To create changes—in culture, in hierarchy—there needs to be the structure and tools for change. The briefings and debriefings, explicitly guided by purpose-built checklists, provide the structure and tools that drive dialogue, he tells HealthLeaders, adding that mere team training without this structured approach is unlikely to accomplish the same goals.
The checklist—which each team can modify based on its needs and experience—enhances safety and promotes dialogue, but it's "not a magic bullet," warns Bagian. Rather, it is a tool that changes behavior, which ultimately can change culture.
Ultimately, it's about driving conversation, he says—and it's the conversation, not the checklist itself, that drives the changes that lead to enhanced outcomes.
The checklist includes open-ended questions that promote conversation and dialogue. During follow-up interviews, team members reported examples of how the briefing helped them prevent adverse events—such as discovering that a patient was anticoagulated or identifying the need for additional implants that were not currently available.
Bagian says he hopes to see other organizations adopt this approach, and an accompanying JAMA editorial echoes the sentiment.
The editorial calls for wider adoption of team training, briefings and debriefings, and locally modified checklists "to ensure patients receive recommended interventions and to trigger crucial conversations among all team members about risks and ways to reduce risks."
Healthcare, it says, "must have as much improvement in teamwork skills as there has been in technical skills. Physicians and all other members of the health care team have an imperative to improve safety and outcomes and to reduce surgical mortality—patients deserve nothing less."