Team debriefing in the COVID-19 pandemic: a qualitative study of a hospital-wide clinical event debriefing program and a novel qualitative model to analyze debriefing content

Abstract

Background Healthcare workers faced unique challenges during the early months of the COVID-19 pandemic which necessitated rapid adaptation. Clinical event debriefings (CEDs) are one tool that teams can use to reflect after events and identify opportunities for improving their performance and their processes. There are few reports of how teams have used CEDs in the COVID-19 pandemic. Our aim is to explore the issues discussed during COVID-19 CEDs and propose a framework model for qualitatively analyzing CEDs. Methods This was a descriptive, qualitative study of a hospital-wide CED program at a quaternary children’s hospital between March and July 2020. CEDs were in-person, team-led, voluntary, scripted sessions using the Debriefing in Suspected COVID-19 to Encourage Reflection and Team Learning (DISCOVER-TooL). Debriefing content was qualitatively analyzed using constant comparative coding with an integrated deductive and inductive approach. A novel conceptual framework was proposed for understanding how debriefing content can be employed at various levels in a health system for learning and improvement. Results Thirty-one debriefings were performed and analyzed. Debriefings had a median of 7 debriefing participants, lasted a median of 10 min, and were associated with multiple systems-based process improvements. Fourteen themes and 25 subthemes were identified and categorized into a novel Input-Mediator-Output-Input Debriefing (IMOID) model. The most common themes included communication, coordination, situational awareness, team member roles, and clinical standards. Conclusions Teams identified diverse issues in their debriefing discussions related to areas of high performance and opportunities for improvement in their care of COVID-19 patients. This model may help healthcare systems to understand how CED tools can be used to accelerate organizational learning to promote safety and improve outcomes in changing clinical environments.

Health-care providers' experiences during the COVID-19 pandemic: lessons for leaders

“…Meaningful debriefings – both immediate and ongoing – were suggested by participants in this study. Debriefing can lead to improved teamwork and emotional processing as well as developing resilience (Welch-Horan et al , 2022). Providing the opportunity to assemble staff for debriefings may help to decrease health-care providers’ stress while also creating a sense of belonging and facilitating relationships among staff.…”

What and when to debrief: a scoping review examining interprofessional clinical debriefing

“…Most papers did not quantify when immediate CD occurred; however, those that did reported that it took place minutes to hours after a specific event (see online supplemental material for details). Immediate CD lasted anywhere from 1 min to 20 min1 11 13 15 23 35–38 40–45 and was reported to be used by teams working with adult (n=15) and paediatric (n=12) populations.…”

“…Most papers described that tools were used to facilitate a Plus-Delta design which involved identifying what went well (‘plus’) and what could have been improved (‘delta’). Some authors described the development of CD tools specific to the clinical context of the study 13 15 19 23 38 43–45 47 67. A few of these were used in subsequent studies61 63 68 and one crossover study examined the utility of two different CD tools 41…”