody gets behind.”
- Nurses spoke highly of face-to-face team “safety huddles” for risk information or “care huddles” about patients. The huddles are faster, more up to date and allow for rapid feedback. “We need faster communication from the top on down, however they need to filter it,” one nurse said. “I barely have time to eat or go to the bathroom. I’m definitely not pulling up emails when I’m working.”
- Several participants said that organizational meetings are prime opportunities for effective safety and risk communication. But physician attendance at those meetings is sparse, due in part to the current amplified pressure to discharge patients quickly and because health care is increasingly being provided in physicians’ offices and outpatient sites rather than in hospitals.
- All participants interviewed said they wear a mobile communication badge beneath their personal protective equipment (PPE). The system gives timely and secure one-to-one or one-to-all voice messaging, as well patient emergency alarms. Participants largely agreed the system was vital because it is secure and patient details can be exchanged legally. But workers also said it could limit communication, given its sluggish voice mail feature and inability to understand voice commands. Said one nurse: “It’s your best friend or your worst enemy. It’s very much like when you call someone and get electronic voicemails and you to sit through menus or say something and it doesn’t understand you . . . And automatically, bed and chair alarms every conversation off.”
- Many managers, who may be responsible for issuing safety messages, liked email because they check it frequently and can give timely summaries about safety and risks. But they may experience an overload of a different kind. Said one: “My door is always open. I usually have a line at my door. But even when I am off, I expect to be interrupted at least for about two hours a day. There’s always this expectation to check your emails when you’re ‘off.’ You’re never off.”
- Several nurses and doctors said they wished they had “secure texting,” as some hospitals do. Secured texting allows rapid communication of personal information over an unencrypted channel and protects patience privacy and security to comply with the Health Insurance Portability and Accountability Act (HIPAA). Secured texting also could reduce time spent on phone calls to time-constrained doctors, particularly at night, workers said.
Simple Solutions
Health care providers offered some recurring suggestions to improve communication, Barrett said.
One idea is to limit risk and safety emails — especially those from management — to three take-ways and convey them with bullet points. Those messages could be discussed and reinforced in brief face-to-face encounters, such as morning huddles.
“Huddles could be the key to reducing overload and increasing safety message effectiveness in a timely way,” Barrett said. “The providers congregate on the floor to discuss updates, patient concerns and safety and risk issues. Huddles often include a diverse range of people and afford open conversations, continuity of care and accountability.
“Huddles make frontline employees stop, listen and pay full attention while also providing them access to leadership,” she said. “And messages in huddles cannot be deleted, muted or delayed.”
*Co-researchers included Jessica Ford, Ph.D., assistant professor of communication studies at Baylor University and Yaguang Zhu, Ph.D., assistant professor of organizational communication at the University of Arkansas.
