Routine versus prompted clinical debriefing: aligning aims, mechanisms and implementation

Abstract

The great art of learning is to understand but little at a time. —John Locke Clinical debriefing (CD) is rapidly gaining traction as a valuable activity. CD is usually conducted as a guided exploration and reflection of clinical events in an attempt to bridge the gap between experience and understanding, with the ultimate aim of influencing future practice.1 CD has the potential to improve outcomes for staff, teams, patients and systems.2 3 The evidence for CD exists and continues to grow; benefits range from changes in staff attitudes4 to favourable outcomes following cardiac arrest.5 Despite this, some clinicians have been sceptical about the impact of CD, and there are various barriers which may limit implementation. These include lack of clear purpose, actual or perceived lack of time, lack of experienced debriefers and cultural resistance to change.6 Our focus should now be shifting towards overcoming barriers to implementation, a disappointingly difficult feat.7 8 The paper by Paxino et al 9 in this issue of BMJ Quality & Safety responds to this call and suggests that a lack of standardised terminology to describe CD practices may be part of the implementation problem. Paxino et al use scoping review methodology to explore how contextual factors relating to interdisciplinary CD are described in the existing literature, and whether these can be used to differentiate approaches to CD. They explore 46 studies using the ‘Who–What–When–Where–Why–How’ framework, with particular emphasis on contextual factors related to the ‘What’ and ‘When’ elements to differentiate between CD approaches. Based on their findings, they reconceptualise the terminology of CD practices into ‘prompted’ (further differentiated into ‘immediate’ and ‘delayed’) and ‘routine’ (further differentiated into ‘postoperative’ and ‘end of shift’), and propose a move away from a one-size-fits-all way of describing CD practices. They argue that …