Table 2 Elements of a Successful Debriefing Program: Creating a Culture of Safety

Timely. Meaningful Clinical Feedback

“if something occurred yesterday in the operating room, in this morning’s team huddle, of that entire division, they’ll talk about whatever that issue was at a debrief that happened the previous day.”

“if you don’t feed it back, then it’s not part and parcel of your performance improvement program and then it just becomes a task. And I think, in places where this does not succeed it is merely a task”

“if you’re going to ask people to be observant, to see it, and you’re going to ask them to tell you, to say it, then you have an obligation to fix it”

“the surgeon will say “make sure that goes in the debrief” or anesthesia will say “make sure that goes into the debrief” because they want to see that their headline got put into the paper.”

“if they have investigated and resolved then they will see the resolution… and then we’ll come back to those people directly after the fact if… we didn’t get an immediate closed loop solution.”

“Some surgeons really buy into it and say “okay this is what happened today, this is what I want to address. Please put this in the debrief, and I really want to get feedback on it”.”

“We said “you will be responsible for taking the defect that has surfaced, resolving it, but also getting feedback to the personnel who were involved when the defect was identified”. We knew that if we didn’t do that the personnel, and more importantly the surgeons, would not endorse this process.”

“the orthopedic guys, they are quick to point out problems and they were complimentary of the process saying “if I put it in the debriefing, I know it’s going to get attended to”.”

Feedback to Executive Leadership

“they’ll talk about whatever that issue was at a debrief that happened the previous day. The information is aggregated and fed back at departmental meetings”

“We report out the results now every year and, well, there is a quarterly written report and we generally do an oral report.”

Focus on Communication

“improved and excellent communication that occurs between all parties in these areas leads to improved safety and that’s their feeling and I think that they feel safer in the organization.”

“The assistants at the table who were… arguably some of the most critical people on the team with respect to errors because of what the instruments that they are handing, specimens that they are managing, drugs that are passing from the non-sterile to the sterile, that as an example is a group of people who felt they had the least amount of respect, the least amount of ability to influence events, but once released and empowered had a huge impact”

“[it is] important… to be attentive to the psycho-emotional wellbeing of the workforce… it’s going to be a learning environment, respect and civility is going to be a priority.”

“we wanted to be quiet because we were afraid to speak up and now I think that’s changed, I think people are much more collaborative.”

“I have much more open ability to talk to surgeons and other staff. I know a lot of the nurses and techs on a first name basis which I never did before because we encouraged people to use their first names during the surgical brief. And we are starting to understand that if we don’t communicate this way that the patients don’t actually get the best outcome… introducing each other and talking about stuff has made a huge huge difference.”

“the communication piece was the critical component; it was decreasing the hierarchy so you could promote communication.”

“I always started with the most junior person in the room, I didn’t want them to not feel comfortable about speaking up about something they saw when somebody else said something different as to what their observation was.”

“by promoting communication, I had heard things I never heard before, people were willing to speak to me, they were fearful of speaking to me because of my title”

Continuous Improvement in Patient Safety

“you’ve got to bring them at least to a minimum standard. Number one. And then, number two, you’ve got to continually move the minimum standard to the right side of the equation- so that you narrow your bell curve…. Raising the bar continuously must become an organizational imperative.”

“If you’re not constantly reinvigorating the team component, it has a propensity to deteriorate back to siloed activity and poor communication skill.”

“the training itself and the rounding need to be used to reinvigorate the process. I think that if you train once and forget it, you will, at best, have a task. But if you reinvigorate that learning so that it’s done every day and becomes part of the culture of the organization”

“although I think we’ve done pretty well, I’m totally of the opinion that we have to continue… this is a work in progress... and we will have to continue to stay focused in this area if we expect continued improvement.”

“the reporting cycle times are so short, both the financial ones and the medical ones… that the experimentation and the piloting can happen on short cycles and so we learn from it, and when you learn from it then it gives you the idea of the next thing that you want to do with it, and the next thing, and the next thing.”

“prior to beginning this work, about 30% of the people polled in our operating room using the culture of safety survey felt that it was safe to have surgery in our operating room… we saw a huge change in the culture of safety in the operating room and the comfort level that people had: safety mattered, that somebody was listening, somebody would do, somebody would act”

“to be mindful, and that’s what we’re trying to become-a higher reliability organization. That’s one of the things that we tell people is that mindfulness, that session with failure points, that taking the time out of that busy, the business of your life of your clinical practice or whatever have you and stop and really pay attention to what went right here and what went wrong here”

“in surfacing the defects the idea was that if you could identify these identified patterns, hopefully you could prevent their occurrence in subsequent operations.”