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International impact of TALK©: a simple and practical approach to multi-professional structured feedback and debriefing, to be used after unplanned learning events in clinical environments.

Periodic Reporting for period 1 - TALK (International impact of TALK©: a simple and practical approach to multi-professional structured feedback and debriefing, to be used after unplanned learning events in clinical environments.)

Reporting period: 2017-06-01 to 2019-05-31

TALK© is a communication tool which aims to guide multi-professional clinical teams learning and improving the quality of patient care and patient safety together.
It is a simple and practical approach to multi-professional structured feedback and debriefing, to be used after unplanned learning events in clinical environments.

Patient safety is far too often threatened by unidentified system flaws, poor practices, weaknesses in team communication and lack of appropriate action after critical events. This has been highlighted in the UK by the Morecambe Bay Investigation (Kirkup 2015), the Mid Staffordshire NHS Foundation Trust Public Inquiry (Francis 2013) and the Trusted to Care Independent Review (Andrews 2014).

The relevance of a culture of safety and communication is emphasised by the World Health Organisation (Human Factors in Patient Safety, Review of Topics and Tools, 2009).
It advocates debriefing, a process of formally reflecting on own performances after a particular task, shift or event. It can enhance safety by learning lessons from both well managed and poorly managed events. However, debriefing is still not adequately embedded in clinical practice.

Two meta-analyses support the use of clinical feedback and debriefing to improve performance. One of them demonstrates improved patient outcomes in the context of life threatening emergencies (Couper 2013). The other covers a wider range of environments in medical and non-medical organisations, and states that debriefs are a potentially powerful yet simple tool to improve the effectiveness of teams and individuals, achieving 20% to 25% average improvements, which can be boosted through structure and effective facilitation (Tannenbaum 2013).

A structured approach to debriefing is used in a number of fields, including aviation and the military. However, in healthcare there is only limited use of debriefing tools in very specific contexts.
The TALK approach to clinical debriefing may transform the way that healthcare teams communicate and learn from clinical events, as well as contribute to a supportive culture centred on patient safety. Additionally, staff wellbeing might be enhanced by empowering all members to initiate and participate in non-judgmental learning dialogues.

The objectives of this project are:
1. Quantify and promote guided reflection within clinical teams as a way to improve and maintain patient safety, increase efficiency and to contribute to a supportive culture of dialogue and learning, which would subsequently enhance staff wellbeing;
2. Share best practice, knowledge and experiences to further enhance the development of the TALK tool, with the end goal of implementing it on an international scale;
3. Promote international and inter-sector collaboration through research and innovation staff exchanges (Marie Curie Fellows), and sharing of knowledge and ideas from research to wider implementation.
Project phases
1. implementation of TALK for clinical debriefing in specified units across 3 countries and research to better understand the benefits of structured debriefing (WP3).
2. further training materials will be developed and translated to support the wider deployment of the TALK tool (WP4).
3. wider dissemination of the TALK tool across and beyond all participating partners (WP5).

WORK PACKAGE (WP) 1 - Project Management and Coordination

The lead beneficiary is CVUHB but all other beneficiaries have contributed through participation in governance structures. They include an Executive Board and a Supervisory Board.
Project board meetings have taken place regularly according to their Terms of Reference and have been minuted.
A very engaging Kick-off Meeting took place in June 2017, followed by a constructive and successful Mid Term Meeting in December 2018.

WP2- Communication & Dissemination

The project enjoys a wide social media platform including its own website (www.talkdebrief.org) and blog as well as Twitter (@TALKdebriefing), LinkedIn (Talk clinical debriefing), instagram (TALKdebriefing) and YouTube accounts. Press releases have been provided as appropriate.

Events organised during this period include workshops, training seminars and two international conferences (Cardiff, April 2018 and Stavanger, May 2019).
International presentations at relevant conferences and meetings have been carried out.

A charity, The TALK Foundation, has been created and registered with the Charity Commission, UK (registration number 1177093) to provide a legacy in order to preserve the longevity of the project beyond the period funded through MCSA-RISE.

WP3- Framework Application and Research Activities

Framework application activities include design/translation of implementation materials, presentations, group discussions, training sessions.
TALK framework implementation took place in theatre environments in CVUHB and Critical Care Units in HCB. HSHF is ready to commence implementation in October 2019.

Research activities completed include:
Protocol write up, ethical approval and permissions on all sites.

Data collection: CVUHB commenced September 2017, Barcelona commenced in September 2018, Stavanger prepared to commence data collection in September 2019.
Data handling including analysis of preliminary data has been carried out in Cardiff and Barcelona sites.

WP4- Development of further training materials

Previous training materials have been reviewed and updated. A full set of new materials have been developed and are being translated. Available materials freely downloadable from the TALK website include:
- TALK cards, flashcards and posters (English, Spanish, Norwegian, French, Dutch)
- TALK User guide animation Part 1 and Part 2 (English, Spanish subtitles)
- TALK User guide PDF
- TALK video examples (English, Spanish subtitles)
- Testimonials
- TALK implementation guide PDF
The European context is described in the “Detailed analysis of countries' reports on the implementation of the Council Recommendation (2009/C 151/01) on patient safety”. This report indicates that debriefing does not form a part of ensuring patient safety, which this project aims to address. An improvement in multi-professional clinical feedback might contribute substantially to patient safety, efficiency and staff training, satisfaction and well-being.

Current debriefing methods in standard educational settings are designed to focus the discussion around pre-set learning objectives. Clinical learning does not allow for such pre-set objectives, and therefore requires a much more flexible and fluid method.
The only other democratic team debriefing structure besides TALK for use in clinical environments is the DISCERN tool (Mullan 2012). It has been designed for use exclusively after resuscitation scenarios.

This project aims to escalate the TALK debriefing tool beyond the current state of the art by providing a more generic tool for any clinical environment.
A more flexible tool which can be utilised and adapted by any team within any clinical environment would help foster a patient safety culture.

TALK encourages teams to communicate, learn together and find agreed solutions to clinical challenges. It prompts and empowers all team members to take responsibility in moving forward a culture of shared reflective practice.
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