Abstract
BackgroundThe goal of this study was to identify taken-for-granted beliefs and assumptions about use, costs, and facilitation of post-event debriefing. These myths prevent the ubiquitous uptake of post-event debriefing in clinical units, and therefore the identification of process, teamwork, and latent safety threats that lead to medical error. By naming these false barriers and assumptions, the authors believe that clinical event debriefing can be implemented more broadly.MethodsWe interviewed an international sample of 37 clinicians, educators, scholars, researchers, and healthcare administrators from hospitals, universities, and healthcare organizations in Western Europe and the USA, who had a broad range of debriefing experience. We adopted a systemic-constructivist approach that aimed at exploring in-depth assumptions about debriefing beyond obvious constraints such as time and logistics and focused on interpersonal relationships within organizations. Using circular questions, we intended to uncover new and tacit knowledge about barriers and facilitators of regular clinical debriefings. All interviews were transcribed and analyzed following a comprehensive process of inductive open coding.ResultsIn total, 1508.62 min of interviews (25 h, 9 min, and 2 s) were analyzed, and 1591 answers were categorized. Many implicit debriefing theories reflected current scientific evidence, particularly with respect to debriefing value and topics, the complexity and difficulty of facilitation, the importance of structuring the debriefing and engaging in reflective practice to advance debriefing skills. We also identified four debriefing myths which may prevent post-event debriefing from being implemented in clinical units.ConclusionThe debriefing myths include (1) debriefing only when disaster strikes, (2) debriefing is a luxury, (3) senior clinicians should determine debriefing content, and (4) debriefers must be neutral and nonjudgmental. These myths offer valuable insights into why current debriefing practices are ad hoc and not embedded into daily unit practices. They may help ignite a renewed momentum into the implementation of post-event debriefing in clinical settings.
Highlights
Post-event debriefing is held in clinical settings among healthcare providers and is an educational, team learning, and patient safety intervention [1,2,3,4]
We interviewed an international sample of clinicians, educators, scholars, healthcare administrators, and researchers who had a broad range of debriefing expertise, and adopted a systemic-constructivist approach that aimed at exploring in-depth assumptions about debriefing beyond obvious constraints such as time and logistics and focused on interpersonal relationships within organizations
We discuss implicit debriefing theories that qualify as debriefing myths in the subsequent discussion section
Summary
Post-event debriefing is held in clinical settings among healthcare providers and is an educational, team learning, and patient safety intervention [1,2,3,4]. Debriefing is best facilitated by trained debriefers, there are literature, courses, and videos freely available on the numerous approaches for how to structure debriefing, create a psychologically safe and engaging setting, use of co-debriefing, and the management of difficult debriefing situations [5, 23, 30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45] Another contributing factor is logistical barriers such as high workload, interprofessional scheduling issues, social distancing, or lack of interest [22, 23, 46]. By naming these false barriers and assumptions, the authors believe that clinical event debriefing can be implemented more broadly
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