Psychological Safety and Hierarchy in Operating Room Debriefing: Reflexive Thematic Analysis

Area of Science:

• Healthcare Management
• Patient Safety
• Team Dynamics

Background:

• Barriers hinder consistent and effective team debriefing in clinical settings, particularly operating theaters.
• Frontline workers' insights are crucial for developing practical debriefing policies.
• Operating room environments present unique challenges for team communication and learning.

Purpose of the Study:

• To gather frontline operating room staff perspectives on establishing an effective debriefing policy.
• To identify key elements for successful implementation of team debriefing in surgical settings.
• To understand the facilitators and barriers to operating room debriefing from the staff's viewpoint.

Main Methods:

• Qualitative study involving interviews with operating room personnel at a tertiary children's hospital.
• Audio-recorded interviews were transcribed and analyzed using reflexive thematic analysis.
• Data collected from 40 operating room staff, including nurses, anesthetic technicians, anesthetists, and surgeons.

Main Results:

• Three core themes emerged: commitment to learning, the necessity of a safe space for psychological safety, and the role of leadership.
• Healthcare workers demonstrated a strong commitment to teamwork and quality improvement.
• Psychological safety was identified as both a prerequisite for and a product of effective debriefing.

Conclusions:

• Psychological safety is foundational for successful debriefing and is enhanced by the process.
• Leadership, when viewed as a shared responsibility, can dismantle hierarchical power structures.
• Routine, well-executed debriefing is likely to improve psychological safety, team learning, reduce errors, and enhance patient safety.