# Open-access healthcare debriefing videos need to incorporate more Safety-II learnings

## TL;DR

This paper argues that open-access healthcare debriefing videos focus too much on why things go wrong and should include more discussion on why things go right to improve patient safety.

## Contribution

The paper highlights the underrepresentation of Safety-II concepts in open-access healthcare debriefing videos and suggests incorporating both Safety-I and Safety-II perspectives.

## Key findings

- Current open-access healthcare debriefing videos emphasize Safety-I over Safety-II.
- Including Safety-II concepts in debriefing can lead to a more holistic understanding of performance.
- Future research should explore the impact of Safety-II debriefing on safety culture and wellbeing.

## Abstract

Patient safety science and debriefing approaches have historically tended to focus most heavily on Safety-I or “why things go wrong” and learning from unfavorable performance, root cause of adverse outcomes, and improvement opportunities learned from failures. Consequently, rich opportunities for analysis and learning from “why things go right,” successful performance, and exploration of how systems succeed, adapt, and perform effectively regardless of outcome—Safety-II—are often underrepresented.

Open-access videos of healthcare debriefing were sought by searching Google and YouTube via search terms “healthcare debriefing,” “healthcare debrief,” “healthcare debriefing video,” “healthcare debrief video,” “healthcare debriefing example,” “healthcare debrief example,” “simulation debriefing,” and “simulation debrief.” Additionally, a search of major professional organization websites was utilized. Included videos were reviewed to score all utterances on the following: (1) phase of debriefing; (2) question or statement; (3) by facilitator or participant; (4) if utterance was neutral, related to positive performance/ “what went well” or negative performance/“what could be improved”; (5) if facilitator utterance was general or a follow-up, reflective utterance building upon previous discussion; (6) if participant utterances were general or specific reflective, insight offering comments; (7) all facilitator follow-up/ specific reflective type utterances were further analyzed and coded as exploration into Safety-I (e.g., exploration of why error occurred) or Safety-II (e.g., adaptability, variation, reproducing success) concepts.

A review of open-access video examples of healthcare debriefing demonstrates disproportionate emphasis on Safety-I and highlights the opportunity for open-access examples of healthcare debriefing to include additional language and techniques that promote and role model inclusion of Safety-II discussion.

While there is always room for improvement and we must all strive to do the best we can, we are missing a major opportunity to build resilience by Safety-II exploration into analyzing why things go positively. Those designing such instructional videos should intentionally include debriefing focused on both Safety-I and Safety-II aspects of performance, regardless of outcome, as they are both important, complimentary, and result in a more holistic understanding of improvement opportunities and success. Future study on the impact of Safety-II debriefing should focus on context-specific promotion of quality and patient safety, as well as impact on participant wellbeing and overall safety culture.