The impact of proactive huddles and personal accountability on missed nursing care: A randomized controlled design

Background: Evidence on effective interventions to reduce missed care is limited. While various strategies exist, proactive huddle intervention remains underexplored. Objectives: This study aimed to develop, implement, and evaluate proactive huddles as an effective process to reduce missed care in nursing wards. A secondary objective was to investigate the moderating effect of personal nurse accountability on the relationship between proactive huddles and missed care. Methodology: A randomized controlled study was conducted in a medium-sized hospital, involving 180 nurses across six internal and four surgical wards. Methods: Participants were randomly assigned to a 3-month intervention (n = 85) and control (n = 95) groups between March 2022 and May 2023. The intervention consisted of daily huddles, incorporating four key elements: status of tasks, potential delays, tasks that might not be completed, and assistance needed. The MISSCARE Survey (measured on three different occasions) and the 3D Accountability Questionnaire were assessed at baseline and immediately after the 3-month intervention. Results: A total of 602 huddles, each lasting about 5 minutes, were included. Gaps were identified in 69% of huddles, with 57% resolved. The intervention group showed reduced missed nursing care compared to the control, with effectiveness moderated by personal accountability—benefiting nurses with lower accountability more. Conclusions: Huddles require minimal resource investment to reduce missed nursing care, especially for nurses with lower personal accountability. Making huddles a standard practice can improve nursing care quality. Practice Implications: Nursing managers are encouraged to support consistently implementing huddles in hospital settings.