7 Steps to Conducting an Effective Debrief: Closing the Loop on Conflict and Keeping Lines of Communication Open Between Team Members

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LifeWings, a patient safety consulting firm, offers 7 steps to conduct a debrief for healthcare organizations similar to that which is used in aviation. A very carefully constructed script is followed that allow critique without emotional content, as well as provides a mechanism to close the loop on conflict among team members and keep the lines of communication open.

Medical teams conducting a debrief in the OR.

This habit of performance feedback allows critique without emotional content, as well as provides a mechanism to close the loop on conflict among team members and keep the lines of communication open.

LifeWings Partners is a patient safety consulting firm that is strongly committed to making a difference in healthcare. The company's training is based on aviation principles and notes the similarity between pilots and their flight crews and physicians and their medical teams.

Aviators conduct a core CRM practice by performing a feedback session after a flight mission. During the session all team members involved in the flight discuss what happened and what can be learned to improve performance for next time. A very carefully constructed script, or guide, is followed which keeps the discussion on point and precisely targeted to the most essential action steps needed to improve outcomes. These sessions normalize discussions about effective and ineffective performance. This habit of performance feedback allows critique without emotional content, as well as provides a mechanism to close the loop on conflict among team members and keep the lines of communication open.

Most healthcare organizations conduct debriefs in the operating room (OR) or at the end of a shift in the ICU or ED. However, the concept can be applied anywhere in a healthcare organization. Debriefs normally take 30 seconds to three minutes. The length is determined by the complexity of the event, the time available, and the lessons that need to be learned.

The following example is based upon an OR debriefing. When conducted in the OR, the debriefing format, or script, is often posted on the wall of the OR for ready reference. Additionally, a form corresponding to the wall-mounted guide will also be used to capture, in writing, significant items of discussion. There are also apps available with debriefing guidelines. Using the debriefing guide effectively, the healthcare team will follow these 7 steps:

At the appropriate time, usually as the incision is closed, the team lead will call for the “Debriefing Checklist.” Normally, the team lead is the surgeon, but for purposes of the debrief, the circulator or another team member can call for, and conduct, the checklist. It is important for all members of the team to be present and participate.

One member of the team will be designated to act as the unit “scribe” to capture significant discussion on the debriefing form.

The team lead will refer to the wall-mounted checklist and ask the first question on the script, “What went well?” Team members may answer only by exception; there is no need to say anything if they have nothing of significance to add. Or, some institutions require all team members to provide an answer. We recommend that all team members be required to participate. To encourage participation, the most junior team member goes first, and then each team member answers in turn. The team lead responds last.

The team lead will then ask the next question on the checklist, “What should we do differently to improve for next time?” The focus should be on personal performance issues, including teamwork, communication, coordination, and technical skill. Again, team members might answer only by exception or in sequence by team seniority, most junior to most senior. Significant performance improvement items should be annotated on the debrief form.

When discussion is complete, the team lead will move on to the next item on the checklist, “Did we have everything we needed to do our job?” This question deals primarily with equipment issues and is used to tweak the “system” to ensure needed equipment is always in place, tested properly, and operable. Again, it is vitally important that any significant discussion in response to this question is recorded on the debrief form for follow-up. If identified issues are not corrected, personnel will soon stop debriefing.

The team lead will announce, “Debrief Checklist complete,” when discussion is finished.

The debrief form is then dropped off at a central collection point, to be gathered up at the end of the day for analysis. This step is included on the checklist to ensure it is not forgotten. Discussion items recorded on the form will be entered into a database for trend analysis and to provide a mechanism for follow-up on items needing attention.

Using this system has several byproducts. Essential communication and coordination skills are hardwired into daily operations. When properly conducted, conflict is resolved and barriers to communication among the team members are removed. A well-designed debriefing system with adequate and consistent follow-up will prevent the same problems from happening repeatedly, thus creating a tight cycle of improvement leading to consistently better quality of care.

About LifeWings:

LifeWings Partners, LLC is a team of physicians, nurses, Toyota-trained Lean experts, health risk managers, astronauts, military surgeons, and flight crews. Our team was the first in the United States to study the best practices of organizations with high reliability, and successfully adapt their strategies for use in healthcare. We have distilled the methodology used in commercial aviation, military aircraft carriers, nuclear submarines, and cutting-edge manufacturing to assist healthcare organizations create safe, efficient, and high quality hospitals and clinics.


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Stephen Harden
Lifewings Partners, LLC
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Angela Myers
LifeWings Partners, LLC
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