From talk to action: A randomized controlled design on the role of huddles in shaping safety climate and reducing missed nursing care

BACKGROUND: Missed nursing care compromises patient safety and care quality worldwide. Although inadequate staffing, high workloads, and poor work environments contribute, brief structured team interventions may reduce care omissions. Proactive huddles aim to enhance communication, coordination, and early risk identification, yet the mediating role of safety climate remains unclear. OBJECTIVE: To evaluate the effectiveness of proactive huddles in reducing missed nursing care and examine the mediating role of safety climate. DESIGN: Randomized controlled design. METHODS: Data were collected between July 2022 and May 2023 from ten hospital wards, pair-matched by type and size and randomly assigned to proactive huddles or usual practice. The sample comprised 180 nurses (85 intervention, 95 control). The MISSCARE Survey, Safety Organizing Scale, and NASA Task Load Index were administered pre- and post-intervention across three shifts. Linear mixed-effects models and moderated mediation analysis were conducted. RESULTS: Proactive huddles were associated with improved safety climate compared with usual practice (b = -0.217, p < .001) and with reduced missed nursing care (b = 0.123, p < .001). Higher safety climate was associated with lower missed nursing care (b = -0.184, p < .001). Moderated mediation indicated a greater mediated reduction in missed nursing care via safety climate in the intervention group (difference in average causal mediation effect = -0.038; 95% CI [-0.059, -0.018]; p < .0001). CONCLUSION: Proactive huddles may offer a feasible, time-efficient strategy for reducing missed nursing care. Safety climate may be one mechanism linking structured communication with improved care quality, alongside other team-level mechanisms.