The Portland-based Oregon Patient Safety Commission offers tips on interviewing adverse event witnesses. The following is some of the advice:
- Be prepared to respond to questions the patient or family may have about the event and what is being done to improve care for future patients.
- Use plain language, avoid jargon, and check for understanding throughout.
- Actively listen and respond with empathy.
- Start with broad, open-ended questions, and then narrow them down to clarify your understanding of what has been shared.
- Practice “humble inquiry”: drawing someone out by asking questions to which you do not already know the answer, using curiosity and interest to build a relationship.
- Designate a contact person whom the patient or family can reach with questions or if they remember additional information. (For more information, readers can go online to http://bit.ly/298HJgX.)
In addition, the Agency for Healthcare Research and Quality (AHRQ) offers advice on how to debrief clinicians involved with adverse events. AHRQ notes that all forms of debriefing have a shared structure that involves setting the stage followed by three phases, including description or reactions, analysis, and application. The following is some of the advice from AHRQ:
- Setting the stage: To be effective, a debriefing must be conducted in a manner that supports learning. Thus, the purpose is not to identify error and assign blame, but to understand why actions and decisions made sense to clinicians in the moment. This step requires establishment of psychological safety for participants regardless of the type of debriefing conducted. Whether engaged in a clinical debriefing lasting three minutes or a simulation debriefing lasting 30 minutes, the tone set by the leader and the leader’s management of the discussion are critical to maintaining psychological safety.
- Description or reactions: During this phase, the leader generally elicits perspectives from team members about how events unfolded in the clinical situation or simulation scenario and asks them to describe their reactions. Participants should be requested to identify the important issues to address, and the sequence of events should be clarified.
- Analysis: The leader should develop the priorities for discussion with the participants. The leader should balance participant priorities with any other critical safety concerns that were noted during the event. The goal is to explore clinicians’ rationales for observed behaviors, identify and close performance gaps by discussing pros and cons of chosen actions, and determine any modifiable systems issues that may have interfered with performance.
- Application: This phase of debriefing is designed to identify and summarize the main learning points and consider how they can be incorporated into future practice. Explicitly summarizing lessons learned from the scenario or clinical event may help team members recall and apply these lessons in the future. (The AHRQ advice on debriefing is available at http://bit.ly/29oyrx4.)