QUERI – Quality Enhancement Research Initiative

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Teamwork Training Hub: Frontline Huddling for Quality Improvement Implementation

Teamwork Training Hub: Frontline Huddling for Quality Improvement Implementation

Bedford, MA

Principal Investigator: Christine W. Hartmann, PhD; contact at Christine.Hartmann@va.gov


Staff-based initiatives have tremendous influence on the quality of patient care, particularly when changes are implemented at the frontline. Yet many quality improvement programs under-emphasize the crucial importance of learning from and engaging frontline staff in quality improvement efforts. Teamwork Training Hub QUERI developed a unique, evidence-based implementation framework known as LOCK (Learn from the bright spots, Observe, Collaborate in huddles, and Keep it bite-size) to address this gap. When fully implemented, LOCK produces documented positive effects in structures, processes, and outcomes.

Relationships between Evidence-Based Concepts and LOCK Elements

A current, VA Office of Geriatrics and Extended Care-funded national program for Community Living Centers, for example, uses this framework in an This Hub supports practical training for VA frontline providers, managers, operations staff, and VA Diffusion of Excellence Initiative Gold Status Fellows in using the LOCK implementation framework to improve care at the frontlines.


Teamwork Training Hub QUERI investigators leverage the materials and structure of the current national program in this Hub, which has the following goals.

  • Train participants on the fundamentals of LOCK and its effective implementation (including rapid cycle quality improvement) through a series of virtual trainings.
  • Facilitate action periods between trainings in which participants pilot the LOCK-based implementation of systemic changes using rapid cycle improvement techniques – and measure the impact of their interventions.

The Hub’s two training goals will help participants achieve rapid-cycle improvement in their settings and ensure that participants adhere to the core LOCK principles. Virtual (interactive webinar-based) trainings will teach about the LOCK framework and its implementation. Learning sessions will be interspersed with action periods in which participants trial what they learn. Mentoring will take place real time via email and a SharePoint site and in monthly coaching calls. The training curriculum focuses on how to build and sustain leadership and organizational practices and a quality improvement infrastructure for high performance at the frontlines of care.

Expected Impacts

This Hub achieves improvement by doing the following:

  • Training participants on effective practices and having participants share their experiences implementing these practices
  • Using action periods to enable participants to trial what they learn

By implementing practices and learning from their peers rather than only from instructors, participants efficiently learn how colleagues overcame barriers and successfully spread their interventions using LOCK implementation framework. This accelerates spread and promotes rapid adoption of effective processes.