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Table 1 Safety-II debriefing tool

From: Debrief it all: a tool for inclusion of Safety-II

Debriefing phase and goal

Safety-II concept(s) highlighted

Sample language/phrases

Debriefing introduction/setting the scene

• Safety-II expands on Safety-I (study of failures) to analyze the complexity and adaptability of the system and capitalize on good performance.

• “Safety is not about the absence of negatives; it is about the presence of capacities” [8].

• Let’s take a look at how our work really operates, including the systems and relationships that support us.

• We’ll also discuss the challenges we may encounter and how we adapt to overcome those challenges.

• How we adapt in different circumstances offers insights into why we succeed.

• Understanding how things work and why things go right helps us improve.

• Our goal is to collaboratively discuss this case, the outcomes, and the performance aspects that went well and why, so we may better understand and capitalize on them in the future.

• In addition, we will discuss opportunities for improvement.

Case summary/description

Value of understanding normal workflow (work as done vs. work as imagined)

Can you please share the facts/short summary of the case?

Analysis

• How does the work actually work?

• Variability

• Adaptability

• Flexibility

• Workarounds

• Near misses and harm mitigation strategies

• Reproducing success

• Leveled hierarchies/ability to share concerns

• What conditions make success more likely? What conditions make success more difficult?

Let’s focus on what went well:

• Why did X go so well in this case? How can we ensure this happens again this way in the future?

• How did people adapt to overcome challenges in this case? What behaviors facilitated good performance?

• What resources enabled good performance?

• How does this work usually happen? Are the behaviors and/or resources reliably available/performed?

• Are there strategies that were used in this case or that you use in your normal work to be more efficient or more effective?

• How has this played out during a similar clinical situation? Are there examples of cases like today’s when it didn’t go well? What is the difference between that case and today?

• How do we ensure reliability of available resources and encourage useful behaviors?

Let’s now explore what could be done differently or improved:

• Let’s specifically discuss X that could have been done differently this time. Has it gone right before? Why has it gone right/differently other times but not during today’s case?

• Were there any near misses? If so, how did the team adapt to prevent harm from occurring? (e.g., X event? Mutual support between Nurse X and Dr. Y prevented medication being administered into an IV line that Nurse X noticed was infiltrated)

• Were there systems challenges encountered that made this case more difficult than it needed to be? How could those systems improve to support your work in the future?

Summary/take home points

• Reproducing success

• Identifying opportunities for systems improvement

What occurred in this case that we want to continue in the future? e.g., What is needed to ensure this happens reliably again in the future?

How can each of us help to make this happen?