Considerations for psychological safety with system-focused debriefings

Dubé, Mirette; Kessler, David; Huang, Lennox; Petrosoniak, Andrew; Bajaj, Komal

doi:10.1136/bmjstel-2019-000579

Cited by 7 publications

(6 citation statements)

References 15 publications

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“…The importance of using simulation as a "first choice" strategy for ensuring individual, team, and system readiness in times of crisis is supported by multiple publications in the literature [5,[51][52][53], and highlights that a sustained investment in simulation programs will have immeasurable impacts across healthcare systems following the pandemic. Many of these papers [3, 6-9] indicate a single site or unit approach to pandemic preparation, although do not specifically highlight using a coordinated and centralized simulation team, development of robust valid curriculum, and real time data analysis of emerging themes from hundreds of simulations.…”

Section: Discussionmentioning

confidence: 99%

COVID-19 pandemic preparation: using simulation for systems-based learning to prepare the largest healthcare workforce and system in Canada

et al. 2020

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Healthcare resources have been strained to previously unforeseeable limits as a result of the COVID-19 pandemic of 2020. This has prompted the emergence of critical just-in-time COVID-19 education, including rapid simulation preparedness, evaluation and training across all healthcare sectors. Simulation has been proven to be pivotal for both healthcare provider learning and systems integration in the context of testing and integrating new processes, workflows, and rapid changes to practice (e.g., new cognitive aids, checklists, protocols) and changes to the delivery of clinical care. The individual, team, and systems learnings generated from proactive simulation training is occurring at unprecedented volume and speed in our healthcare system. Establishing a clear process to collect and report simulation outcomes has never been more important for staff and patient safety to reduce preventable harm. Our provincial simulation program in the province of Alberta, Canada (population = 4.37 million; geographic area = 661,848 km 2), has rapidly responded to this need by leading the intake, design, development, planning, and co-facilitation of over 400 acute care simulations across our province in both urban and rural Emergency Departments, Intensive Care Units, Operating Rooms, Labor and Delivery Units, Urgent Care Centers, Diagnostic Imaging and In-patient Units over a 5-week period to an estimated 30,000 learners of real frontline team members. Unfortunately, the speed at which the COVID-19 pandemic has emerged in Canada may prevent healthcare sectors in both urban and rural settings to have an opportunity for healthcare teams to participate in just-in-time in situ simulation-based learning prior to a potential surge of COVID-19 patients. Our coordinated approach and infrastructure have enabled organizational learnings and the ability to theme and categorize a mass volume of simulation outcome data, primarily from acute care settings to help all sectors further anticipate and plan. The goal of this paper is to share the unique features and advantages of using a centralized provincial simulation response team, preparedness using learning and systems integration methods, and to share the highest risk and highest frequency outcomes from analyzing a mass volume of COVID-19 simulation data across the largest health authority in Canada.

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Section: Discussionmentioning

confidence: 99%

COVID-19 pandemic preparation: using simulation for systems-based learning to prepare the largest healthcare workforce and system in Canada

et al. 2020

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“…The survey respondents were asked to select all applicable multiple choice options from a list of outcome measures in clinical management, teamwork behaviors, and health systems issues. Clinical management categories were based on content expertise of the research team, teamwork behavior categories were based on the Crisis Resource Management framework ( Savoldelli et al., 2006 ), and health systems issue categories were based on the Systems Engineering Initiative for Patient Safety (SEIPS) model ( Dubé, Kessler, Huang, Petrosoniak, & Bajaj, 2020 ; Holden et al., 2013 ). The SEIPS 2.0 model is a health care human factors framework which identifies key work system components (people/teams, organization, tools and technology, tasks, environment) that contribute to categorizing processes and outcomes in complex adaptive health care systems.…”

Section: Methodsmentioning

confidence: 99%

“…The importance of participant psychological safety cannot be overstated as the nature of the simulation topic may generate strong emotional reactions from participants who may feel varying levels of support from their employer, anxiety regarding their own health or the health of their family, or fear of practicing outside of their comfort zone. Psychological safety was addressed throughout the process from planning meetings with site leaders, to the scenario prebrief and debrief with the participants ( Cheng et al., 2020 ; Dubé et al., 2020b ).…”

Section: Limitationsmentioning

confidence: 99%

Use of Virtually Facilitated Simulation to Improve COVID-19 Preparedness in Rural and Remote Canada

Reece

Johnson

Simard

et al. 2021

Clinical Simulation in Nursing

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This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

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“…Upon completion of the ISS scenario, two simulation and debriefing experts (AP and KW) led an interprofessional 20-min debriefing session following established system integration debriefing best practices. 14 15 Participation in the debriefing was optional but encouraged. At any point during the simulation or debriefing, participants could attend to urgent clinical duties if they deemed it an essential patient care situation.…”

Section: Methodsmentioning

confidence: 99%

“…We began the debriefing by promoting psychological safety among the participants, notably highlighting that individual performance would not be evaluated and all participant feedback would be anonymised prior to data analysis. 15 This serves to allow participants to speak freely and provide honest feedback without fear of repercussions. All participants in attendance during the debriefing were invited but not required to speak.…”

Section: Methodsmentioning

confidence: 99%

Latent safety threat identification during in situ simulation debriefing: a qualitative analysis

2020

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BackgroundLatent safety threats (LSTs) in healthcare are hazards or conditions that risk patient safety but are not readily apparent without system stress. In situ simulation (ISS), followed by post-scenario debriefing is a common method to identify LSTs within the clinical environment. The function of post-ISS debriefing for LST identification is not well understood.ObjectivesThis study aims to qualitatively characterise the types of LSTs identified during ISS debriefing.MethodsWe conducted 12 ISS trauma scenarios followed by debriefing at a Canadian, Level 1 trauma centre. We designed the scenarios and debriefing for 15 and 20 min, respectively. Debriefings focused on LST identification, and each session was audio recorded and transcribed. We used an inductive approach with qualitative content analysis to code text data into an initial coding tree. We generated refined topics from the coded text data.ResultsWe identified five major topics: (1) communication and teamwork challenges, (2) system-level issues, (3) resource constraints, (4) positive team performance and (5) potential improvements to the current systems and processes.ConclusionsDuring simulation debriefing sessions for LST identification, participants discussed threats related to communication and interpersonal issues. Safety issues relating to equipment, processes and the physical space received less emphasis. These findings may guide health system leaders and simulation experts better understanding of the strengths and limitations of simulation debriefing for LST identification. Further studies are required to compare ISS-based LST identification techniques.

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Considerations for psychological safety with system-focused debriefings

Cited by 7 publications

References 15 publications

COVID-19 pandemic preparation: using simulation for systems-based learning to prepare the largest healthcare workforce and system in Canada

COVID-19 pandemic preparation: using simulation for systems-based learning to prepare the largest healthcare workforce and system in Canada

Use of Virtually Facilitated Simulation to Improve COVID-19 Preparedness in Rural and Remote Canada

Latent safety threat identification during in situ simulation debriefing: a qualitative analysis

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