"Debriefing and Organizational Lessons Learned" (DOLL): A Qualitative Study to Develop a Classification Framework for...

Area of Science:

• Healthcare Management
• Clinical Debriefing
• Organizational Learning

Background:

• The COVID-19 crisis significantly impacted healthcare institutions, highlighting the need for effective reflection methods.
• Clinical debriefings offer a platform for healthcare professionals to discuss successes (pluses) and challenges (deltas).
• Effective debriefings, when integrated into unit management, are well-received by clinicians.

Purpose of the Study:

• To develop a novel framework for categorizing clinical debriefings.
• To assess the utility and value of this framework in a real-world clinical setting.
• To identify actionable insights from debriefings for organizational improvement.

Main Methods:

• A qualitative approach using grounded theory was employed to develop the "Debriefing and Organizational Lessons Learned" (DOLL) framework.
• Debriefings were conducted in two Emergency Departments over eight weeks.
• Framework validation involved independent categorization of debriefing transcripts and statistical analysis (Chi-square) of identified items.

Main Results:

• The DOLL framework, comprising seven dimensions and 13 subdimensions, was applied to 163 debriefings, identifying 339 items (97 pluses, 242 deltas).
• Significant associations were found between the frequency of pluses/deltas and the framework's dimensions (p < 0.001).
• Deltas primarily related to the work environment (e.g., equipment), while pluses focused on organizational aspects (e.g., communication, roles).

Conclusions:

• The DOLL framework enhances clinical debriefings by organizing findings into actionable management areas.
• Leadership found the DOLL to be a valuable tool for unit management and organizational learning.
• Further research is recommended to explore DOLL's application in non-crisis situations and its integration into incident reporting and risk management.