“Debriefing and Organizational Lessons Learned” (DOLL): A Qualitative Study to Develop a Classification Framework for Reporting Clinical Debriefing Results

Abstract

BackgroundThe COVID-19 crisis has radically affected our healthcare institutions. Debriefings in clinical settings provide a time for the clinicians to reflect on the successes (pluses) and difficulties (deltas) encountered. Debriefings tend to be well-received if included in the broader management of the unit. The goal of this study was to develop a framework to categorize these debriefings and to assess its worthiness.MethodsA qualitative approach based on a grounded theory research method was adopted resulting in the “Debriefing and Organizational Lessons Learned” (DOLL) framework. Debriefings were conducted within two Emergency Departments of a Belgian University Hospital during an 8-week period. In the first step, three researchers used debriefing transcripts to inductively develop a tentative framework. During the second step, these three researchers conducted independent categorizations of the debriefings using the developed framework. In step 3, the team analyzed the data to understand the utility of the framework. Chi-square was conducted to examine the associations between the item types (pluses and deltas) and the framework's dimensions.ResultsThe DOLL is composed of seven dimensions and 13 subdimensions. Applied to 163 debriefings, the model identified 339 items, including 97 pluses and 242 deltas. Results revealed that there was an association between the frequency of pluses and deltas and the dimensions (p < 0.001). The deltas were mainly related to the work environment (equipment and maintenance) (p < 0.001) while the pluses identified tended to be related to the organization of the unit (communication and roles) (p < 0.001). With leadership's support and subsequent actions, clinicians were more enthusiastic about participating and the researchers anecdotally detected a switch toward a more positive organizational learning approach.ConclusionThe framework increases the potential value of clinical debriefings because it organizes results into actionable areas. Indeed, leadership found the DOLL to be a useful management tool. Further research is needed to investigate how DOLL may work in non-crisis circumstances and further apply the DOLL into incident reporting and risk management process of the unit.

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

“…End of shift CD was reported in four studies; three based in ED19 67 68 and one which described end of shift CD occurring in ICU, ED, and a labour and delivery unit 69. End of shift CD was reported to be used to debrief work processes, such as communication, that occurred throughout the entire shift68 69 and interactions lasted 10–30 min.…”

“…End of shift CD was reported in four studies; three based in ED19 67 68 and one which described end of shift CD occurring in ICU, ED, and a labour and delivery unit 69. End of shift CD was reported to be used to debrief work processes, such as communication, that occurred throughout the entire shift68 69 and interactions lasted 10–30 min. All papers that reported end of shift CD were published after 2020, describing initiatives that were implemented to help deal with the impact of COVID-19 on healthcare teams 19 67–69…”

“…For example, interactions were often described to include a question such as ‘is everyone ok?’ which suggests that attending to well-being was an additional purpose of CD. Some authors explicitly stated that CD was implemented to improve team performance and operations as well as to provide psychological support 19 48 67–69…”

“…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…”

Association of burnout and intention-to-leave the profession with work environment: A nationwide cross-sectional study among Belgian intensive care nurses after two years of pandemic

“…This can be explained by several elements including the lack of personal protective equipment, fear of being contaminated, increased mortality rates compared to normal, successive waves, societal expectations, and accumulation over time (Bruyneel et al, 2021b;Khan et al, 2022;LeClaire et al, 2022;Moradi et al, 2021). Hospitals have implemented, in a variable and heterogeneous way, several internal measures (e.g., psychologists, debriefing, meditation) which may have influenced the results with ICU nurses in Belgium (Paquay et al, 2022;Servotte et al, 2020;Van Den Heede et al, 2022).…”