In this episode of SIM Moove, Fouad Marhar sits down with Meryl Paquay, an expert in clinical debriefing and a key figure in the healthcare simulation world from the University of Liège, Belgium. Their conversation, rich in insights, touches on the evolution of debriefing practices, the challenges of integrating them into clinical environments, and the profound impact they can have on team dynamics and patient outcomes.
A SIMZINE exclusive based on SIM Moove podcast interview with Méryl Paquay
In the bustling world of healthcare simulation, few innovations have shown as much promise in bridging the gap between training and clinical practice as routine clinical debriefing. In a recent episode of SIMZINE’s healthcare simulation podcast, host Fouad Marhar explores this transformative approach with Méryl Paquay, a pioneering nurse researcher from Liège, Belgium, whose work is reshaping how healthcare teams communicate, learn, and grow.
Serendipity in Simulation: A Researcher’s Journey
“It wasn’t at all something I had planned,” Méryl admits with a smile in her voice, describing her entry into the world of simulation. After completing her nursing degree and a master’s in public health management, she found herself hired by the University of Liège’s simulation center to work on European research projects. What started as a position focused on healthcare safety quickly evolved into a passionate pursuit of debriefing methodologies and Crisis Resource Management (CRM).
Rather than choosing between her two professional loves – hospital management and simulation – Paquay found a way to merge them. This synthesis led to her groundbreaking work in clinical debriefing, supported by two influential mentors: Professor Alexandre Ghuysen (known as Sacha) and Professor Robert Simon from Boston, whom she credits as “the basic assumption personified.”
Clinical Debriefing: A Managerial Tool
One of Paquay’s most significant contributions to the field is bringing clarity to the often-muddled terminology around clinical debriefing. She outlines two distinct approaches, each serving different but complementary purposes:
- Post-event clinical debriefing: These sessions follow emergency or critical situations, focusing on improving both technical and non-technical skills. They typically last longer and dive deep into specific incidents to extract learning points and improve future responses.
- Routine clinical debriefing: These are scheduled, shorter sessions (7-12 minutes) that focus primarily on organizational learning. They occur 2-4 times per week and create a regular rhythm of reflection and improvement.
The routine clinical debriefing process, while sharing DNA with simulation debriefing, has been carefully adapted for the fast-paced clinical environment. It follows a streamlined but effective format:
- A brief welcome and check-in to gauge team energy and readiness
- Open discussion of the day’s experiences, celebrating successes and acknowledging challenges
- Focused analysis of one specific element for solution-finding
- Clear summary and action planning for implementation
This structure ensures that even in busy clinical settings, teams can maintain consistent communication and learning without disrupting patient care.
Measuring Success: The Data Behind the Dialogue
The implementation of routine clinical debriefings has yielded impressive results across multiple dimensions. At the organizational level, Méryl reports a fundamental shift in management dynamics. “It really helps what we call bottom-up management,” she explains, describing how teams now not only identify problems but propose solutions, creating a more participative leadership structure. Debriefings allow leaders to stay connected with the realities on the ground, while also giving staff a sense of ownership over the solutions to the problems they face. The result is a healthier, more collaborative working environment where everyone feels heard and valued.
Méryl emphasizes that this kind of feedback loop—where teams propose solutions, and leaders implement and communicate decisions—can greatly improve organizational culture. “It makes leadership more visible and shows that their actions are aligned with the needs of the staff,” she notes. This, in turn, helps build trust and strengthens the relationships between healthcare teams and management.
The impact extends beyond organizational charts. “We’ve seen a significant increase in the number of undesirable events being reported, as well as a greater willingness to speak up in general,” Méryl explains. This culture of openness, where team members feel safe to voice concerns and offer feedback, is essential for improving patient safety and fostering a learning environment. Moreover, Méryl highlights a phenomenon she describes as “self-debriefing,” where teams begin to debrief themselves without formal facilitation. This, she says, is a testament to the power of routine debriefing in creating a mindset of continuous reflection and improvement. “Even those who aren’t formally trained in simulation are now asking themselves reflective questions during their work, which is a huge win,” she says.
The Magnet Effect: Attracting and Retaining Excellence
During the COVID-19 crisis, Méryl’s research team conducted an illuminating study examining the relationship between clinical debriefing and the concept of “magnet hospitals” – healthcare institutions known for their ability to attract and retain staff while maintaining excellent patient outcomes. The study, which included 100 qualitative interviews, revealed strong links between debriefing implementation and improved hospital magnetism.
Several key factors emerged from the research:
- Strengthened medical-nursing relationships through regular, structured communication
- Increased trust between different professional groups
- Daily opportunities for learning and professional growth
- Enhanced organizational intelligence through systematic learning from both successes and setbacks
- Improved team resilience and adaptability in the face of challenges
Scientific Rigor and Future Horizons
While the initial results are promising, Méryl maintains a commitment to rigorous scientific validation. She advocates for more comprehensive research approaches, including:
- Multicenter studies to validate findings across different healthcare settings
- Long-term measurement of well-being at individual, team, and institutional levels
- Analysis of the interaction between different levels of resilience
- Investigation of seasonal and contextual factors affecting debriefing effectiveness
“We have different levels of resilience,” she notes, emphasizing the importance of understanding how debriefing affects each layer of the healthcare system. This multilayered approach to research reflects the complexity of healthcare organizations and the need for nuanced understanding of improvement initiatives.
Practical Wisdom for Simulationists
For those inspired to implement clinical debriefing in their own institutions, Méryl offers invaluable guidance drawn from her experience:
- Stay true to your passion and trust your instincts about potential applications
- Avoid rigid thinking about what constitutes “proper” simulation or debriefing
- Start small but maintain consistency in implementation
- Focus on creating psychological safety before expecting open dialogue
- Document and track outcomes to build support for the program
As she puts it, “If you see a link with simulation, even if people tell you, ‘No, but that’s not simulation,’ go ahead.” This openness to innovation, combined with scientific rigor, characterizes Méryl’s approach to advancing the field.
The Future of Clinical Debriefing Research
In a healthcare landscape increasingly focused on both patient and provider well-being, Méryl’s work on clinical debriefing offers a practical pathway toward more collaborative, reflective, and ultimately more effective healthcare teams. As this field continues to evolve, her research promises to help bridge the gap between simulation-based learning and daily clinical practice, creating healthcare environments where continuous improvement is not just an aspiration but a daily reality.
The ultimate goal, as Méryl sees it, is to create healthcare environments where speaking up is normal, learning is continuous, and both patients and providers thrive. Through routine clinical debriefing, this vision is becoming increasingly achievable, one conversation at a time.
Full conversation available in French on SIM Moove
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