Team debriefings in healthcare: aligning intention and impact

Dear Editor

As a foundation doctor and newly qualified social worker, we valued Kolbe et al.’s recent piece on debriefing in healthcare [1]. The article highlights that difficult situations often trigger non-specific (or ‘vague’) debrief needs, which are addressed following proactive requests for debriefing from staff. Such a model places the onus on individuals within the healthcare team to seek out support.

It has been striking to compare the structures of support, supervision, and ‘debriefing’ opportunities within our professions. As Kolbe et al.’s paper suggests, debriefing in medical settings is of great value, however there are many barriers to accessing this support; lack of allocated time, appropriately trained and accessible staff, and an “I’m fine” culture can limit opportunities for quality and productive debriefing and reflection. In contrast, support for social workers, particularly those who are newly qualified, is structured and considered necessary and protected time. This is combined with education surrounding models of debrief that focus on reflective, rather than learning-based, models (such as those offered by Kolb [2] and Fook [3]). Ultimately, there appears to be a divide between reactive and proactive attitudes towards debriefing and responding to difficult situations within our professions (accepting, as Kolbe et al. note, the limits of these approaches for addressing symptoms of PTSD and depression).

This reflects, and perpetuates, significantly different professional cultures which influences the ways in which individuals are able to access and benefit from debriefing opportunities. This disparity may even be evident within a single multi-disciplinary team.

Given the challenges of staff wellbeing [4] and retention [5], medicine needs to do better. Social care faces interrelated challenges, however supervision and reflective practice is a strength within the social work profession that could be beneficially shared with medical colleagues. This may require a reimagining of already stretched medical rotas, where protected non-clinical time is at a premium.

References:
1. Kolbe et al. Team debriefings in healthcare: aligning intention and impact. BMJ 2021;374:n2042. doi:10.1136/bmj.n2042 pmid:34518169.

2. Kolb, D. (1984) Experiential Learning: Experience as the Source of Learning and Development. Englewood Cliffs: Prentice Hall.

3. Fook, J. (2002) Social Work: Critical Theory and Practice. London: Sage.

4. Thornton, J. NHS staff survey: just 29% of organisations take health and wellbeing seriously. BMJ 2019;364;l924. doi:10.1136/bmj.l924 pmid: 30814050.

5. BMA. BMA covid-19 tracker survey February 2021. https://www.bma.org.uk/media/3810/bma-covid-tracker-survey-february-2021....