Safety culture is a facet of organizational culture that captures attitudes, beliefs, perceptions, and values about safety. A culture of safety is essential in high reliability organizations and is a critical mechanism for the delivery of safe and high-quality care. It requires a strong commitment from leadership and staff. In this course, a safe culture is promoted through the use of identifying and reporting patient safety hazards, accountability and transparency, involvement with patients and families, and effective teamwork.
Briefings and Debriefings
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来自 Johns Hopkins University 的课程
Setting the Stage for Success: An Eye on Safety Culture and Teamwork (Patient Safety II)
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从本节课中
Strengthening Safety Culture Through Teamwork
Research shows that many errors can be attributed to breakdowns in teamwork and communication. In this module, participants will learn how safety culture can be strengthened though teamwork and communication. Participants will learn skills critical in the prevention and mitigation of medical errors.
与讲师见面
Eileen Kasda
Hello. Thank you for watching this video on briefings and debriefings.
Here, we're going to continue our deeper dive into
specific interventions that have been used to
improve teamwork and communication in healthcare.
Like team training, like structure communication tools, briefings,
and debriefings are pretty common way for organizations to attempt
to improve how their teams are working together and to support them in their work.
So, why do we focus on briefings and debriefings?
And I have a little bias here,
these are one of my preferred places to start for
organizations in improving teamwork communication.
These are a transition team process,
both preparing for our work as a team,
and reflecting on how we did as a team,
and they really help by ensuring the basics are in place.
So, teams do well when they have a high quality plan,
they understand what's going on,
they have some common goals.
Everyone kind of understands the pieces that need
to happen and what's coming down the road.
They share that plan, we're on the same page,
and we learn and improve over time.
We reflect on that plan,
we adapt when the plan doesn't go according to plan,
and briefings and debriefings are ways to
make sure that those things happen with some regularity.
The challenge with briefings and briefings, like many things,
is we tend to structure these into checklists or other supporting tools,
and those have a tendency to be viewed as an administrative task over time,
if they're not viewed as beneficial.
So, just checking the box does not help us achieve those things that we outlined above.
Having a good plan,
sharing that plan and improving and learning over time.
So, that's what we have to think about when we try
to implement briefings and debriefings.
How are you going to do it in a way that people mindfully engage in this process,
they're participating with the intent of achieving those aims of knowing the plan,
sharing the plan, and learning over time?
So, there's one great way to think about what we're trying to
achieve with this intervention.
And it comes from work actually from NASA on Team resilience.
For them, crews need to be able to respond to stressful environments in an effective way,
in a proactive way,
they manage themselves in
a resilient and adaptive fashion respond to stressors effectively.
And they look at this as a three part kind of process much like our briefings,
our task execution phase,
our action phase, and our reflection.
Upfront, we're seeking to minimize risks, minimize stressors.
So, we're trying to anticipate challenges and plan contingencies.
We're trying to understand our current level of
readiness to address the challenges that will present themselves to us
as we start executing our tasks and identify
any early warning signs that will let us know when we're not performing as expected.
And we also want to prepare to handle those stressors,
prepare to handle different types of scenarios as they may unfold.
And that's one of the key things we're trying to address in a briefings.
On top of having a plan,
we want to kind of think through some of these other pieces that will help
our team perform effectively, resiliently, and adaptively.
During task execution, we want to assess
the challenges that present themselves to us quickly and accurately,
address any kind of chronic stressors that we perceive,
whether this is challenges coordinating with other units,
or functional areas within the hospital.
We want to maintain processes under stress.
When a team is put under high levels of stress, what typically happens,
what often happens is people revert to
their own individual pieces of the work and we lose track of the bigger picture and
the team kind of falls apart and
good teams keep that in check and keep that from happening.
And we seek guidance externally when when we need to.
And then after these stressful events,
we try to mend and this is what we're trying to focus on with the debriefings.
We regained situational awareness of what happened,
we try to address any concerns or risk points that came up in our performance episode,
and we express appreciation for one another.
We're trying to again build a trust, trusting environment,
a respectful environment, where people can grow and learn and improve over time.
And debriefing can help us perform these kind of mundane tasks on a regular basis.
So, that's one way to think about what we're trying to
achieve with the cycle of briefing and debriefing,
is putting in some supports to minimize the problems we're going to have ahead of time,
and to mend or repair for many challenges we've experienced during task execution.
And here, again from the team steps curriculum,
are some common things that are included in briefing checklists,
and again these can occur pre-procedure in the operating room,
these can occur at the beginning of a shift,
at shift hand-offs for other roles,
wherever makes sense for the work process for the day.
We can insert this transition process where we prepare for our work,
and this includes discussing who's on the team,
making sure we have clear goals for the day, for specific patients,
what are we trying to achieve,
roles and responsibilities for achieving those goals are clear.
We have a plan. We understand the resources in terms of staff or
equipment or other things we need to achieve our goals,
and we set expectations for workload is going to be,
we try to anticipate what workload is going to be,
so we can keep our eye on people,
keep our eye on the team, and make sure we support them when they need it.
And all of those things help us minimize our risks throughout the day.
In our debriefing checklist in addition
to whatever specific issues may have come up that day,
we can spend time on the team itself,
thinking about how do we communicate today.
Was it clear, was it timely?
Were things falling through the cracks or not?
Do we have any ambiguity that came up around who was responsible for what?
Were we able to maintain our awareness of the team,
our team situational awareness,
was workload distributed well,
or some people overworked much more than others?
Were some people pushed a bit further in their capacity than others,
when we could have done a better job of distributing that?
Do we ask for or help offer assistance when it was needed?
And do we have any good catches?
Were there any things that we proactively raised and addressed throughout the day?
And essentially, what went well as a team?
What can we do better next time as a team?
And there's a lot of evidence around
the effectiveness of briefings and debriefings outside of healthcare,
but within healthcare as well.
Most of it's within the operating room,
and there's clear evidence that different briefings and debriefings implemented well,
can help reduce communication breakdowns in the O.R.
also including delays, and on time starts.
We have better, more efficient OR's,
with briefings and debriefings.
Reductions and procedure miscommunication related disruptions,
in nursing time spent in the course,
so that's time nurses spend outside of the actual OR,
trying to manage things that
weren't planned for appropriately at the beginning of the case, improved communication,
and teamwork and well,
as reductions in some clinical outcomes including complications,
infection rates, and even mortality, in some cases.
Now, just like team training and just like
any other comp innervate organizational change intervention
in complex organizations, they don't always work.
There's a failure rate to these things,
but on average there's now many analyses that
indicate that these types of interventions in the O.R.
have positive impacts on complications exercise,
surgical site infections and mortality.
So, they can have dramatic impacts on the organization.
But like anything, we need to be mindful of how they go wrong and how they can
go wrong so we can better support or
interventions we're trying to introduce these practices.
As I introduced the video the risk for briefings and debriefings is they
become a checklist that people go through without really mindfully engaging in it.
So, how do you develop that mindful process,
and how do people,
how do we create an environment where people take these
seriously and get value out of them?
Part of is is coaching, role modeling, and feedback again.
Your people need to believe that the organization values
this process that's going to be a good use of their time.
This comes from the people that they take cues from
formal and informal leaders and their peers.
So, engaging people who are positive about this and even starting small,
with a small set in the ORs of surgeons or anesthesiologists,
who can help promote this practice is great in other areas same thing, find key,
early adopters that are in positions of influence and help develop
their skills and providing feedback to other people about how to engage in this process.
And one thing that's worked extremely well in the O.R.
is having a closed loop process for the debriefs.
So, basically, any of the issues that get raised in a debrief,
to some extent, these are problem finding engines.
We're trying to surface what went wrong.
We can then catalog those things and have someone who follows up with staff,
so if it's not something we can fix right here in this moment,
we need to know that someone is working on it.
Otherwise, we're spending our time discussing things that don't change,
and it's not an effective process,
and it's not something people feel motivated to engage in.
So, really trying to find ways where we can connect what happens in
debriefs to larger change initiatives happens,
is a great way to kind of promote
these interventions and to make them as effective as they can be.
And that goes back to a broader theme of
all these teamwork improvement interventions need
to be connected to the larger approach for improving safety and quality in health care.
In our next video,
we're going to be talking about measurement.
So, how do we know we're doing a good job with these interventions?
How do we know we're reducing risk
for patients to experience a communication related harm?
