Psychological safety, hierarchy, and other issues in operating room debriefing: reflexive thematic analysis of interviews from the frontline

Abstract

AbstractBackgroundDebriefing is a team discussion in a constructive, supportive environment. Barriers exist to consistent, effective, operative team debriefing.AimTo identify barriers to debriefing and their potential solutions as articulated by operating room personnel.DesignQualitative study.MethodsBetween December 2021 and February 2022 we interviewed operating room workers in a tertiary children’s hospital. We used purposive sampling to interview a variety of professions and specialties who work in the operating room environment. Interviews were audio-recorded, transcribed, and coded. The qualitative approach was reflexive thematic analysis with the theoretical framework was critical realism.ResultsInterviews were analysed from 40 operating room staff: 14 nurses,7 anaesthetic technicians, 7 anaesthetists, and 12 surgeons; 25 (62%) were female. The five key themes were: 1) “commitment to learning” – healthcare workers are committed to teamwork, quality improvement, and teamwork; 2) “it’s a safe space” – psychological safety is a pre-requisite for, and is enhanced by, debriefing; “natural born leader” – the value of leadership and also the limitations caused by psychological constructs about what and who is a leader; 4) “space-time” – finding time to debrief after routine operations and after critical events; and 5) “doing the basics well” – debriefing needs structure without being over-complicated.ConclusionPsychological safety is both a prerequisite for and a product of debriefing. Leadership, if viewed as a collective responsibility, could help break down power structures. Given the results of this study and evidence in the literature, it is likely that routine debriefing, if well done, will improve psychological safety, facilitate team learning, reduce errors, and improve patient safety.Relevance to Clinical PracticeDebriefing is challenging to perform, requires leadership and training, but is worth the effort. Nurses can take a leading role in promoting routine debriefing in healthcare.What does this paper contribute to the wider global clinical community?Debriefing, if done well, promotes teamwork, psychological safety in the workplace, quality and safety, and organisational learning.Setting up an effective debriefing programme is challenging but worth the effort.Debriefing requires collaboration and nurses are well placed to be leaders in debriefing policy design and to lead multidisciplinary debriefs.