Perceived barriers and facilitators on the performance of perioperative briefing and debriefing
In total, the interviewees brought up 25 barriers and facilitators: 14 barriers and 10 facilitators, of which one was also a barrier (Table 3). Most barriers were related to debriefing (n = 10), and most facilitators were related to briefing (n = 6). We divided the barriers and facilitators into four categories: innovation, professional, social context and organisational context.
The barriers were mainly categorised into organisational (n = 6) and social context (n = 3). The prominent organisational barriers were: lack of dedicated teams, incomplete team, no follow-up of learning goals and lack of control of improvement actions. Barriers to briefing were related to innovation (n = 3), e.g. irrelevant questions and lack of personal interest. The often mentioned professional-related barriers to debriefing were: absence of a safe culture for (negative) feedback, lack of culture of accountability and lack of priority by healthcare professionals.
Facilitators were related to all categories. The important facilitators for briefing were: the feeling that discussing the surgical programme, including potential difficult situations, at the beginning of the day fosters efficiency and helps maintain a good work flow. The important facilitators for debriefing were the opportunity to give positive feedback and to discuss complications or concerns regarding surgery.
Insert Table 3 Perceived barriers and facilitators by the interviewees here -
Despite all the barriers, all interviewees acknowledged the added value of both briefing and debriefing and their positive influence on team climate. None of the interviewees suggested that either briefing or debriefing should be abolished. All interviewees provided suggestions for improvement (Table 4). Four were related to debriefing only, three to briefing only and three to both briefing and debriefing. Most of the suggestions (6/14) were related to innovation (e.g. timing and place, asking more specific and relevant questions), two were related to organisational factors (e.g. creating a reward system) and three to social context (e.g. more attention to role models and constructive feedback).
According to the interviewees, giving constructive feedback is beneficial for team climate and professional learning. However, they also acknowledged that they would rather not provide such feedback during debriefing with the whole team, despite the fact that this is a key element of debriefing. They would either ignore it or try to discuss it face-to-face. Anaesthesiologists and surgeons should act as role models when giving feedback within teams. The interviewees were unable to present solutions for creating a safer culture for providing feedback.
Insert Table 4 Suggested improvements for perioperative briefings and debriefing by the interviewees here -