Debrief it all: a tool for inclusion of Safety-II
This looked at the development and use of a debriefing tool based on Safety-II concepts. I don’t have a lot to say about this one as it’s open access and it was mostly just briefly covering the initial piloting of the tool.
[I summarised this paper a year ago so if I don't post it now I likely never will.]
As some background, the authors note their inspiration was to develop a tool to help people operationalise a focus on learning not just from bad events but from all events, routine and mundane, and on normal work.
They argue that while debriefing is not new or uncommon, “many common debriefing strategies are more focused on Safety-I” (p1), e.g. more focused on learning from what went wrong and not enough focus on normal work and how work occurs due to capacities, adjustments, variation and adaptation in complex systems.
You may argue with the logics, underlying research (around S-II) or the study methodology but the example questions they ask in the tool (shown below) may be of interest to my network who are starting out in the S-II space.
[That is, even if you disagree with S-II/new view etc., the sample questions are probably worth asking based on any ideology.]
Regarding the tool, it was developed iteratively by simulation experts and tested with 2 pilot groups, who provided feedback. Likert-scale assessments were also undertaken on user feedback for the overall impression of the tool, readability and anticipated use of the tool.
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Results:
Based on limited feedback of the tool during piloting (n = 10), there was 100% feedback for strongly agree or agree to questions on utility and useability of the tool. People noted that the tool “added much value to depth of [their] debriefing” or use of the tool “will be so useful to probe deeper during a ‘smooth’ case” (p4). In another instance, feedback indicated that a user will “definitely use this again, it helped me expand on the ‘why did it go right’ question I always try to ask” and in another case a user says that this type of tool will help them not to fumble through learning about what goes right (p4).
Several instances were noted of how the question set helped frame discussions about the full spectrum of work; noted how it helped to actually give them the “language” to comment on the concept that they saw happen during work. In one example, it was noted that it seems to be difficult for people to discuss things that went well because they are perhaps so primed to seek out the error or what went wrong”, whereas use of tools and concepts like these may also lead to more people drawing on and using the ideas.
Observed was that use of the tool increased both the number of types and topics (respectively) discussed during debrief meetings. In this case, the topics increased from 14 topics to 21 pre and post tool use. In one example, use of the tool led to discussions around gaps between work-as-imagined versus work-as-done with how hospital paging systems function.
For those interested, you can find the question-set/tool in the open access paper or extract below.
Link in comments.
Study authors: Suzanne K. Bentley, Shannon McNamara, Michael Meguerdichian, Katie Walker, Mary Patterson, Komal Bajaj, 2021, Advances in Simulation, 6, 9.
Executive Director & Facilitator | Incident and Workplace Investigations | Risk Management | Workplace Health & Safety | Investigations, Training, Research & Analysis
2 年Thanks Ben. I am very interested in the concept of debriefing. The services have seen the value in debriefing for a very long time and it is a core process. I have wondered why in industry we are so focused on having pre-start meetings and completely forget about the end of shift meeting. Surely there would be value in a workgroup spending 10 minutes at the end of a shift discussing how the work went.
Coach @ PrimeCoach | Certified RQI practitioner, EMCC certified coach
2 年Paul Stretton Ben Tipney this may be of interest to you.
Changing the definition of safety by embracing HOP and Safety II
2 年Take a read Andy Chhun
O&G Asset management | Operational Readiness | HSE management | Job Demands Resources | HOP practitioner
2 年Thanks for sharing Ben Hutchinson.
Director, Verda Consulting. Supporting your business through enhanced safety performance.
2 年The questions look good and as you say they can be used for many applications one could argue. A common theme exists that, in my opinion, continues to dog the S2 debate however and it is on display here. Questions such as "why did it go right" or "what went well" tend to be judged by the absence of harm argument which S2 rallies against. I also notice that the term performance is used generically and is not specific to a particular function such as safety. So when 'performance' improves how is that being judged? I acknowledge the post was about the tool and not S2 per se yet such fundamental issues remain that could hold such tools back or create situations for organisations using them oerhaps.