Abstract
BackgroundThe role of the “debrief” to address issues related to patient safety and systematic flaws in care is frequently overlooked. In our study, we interview surgical leaders who have developed successful strategies of debriefing within a comprehensive program of quality improvement.MethodsSemi-structured interviews of four implementation leaders were performed. The observations, beliefs and strategies of surgical leaders are compared and contrasted. Common themes are identified related to program success and failure. Quality and safety researchers performed, coded and categorized the interviews and coordinated the analysis and interpretation of the results. The authors from the four institutions aided in interpretation and framing of the results.ResultsThe debriefing programs evaluated were part of comprehensive quality improvement projects. Seven high-level themes and 24 subthemes were identified from the interviews. Themes related to leadership included early engagement, visible ongoing commitment and enforcement. Success appeared to depend upon meaningful and early debriefing feedback. The culture of safety that promoted success included a commitment to open and fair communication and continuous improvement.There were many challenges to the success of debriefing programs. The loss of institutional commitment of resources and personnel was the instigating factor behind the collapse of the program at Michigan. Other areas of potential failure included communication issues and loss of early and meaningful feedback.ConclusionsLeaders of four surgical systems with strong debriefing programs report success using debriefing to improve system performance. These findings are consistent with previously published studies. Success requires commitment of resources, and leadership engagement. The greatest gains may be best achieved by programs that provide meaningful debriefing feedback in an atmosphere dedicated to open communication.
Highlights
The role of the “debrief” to address issues related to patient safety and systematic flaws in care is frequently overlooked
Madigan is staffed by 54 surgeons, 12 anesthesiologists and 49 certified registered nurse anesthetists (CRNAs)
Dr Andrew Foster is Chief of Anesthesia at Madigan and was a physician leader who took on a primary role in creating and maintaining the debriefing program at Madigan
Summary
The role of the “debrief” to address issues related to patient safety and systematic flaws in care is frequently overlooked. Since the publication of “To Err is Human” in 1999, medical error has been acknowledged as a major contributor to the burden of illness in the United States (US) [1]. Over the last 17 years, the quality and safety of surgery in the United States has been addressed through several interventions. One prominent tool developed to improve patient safety is the World Health Organization (WHO) surgical safety checklist [2]. The WHO checklist is a communication tool that involves participation of the surgical team to review issues of surgical safety at three time points: at a sign-in prior to administration of the anesthetic, at a time-out prior to the incision and at a signout or “debrief” at the end of the case. Since the publication of these findings, the checklist has been broadly adopted and incorporated into US hospital accreditation with the expectation that this would lead to national improvement in surgical safety
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