We are all looking for an edge, to improve our relationships, advance in our careers, be happier.

In my work training health professionals to talk with patients and families, I have stumbled on a powerful and simple way to perform at a higher level when communicating in difficult situations.

Telling the Truth When Patients are Harmed

In my academic job, I try to make healthcare safer for patients, and I work on improving the way healthcare systems respond when things go wrong and patients suffer unexpected harm.

In the early 2000s at the University of Illinois at Chicago, my colleagues Tim McDonald (a physician-attorney) and Nikki Centomani (a nurse and patient safety expert), inspired by other programs around the country, began to do something radical.

They started to tell the truth to patients and families after the patient was harmed by healthcare. The effects were amazing, but that’s not what I want talk about today.

I want to talk about what we learned when we started to teach people how tell the truth to patients and families.

You might think that telling the truth is easy, because it’s the right thing to do. But there is a long-standing culture in medicine of “deny-and-defend” when things go wrong, and the majority of health professionals have no training or preparation in how to talk with patients and families in these situations.

These are among the most difficult communication situations imaginable. They are high-stakes, involving intense emotions, life or death issues, millions of dollars, as well as people’s careers and reputations.

The initial conversation should happen very quickly, ideally less than 60 minutes after the harm has occurred. So there is almost no time to prepare, and there is great uncertainty about what happened, why it happened, and how it might turn out.

Training Via Role-Play with Actors Playing “Standardized Patients”

We decided early on that the best way to teach these skills was to use actors to play the patient or family member and to have our learners role-play the difficult interactions. At one of our earliest seminars, we told people to get ready for the role-play and then we’d pick someone at random to come to the front of the room and give it a try.

But the audience stopped us and said, “No, we have to huddle up first. That’s what we do around here.”

The idea of a “huddle” or a short team meeting, has become popular in healthcare, especially so-called safety huddles. A safety huddle is brief team meeting, often done in the morning on a hospital ward.

The idea is to check in with one another about any potential threats or hazards to patients, and to use the team’s collective intelligence and experience to problem solve and keep patients safe.

It’s a great idea with a proven track record of making care safer.

So before doing the role-plays for us, the doctors, nurses, and administrators huddled for 10-15 minutes. The results were impressive.

They performed much better than individuals who had not huddled up, and they seemed to enjoy the training much more also.

After that, the huddle became a fixture in all of our training sessions. We have witnessed the power of these huddles over and over again.

It occurred to me recently that the brief huddle is a technique that everyone can use, at work or at home, to improve performance.

What to Do in a Huddle

Think of the huddle as a context for brainstorming and planning. In our seminars, we ask people to think systematically through a few key questions before each role-play.

• What is the one thing you want to achieve with this conversation?
• Who should represent the group in the conversation?
• When and where should the conversation take place?
• What questions can you anticipate?
• What emotions might the other person be feeling?
• What might you say to answer the questions and handle the emotions?

Then we suggest that people actually role-play the conversation, with one team member playing the patient or family member and another team member playing the doctor or nurse or administrator. This allows the speaker to practice saying exactly what they want to say.

The Benefits of Huddling

Participants in our training tell us that the huddles are one of the most useful things they learned. They identify several benefits:

1. Huddles take advantage of collective wisdom. Two heads are better than one, and three heads are better than two, etc. These situations are complex. It’s almost impossible, especially in a short period of time, for one person to think of all the nuances and pitfalls and perspectives and possibilities. But a small group of about 5-8 people can normally identify most of the key issues. As a result, the strategy that emerges from a huddle is almost always better than one that an individual would come up with.

2. Huddles promote friendship and establish shared mental models among team members. This is a benefit we did not expect or plan for, but often our evaluations say that their teams grew closer together in 2 days of constant huddling than they had in years of working together. These social and professional connections promote better teamwork in the future, and they increase people’s sense of joy and meaning at work.

3. Huddles provide an opportunity for role-play. It’s one thing to think you know what you are going to say. It’s quite another to actually say it out loud. What we see in the huddles is that people struggle to find the right words when they first try to put their strategy into words. But this can get worked out quickly via role-play within the huddle, instead of fumbling over your words or saying the wrong thing in the real situation.

4. Huddles improve performance. The final result of all of these advantages is that people who develop strategies and practice them in the context of huddles perform more effectively than those who don’t.

Incorporating the Huddle into Everyday Life

Not everyone is part of a large team at work.

And in our personal lives, we may live alone or as a couple or in a small family unit.

But regardless of your circumstances, you can still take advantage of the idea of a huddle.

At work, before a difficult conversation with a client or colleague, bring together your team and do the planning and practice. Ask yourself what the goal is, what emotions are likely to arise, what questions you can anticipate, and who the most effective person would be to have the conversation.

Then practice what you're going to say, get feedback, and try again.

In our personal lives, it seems unlikely that we will get 5 to 8 of our closest friends together to huddle up about a difficult conversation, but you can modify the main ideas to work for you in any setting.

For difficult personal situations, we might only huddle with one or two close friends. Two heads may not be better than three, but they are better than one.

The key benefits seem to come from two characteristics of huddling: systematically asking yourself questions about the goals of the conversation and practicing what you would say for a supportive audience who can give you immediate feedback.

You can do this with a huddle of only two people if you have to.

Even if you're alone, you will benefit from systematically asking and answering a small set of key questions about the situation: What’s the goal? When and where should I have the conversation? Who else should be there? What questions or concerns will the other person have, and how can I be prepared to address them? What emotions are they likely to be experiencing, and how can I validate those feelings? What identity issues are at stake?

Give it a Try

Many difficult conversations fail because of a lack of planning.

Huddling up gives you a chance to engage in deliberate planning and practice with a supportive audience that can give you immediate feedback.

We have been astonished at how helpful this simple technique is.

Let me know how you use huddles in your life. Or give it a try and tell me how it works out.