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.

Project Information

TALK

Grant agreement ID: 734753

DOI

10.3030/734753

Project closed

EC signature date 13 December 2016

Start date 1 June 2017

End date 28 February 2022

Funded under

• EXCELLENT SCIENCE - Marie Skłodowska-Curie Actions

Total cost

€ 274 500,00

EU contribution

€ 274 500,00

Coordinated by

CARDIFF AND VALE UNIVERSITY HEALTH BOARD
United Kingdom

Periodic Reporting for period 2 - 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: 2019-06-01 to 2022-02-28

Summary of the context and overall objectives of the project

TALK© is a communication tool which aims to guide multi-professional clinical teams learning and improving the quality of patient care together.
It is a simple and practical approach to structured feedback and debriefing, to be used after any learning event 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, 2009).
It advocates debriefing, a process of formally reflecting on individual and team performances after a particular task, shift or event in order to learn from both well managed and poorly managed events. However, it 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 (Couper 2013). The other covers medical and non-medical organisations, and states that debriefs are a potentially powerful yet simple tool to improve the effectiveness of teams and individuals (Tannenbaum 2013).

Structured debriefing is used in a number of fields, including aviation and the military.
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.

The objectives of this project were:
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
2. Share best practice, knowledge and experiences to further develop the TALK© tool, with the end goal of implementing it on an international scale
3. Promote international and inter-sector collaboration, and sharing of knowledge and ideas.

Work performed from the beginning of the project to the end of the period covered by the report and main results achieved so far

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. development and translation of further training materials to support wider uptake 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

This package has steered the project and addressed all expected and unexpected situations encountered. It has also supported the project, with special attention to financial, logistics, information and coordination issues.


WP2- COMMUNICATION AND DISSEMINATION

We have achieved international recognition within European and global stakeholder communities, as exemplified by the current state of play, with active collaborations in 5 continents.
The project enjoys a wide social media platform including its own website as well as Twitter (@TALKdebriefing), LinkedIn, Instagram and YouTube accounts.

The team has provided worldwide conference presentations.

Events organised during this period include workshops, seminars and international conferences (Cardiff 2018; Stavanger 2019; online conference,Barcelona, 2021).

The TALK Foundation, registered with the Charity Commission, UK, will act as the project’s legacy .


WP3- FRAMEWORK APPLICATION AND RESEARCH

Framework application activities were completed in theatres at CVUHB, critical care training and practice sites at UB and HCB during the first period.
HSHF commenced implementation in October 2019, by establishing learning networks in collaboration with their quality improvement department across a large number of departments.

Research activities completed include:
- Data collection across all clinical sites, initial analysis.
- Publication of the concept paper: Clinical debriefing: TALK© to learn and improve together in healthcare environments, Trends in Anaesthesia and Critical Care, 2021
- Further analysis of CVUHB data, presented at SESAM 2021 conference. Awarded best abstract prize and published as Selected Abstracts from the 26th Annual Meeting of the Society in Europe for Simulation Applied to Medicine: Debriefing in operating theatre areas using the TALK© Framework.
- Collaborative reflection on factors affecting clinical debriefing during COVID, which was published as: Clinical debriefing during the COVID-19 pandemic: hurdles and opportunities for healthcare teams. Advances in Simulation 2021.


WP4- DEVELOPMENT OF FURTHER TRAINING MATERIALS

Training materials have been developed, reviewed and updated when necessary. Translations are available in 8 languages. Our materials are freely downloadable from the TALK website .

The TALK Foundation advocates cascade training, aiming to train instructors who will then deliver local short courses as the main mechanism for teaching and disseminating TALK© within healthcare organisations. Free local training standardised materials will be provided to instructors.


WP5- KNOWLEDGE TRANSFER

Wider implementation within beneficiary institutions has taken place across multiple specialties as well as at a strategic level.

The COVID pandemic has promoted external research and publications on the positive impact of debriefing on resilience and peer support. This has added to the momentum initiated by our group, hence contributing to a wider international adoption of the TALK© approach, with active collaborations in consortium countries (UK, Spain and Norway) and beyond in Netherlands, Denmark, Italy, France, Switzerland, Germany, Portugal, Finland. Argentina, Mexico, Chile, Australia and Niger.

Parallel to the international appetite for implementing the TALK© framework, we have enjoyed growing recognition as a well established safety tool, being referred to or strongly recommended in key guidance articles.

Progress beyond the state of the art and expected potential impact (including the socio-economic impact and the wider societal implications of the project so far)

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.

Clinical debriefing supports Safety II principles (Holnagel 2015), is beneficial for team dynamics (Tannenbaum 2013) and allows organisation leaders to empower clinicians and engage them in collaborative change (IHI 2018).
There is growing evidence of the positive impact of clinical debriefing in patient outcomes (Couper 2013, Wolfe 2014). It is also becoming widely accepted that we should make use of everyday opportunities to learn from clinical experiences with positive outcomes (Moppett 2016). Participatory ergonomic methods and human centred design highlight the importance of genuine clinician engagement in patient centred system design and improvement (Carayon 2020).

Clinical debriefing fulfils this need, and TALK© has been adopted by teams worldwide, as it is an easy, practical, widely applicable, values-based guide to clinical debriefing, designed for clinicians by clinicians.

TALK structure and values

Training materials

TALK website