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Considerations for psychological safety with system-focused debriefings
  1. Mirette Dube1,
  2. David Kessler2,
  3. Lennox Huang3,
  4. Andrew Petrosoniak4,5,
  5. Komal Bajaj6
  1. 1 Department of Simulation, Alberta Health Services, Calgary, Alberta, Canada
  2. 2 Department of Emergency Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
  3. 3 VP Medical and Academic Affairs, The Hospital for Sick Children, Toronto, Ontario, Canada
  4. 4 Department of Emergency Medicine, St Michael's Hospital, Toronto, Ontario, Canada
  5. 5 Department of Medicine, La Ka Shing Knowledge Institute, Toronto, Ontario, Canada
  6. 6 Chief Quality Officer, NYC Health and Hospitals/Jacobi, Jack D Weiler Hospital of the Albert Einstein College of Medicine, Bronx, New York, USA
  1. Correspondence to Mirette Dube, Simulation, Alberta Health Services, Calgary, AB T2N 2T9, Canada; MiretteDube{at}

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Systems integration simulations (SIS) and system-focused debriefing (SFDs) are tools to improve the processes and systems of healthcare.1–4 The goal of SIS/SFD is to identify systems issues/gaps, including latent safety threats to reduce preventable harm.1 2 5 6 Kolbe et al underscore the importance of psychological safety for effective learner-focused debriefings (LFD) and how this is built from a strong organisational culture.7 This may be even more prescient during SFD where participants are being asked for feedback about processes/systems that by their nature may reflect poorly on their leaders or organisation. Threats to psychological safety during SFD can inhibit the desire to openly share issues and undermine future improvement efforts.8

Little is published on how to manage psychological safety relative to a SFD. Kolbe et al describe strategies contributing to psychological safety before, during and after a LFD.7 This editorial highlights key considerations for managing psychological safety at each stage of SFD. Our perspective is based on a combined 40 years of experience conducting SIS/SFD.

The pre-work phase

The SIS/SFD early planning and engagement work, also called the pre-work phase is the starting point for establishing psychological safety.8 Inclusion and engagement of all key stakeholders and a clear endorsement from senior leaders help create a foundation for psychological safety.9 10 Threats to individual psychological safety may come from feeling left out, or that their opinion/role/stakeholder group was not held in high regard.11 Table 1 highlights the potential threats and mitigation strategies during all phases of SFD.

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Table 1

Potential threats to psychological safety during an SIS/SFD with suggested mitigation strategies/sample statements

Pre-work includes a needs assessment to identify and prioritise anticipated highest risk/highest impact changes, which informs scenario design. Ensuring clarity of mission (ie, what types of issues can be mitigated, how they will be resolved, timelines) …

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  • Twitter @MiretteDube, @y2kessler, @petrosoniak

  • Contributors All authors have contributed to the writing of this editorial.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; internally peer reviewed.

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