How To Use Debriefing as a Performance Improvement Tool

Debriefing is a process most healthcare employees link to crisis events.

Debriefing as a performance improvement (PI) tool allows risk management to gain the powerful ability to obtain insight from staff members who were directly involved in an event. Debriefing is a conversation among those involved in a situation to discuss what happened, what was done right and what could be improved upon. PI tools are used in healthcare to determine errors or flaws in processes so changes can be implemented to improve them.

Unfortunately, the debriefing process often makes staff members uncomfortable and is not used regularly in many healthcare organizations. Many associate it with event investigation after a sentinel event or serious medical error. Debriefing may also be used after traumatic events or an extremely stressful situation, such as a violent/aggressive episode involving a patient or even a natural disaster.

Since debriefing is associated with events that cause extreme emotion, it is up to those conducting the process to create a positive experience for employees. By initiating these positive conversations, employees will be more likely to be candid and their feedback vital to improving healthcare facility processes.

To use debriefing as an effective PI tool:

• It must be non-threatening.
  Staff members are often apprehensive about participating in the process for numerous reasons such as fear that they will be blamed for something they did incorrectly or their responsibility in the event. The debriefing environment should not be hostile. The people involved should not yell or blame others. A good rule of thumb would be to set forth this expectation before discussions begin.
  
  
• Focus on the process, not the individual.
  In a Just Culture, we must recognize that humans make mistakes. Processes should be hardwired to prevent errors from making it to the patient and causing harm. The focus of the debriefing should always be on systems and processes- never on an individual.
  
  
• Use it more routinely than causatively.
  Debriefing has the potential to be a valuable learning tool after any situation, not just bad ones. Even in situations where a positive outcome was achieved, there is always room for improvement. Overall, the process is about identifying opportunities for improvement and learning from mistakes.
  
  For example, consider implementing the process as a quick discussion after procedures. Staff simply need to gather, and someone asks the questions, “What went well? What didn’t work well?” Wouldn’t it be better to find out there’s a trend with turnaround times or equipment functionality after an event where nothing major went wrong? This type of process also uses the tool proactively.
  
  
• Keep it confidential.
  The details of a debriefing should be confidential. Staff should be encouraged to be open and honest. While using debriefing as a proper PI tool requires the sharing of results, the names of those involved must always be kept in strict confidence. The learning opportunities gleaned from the process are what should be passed along to others.
  
  
• Organization is important.
  It’s easy for things to get out of control as people start talking over each other or having side conversations. A facilitator of this process must keep it organized by allowing only one person to speak at a time. Sometimes a checklist helps the facilitator to keep on track with the process. Download our sample checklist here.
  
  
• Be sensitive to time.
  Debriefings shouldn’t be long and drawn out. When incorporated routinely, they shouldn’t take more than 5 minutes. Even after bad events, debriefings shouldn’t take more than 15 minutes if the facilitator is organized.
  
  The goal is to determine lessons learned by asking: What happened, what did we do right, what do we need to improve, and are there any other concerns. Depending on the event, emotions can run high. It’s best to give a little time for staff to calm down and cool off before going into a room together to debrief. You might have to wait a day or two before using this tool.

Using staff members to help identify opportunities for improvement is extremely beneficial because they are the best to suggest solutions that will work for them in their daily workflow, recommend areas where they need more training, and identify problematic processes or steps. Employees will also have increased buy-in for new processes because they are allowed to be part of the solution for positive change in their work environment.

Learn More

Want more resources about debriefing? Visit our High Reliability and Culture of Safety toolkit for guidelines, sample checklists, and more.