What do the Navy SEALS, New England Patriots, Blue Angels, FBI SWAT team, and Mayo Clinic surgical teams all have in common…
They Debrief their Performance
All elite, high performance teams are deeply committed to debriefing their performance. Debriefing is an indispensible activity for any person or organization that wants to rapidly improve. It is the engine that drives organizations from “good” to “great.”
I’ve Been Debriefing for 40 Years
I started debriefing when I was learning to fly Navy jet fighters. Every flight concluded with a debrief. Years later I had the good fortune to be selected to serve as an instructor pilot at the Navy’s TOPGUN school. There we elevated debriefing to an art form.
At TOPGUN, we debriefed everything - every flight, every meeting, every class, and every project. Every event, every time. This was our way of doing continuous quality improvement, and the secret of our incredible culture of high performance.
Due to our culture of getting and giving feedback, every TOPGUN instructor pilot was always making constant minor corrections and improving their performance every day. Nothing escaped scrutiny. How did we do it?
How to Debrief
In our debriefing sessions, we asked these three questions:
1. What went well?
2. How can we improve our performance?
3. How, specifically, will we make that happen?
Step 1. Ask, “What went well?”
We always started the debrief session on a positive note by asking ourselves, “What went well?” The key learning principle here is that behavior that gets rewarded gets repeated. By emphasizing exceptional performance we ensured we’d see that level of excellence again.
The key to success is to insist on specifics. Don’t allow the team to hide behind general, nonspecific, non-observable comments. If a team member responds to this question with something like, “We communicated well,” dig deeper and ask them for a specific example. The more specific the more effective the feedback will be.
Just as it did at TOPGUN, noting and praising specific examples of excellent performance creates the reward that will make debriefing a habit in your culture.
Step 2. Ask, “How can we improve?”
Next, we analyzed where performance could have been improved. The key here is to allow each person to analyze their own performance (self assessment) before offering input to one another.
Step 3. Ask, “How can we make it happen?”
In this step, we forced ourselves to be very explicit and specific on exactly what actions must be taken to improve. This step is where the real learning occurs. By verbalizing our action steps for next time we triggered a pattern of electrical signals through our neurons, increasing the speed and strength of the signal through the neural pathways.
Specificity is critical. For example, it wasn’t enough to say, “I need to be a better communicator.” We had to verbalize the exact steps we would take. For example, “I will always start my radio transmission with the call sign of the flight I am talking to, so they will know the information is directed at them.”
Don’t Poison the Well
The team leader or person leading the debrief always asks for input from others before offering their own opinion about what went well or what can be improved. Team leaders that offer their own performance assessment prior to seeking the input of others will taint the quality of the input that is received and cripple the effectiveness of the feedback session.
The tactic we used at TOPGUN, and that you should use as well, is to start the debriefing process with the most junior or least experienced member of the team. This is typically the person least likely to speak up and contribute to the discussion. The leader talks last.
Recap the Action Items
If the debrief has identified needed action items (e.g. revise the checklist, add a step to the protocol, ensure a certain piece of equipment is readily available, etc.), the leader must assign responsibility for the action. The most effective way to do this is to recap the debrief with a brief discussion about “Who does What by When?”
Debriefing Works in Healthcare!
Debriefing is critical to successful healthcare safety and quality initiatives. In 20 years of helping hospitals implement the best practices of highreliability organizations, the most successful implementations (the ones that truly change the culture) occur where the practice of debriefing has become a habit among the leaders and staff.
The evidence base supports our own coaching experience as well. A recent study1 showed that debriefing in the surgical suite reduced the proportion of surgical cases with reported defects, was associated with a significant reduction in the 30-day unadjusted surgical mortality, lowered costs by substantial gains in efficiency and productivity, and led to a better workforce safety climate.
Debriefings can be used almost anywhere in healthcare. In addition to the surgical suite, debriefings can be conducted at the conclusion of:
• Interdisciplinary rounds
• A work shift
• Meetings
• Presentations
• The work day
• Special projects
• Rapid response cases
• Trauma cases
The need to increase value in health care is more urgent than ever. Debriefing is an effective method of producing more efficient, error-free health care and should be in the tool kit, and part of the culture, of every high performing healthcare leader and organization.