Why don’t we do clinical debriefing?

Clinical debriefing is a structured reflective practice enabling healthcare teams to analyze events, identify improvement areas, and enhance patient safety. Our panelists discuss the cultural and logistical challenges hindering its widespread adoption and propose strategies to integrate debriefing into routine clinical workflows.

The debate

Clinical debriefing is an interprofessional meeting that occurs after an event – too often a critical one – and allows members of a healthcare team the opportunity to review and process their experiences in other to improve subsequent performances. Debriefing after critical events has long been recognized as a powerful tool to improve team performance, enhance learning, and, ultimately, improve patient safety. Supported by decades of literature from both medicine and other high-risk industries such as aviation, regular debriefing offers healthcare teams the opportunity to reflect on what went well, identify areas for improvement, and refine their response strategies for future events. However, despite the strong evidence in its favor, clinical debriefing is still far from being a routine practice in many healthcare settings. Studies consistently show that debriefing after critical incidents occurs only a fraction of the time.

This raises important questions: Why is debriefing not happening more regularly in clinical environments? What are the barriers preventing its widespread adoption? And most importantly, what strategies can be implemented to make post-event debriefings a standard practice in all healthcare settings?

To discuss these issues, we have invited a panel of experts in patient safety, clinical education, and healthcare operations. They will explore the reasons behind the inconsistent use of debriefing and propose practical solutions for integrating this valuable process into everyday clinical practice.

Q1 Despite strong evidence supporting debriefing after critical events, it remains underutilized in many healthcare settings. In your opinion, what are the primary barriers preventing its regular adoption? Are these challenges more cultural, logistical, or something else entirely?

Cristina Diaz-Navarro Perhaps we should first consider, what experiences should lead to a debriefing?

From my perspective, team self-debriefing should be part and parcel of the way we communicate in clinical environments. Implementing a simple self-debriefing tool such as TALK^© (Target, Analyse, Learn, Key actions) can be carried out successfully and cost-effectively. The emphasis with this approach is to encourage teams to self-facilitate debriefing conversations as the working day allows, and engaging in iterative improvement.

A greater challenge is the support of complex debriefing following critical events, which requires the provision of dedicated time and space, as well as trained debriefers who are able to facilitate reflection on systems and human factors, manage potential conflict, and able to identify emotional trauma, avoid harm and refer to specialist services if needed. Debriefing following psychologically traumatic events should be reserved for specialized professionals such as psychologists and wellbeing teams.

Méryl Paquay: While cultural barriers, such as normalizing discussions of difficult events and fostering psychological safety, contribute to the underutilization of debriefing, I believe the main issue lies in the absence of a sustainable implementation strategy. Clinical debriefing should be viewed as part of a continuous improvement process, much like Deming’s cycle. However, it is often treated as a one-off event rather than a regular practice.

When challenges arise, leaders frequently interpret these as failures, rather than as opportunities for adaptation. In reality, failure occurs when we abandon the process rather than adjust it.

The key is to keep the improvement cycle moving by continuously identifying and addressing obstacles. The problem is that too much emphasis is placed on the act of performing the debriefing, while the critical work of implementation and sustainability is often overlooked. Both aspects—performing the debriefing and coordinating the process—must be developed with equal strength, as they require different skill sets. Facilitating a debriefing requires communication and reflection skills, while coordinating its regular use demands strong organizational and leadership abilities. Without addressing both components, we risk presenting an incomplete view of what clinical debriefing can truly achieve. Both parts are essential for embedding debriefings into routine practice and ensuring they contribute meaningfully to continuous improvement in healthcare settings.

Q2 Time constraints and clinical workload are often cited as reasons why debriefings are skipped. But is there really no solution? Could integrating debriefing into routine workflows or using shorter, more focused debriefings be part of the solution?

MP: I fully agree: time constraints shouldn’t be an insurmountable barrier. The key is clarifying what we mean by “clinical debriefing.” Not all debriefings require an hour of discussion; it all depends on the objective. If the goal is similar to simulation debriefings—focusing on developing both technical and non-technical skills—then longer sessions are appropriate. However, if the aim is organizational learning—through reflective practice and identifying areas for improvement—shorter, routine debriefings can be highly effective.
For example, in our emergency department, we conduct brief debriefings (7–10 minutes max) three to four times per week, and this process has been ongoing for five years. We also continue to hold longer debriefings (up to 1 hour) for specific, high-impact situations. The reason we can keep these routine debriefings so short is that they are designed as opportunities for reflective practice and as part of our feedback loop to surface operational issues quickly.
The real challenge is being clear about the objective. Trying to compress a debriefing that should last an hour into 10 minutes, or unnecessarily prolonging a short, focused session, can lead to frustration and inefficiency. By aligning the debriefing format with the intended goal, it becomes possible to seamlessly integrate debriefings into routine workflows, even in fast-paced clinical environments.

CDN: Practical and easy debriefing tools such as TALK^© , which I mentioned earlier, allow teams to integrate structured debriefing conversations in their daily working life, as they enable clinicians to make more efficient use of communication episodes that already take place in healthcare environments. That way, verbal interactions are organised, carried out with positivity and result in practical outcomes. 

However, specific debriefing needs arise following serious untoward events or conflictive situations, which would benefit from trained facilitators. 

In any case, institutional support to debriefing programmes is essential, as they should provide the required resources (time, space and trained facilitators for complex or emotional debriefing) as well as support to follow up on any safety gaps or improvement needs identified during debriefing.

Clinical Debriefing: From Simulation to Daily Practice – A Conversation with Méryl Paquay

Q3 Simulation debriefing can provide insight on facilitator and environment attributes. Based on your experience, which type of experience or education is required to become an effective debrief facilitator within a clinical context?

CDN: I believe that multi-professional clinicians are able to have professional conversations to advance patient care, which is our common goal. From that point of view, we all should be able to facilitate everyday debriefing conversations, as demonstrated in our article published last year in British Journal of Anesthesia right about short debriefing implementation (Diaz-Navarro C, et al, 2024). The applicability of this tool is wide, as evidenced in a study we conducted in Latin America (Diaz-Navarro C, et al, 2024)

However, in my opinion we should provide access to 3 levels of debriefing in healthcare environments:

• Team self-debriefing for everyday learning opportunities;
• Trained debriefers to facilitate debriefing following complex situations that might entail psychological, clinical and legal consequences. They should have knowledge and skills enabling them to establish psychologically safe conversations, guide reflection on sociotechnical systems and human factors, utilise specific strategies to diffuse conflict, detect vulnerabilities and identify the need for specialist support when it arises;
• Specialist teams providing facilitation of psychological debriefing following traumatic experiences, ideally psychologists or psychiatrists with specific training in this particular area.

MP: the key qualities for effective debriefing facilitators mirror those required for simulation facilitators: curiosity and empathy. Maintaining a safe environment in clinical settings is particularly challenging, and the facilitator plays a crucial role in upholding the basic assumptions of the debriefing process. When we initiated this process five years ago, we believed that prior experience in simulation debriefing was essential for facilitating clinical debriefings. We thought that only clinicians with backgrounds in simulation could effectively lead these discussions. However, we have since discovered that simulation experience is not a strict prerequisite. Over time, we have come to understand that, as Cristina said, any member of the unit, if properly trained and coached, can become an excellent facilitator of clinical debriefing. As a result, we now have physicians, nurses and administrative staff successfully leading these discussions.
Essential values derived from simulation, such as good judgment, psychological safety, and the basic assumption, are indeed vital. Moreover, we have found that skills like managing difficult conversations and effectively addressing emotions are paramount and can be cultivated through targeted training programs, which can be completed in as little as two days. Consequently, facilitators should be skilled, trained, and coached.
Additionally, having a strong understanding of the clinical environment is a significant advantage, as it allows facilitators to ask more nuanced questions and better comprehend team dynamics. While this knowledge enhances the debriefing process, it is not a strict requirement. However, a thorough understanding of the clinical debriefing process itself is essential for effective facilitation within any clinical context.

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Q4 Leadership and culture play a crucial role in encouraging or hindering the adoption of debriefing practices. How can hospital leaders and managers foster a culture that prioritizes and normalizes debriefing after critical events?

CDN: This is an excellent point. Institutional culture needs to encourage and support debriefing, but not only after critical events. Ideally, we should be learning from the whole range of performance that takes place in any healthcare environment. This means that we should learn from success, failure and everyday variation, aiming to complete each element of our clinical practice as well as possible all of the time, as described in the Safety II approach (Hollnagel and colleagues, 2015). The natural conclusion is that we should debrief after any experience that could drive learning and improvement. These experiences take place daily!Prioritizing debriefing would align with SEIPs 3.0 (Carayon, 2020), which articulates the need for teams to engage in iterative learning and adaptation as a crucial element in ensuring safe patient journeys. If leaders and managers want to foster a culture of debriefing they need to take systematic approaches to implementing new initiatives, such as Kotter’s 8 steps model for change management. I would also recommend referring to Twelve tips for facilitating and implementing clinical debriefing programmes (Coggins and colleagues, 2021).

MP: Sharing a clear vision of expectations and allocating necessary resources is essential. Hospital leadership should appoint a dedicated individual to coordinate all aspects of the clinical debriefing process, ensuring both quality and sustainability. Creating a multidisciplinary coalition is vital for effectiveness, as diverse perspectives can lead to more comprehensive solutions. Leaders must also be prepared to articulate “What’s our story? Why does it matter?” to clarify the initiative’s significance and foster a sense of purpose within the teams.
Healthcare quality initiatives often start strong but can lose momentum, leading staff to adopt a “this too shall pass” mentality. Comments like, “If I wait long enough, this program will go away like the rest of them,” reflect a common skepticism that can be discouraging. To change this narrative, ED leadership must visibly commit to debriefing as a vital quality assurance tool. Acknowledging that the program won’t be perfect from the start and that leadership is devoted to refining it based on feedback and experience is key. In short, publicly committing to “never give up,” and reinforcing the determination to make this initiative a lasting success.
Also, listening to outspoken critics is also crucial; curiosity and respect for concerns can foster a culture of openness. Transparent communication throughout the process builds trust and encourages engagement. Regular public updates on challenges and successes can help build trust and enthusiasm. Establishing clear communication channels is also important; knowing who needs what information – clinicians, action committees and hospital administration – creates a more cohesive approach. Teams should see tangible changes in their daily work through dashboards, newsletters, or follow-ups communicated by the leaders.

Q5 You both said that training healthcare professionals to conduct effective debriefings is essential for its success. What role do educational programs play in preparing teams for regular debriefing? Could the education in debriefing practices before health students, such as nursing or medical fellows, enter the workforce help?

MP: I guess the earlier students – future professionals and leaders – are trained in effective debriefing, the better. Educational programs at the undergraduate level should go beyond merely teaching the mechanics of conducting a debriefing; they must foster self-reflection and cultivate the skills of inquiry and active listening. After all, a good debriefer must first be a good listener.

Moreover, the power of example cannot be understated. As mentors during clinical placements, we have the opportunity to demonstrate clinical debriefing after significant events or supervision days. Engaging students in this process not only exemplifies effective debriefing practices but also reinforces their importance, making the experience more impactful than theoretical discussions.

Additionally, educational programs should emphasize interdisciplinary learning early on. By integrating disciplines through joint undergraduate courses or training, we can reduce tribalism and encourage collaboration among future healthcare professionals. This approach fosters an environment where students can learn from each other’s perspectives, laying a strong foundation for effective debriefing practices in their future careers.

CDN: Whilst specific training programs are required to facilitate complex or psychological debriefing, team self-debriefing requires little training time. For instance, the TALK^© User Course, which has been designed to be delivered free of charge at a local level, can be completed in less than 2 hours. It’s use is supported by cognitive aids such as cards and posters, available from www.talkdebrief.org under a Creative Commons License. This means that they are free to utilise as far as the original authorship is recognised, they are not used in commercial activities and are not changed.

Undoubtedly, introduction of self-debriefing skills at an undergraduate level across healthcare professions is key when aiming to embed a universal culture of constructive dialogue and mutual support. Also, integrating these approaches in postgraduate education and training would be extremely helpful in adopting safe skills and behaviours within the workforce, more so if such training was accessed by multi-professional teams. 

Simulation training within these contexts or as part of continuous professional development interventions could allow participants to self-debrief following a simulated experience, albeit followed by expert facilitation by a trained educational debriefer. 

Further training will continue to be required in order to acquire and develop advanced facilitation skills. The TALK Foundation, in its mission to support patient safety through clinical debriefing, is currently embarking in a new adventure, looking to initiate advanced debriefing programmes soon.

Thank you for engaging with this discussion on clinical debriefing.

Conclusion

Incorporating clinical debriefing into regular healthcare practice is essential for enhancing team performance and patient safety. Overcoming barriers such as time constraints and cultural resistance requires a clear implementation strategy, leadership support, and appropriate training. By normalizing debriefing and embedding it into the workflow, healthcare teams can engage in continuous learning, leading to improved outcomes and a safer healthcare environment.

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