Overview
Initiative type
Service Improvement
Status
Deliver
Published
June 2026
Summary
Qualitative research exploring implementation and performance of a clinical debriefing program in the Queensland Children's Hospital (QCH) Paediatric Emergency Department (ED)
Dates: January 2025 - December 2025
Implementation sites: Queensland Children's Hospital
Aim
To evaluate the implementation and performance of the QCH ED Clinical Debriefing Program (CDP), exploring staff experiences and perceptions, identifying barriers and enablers to its use, and examining the mechanisms through which it was embedded in routine practice.
Outcomes
There were multiple implementation outcomes, underpinned by interactions between context and mechanism, and illustrating successful integration of Clinical Debriefing (CD) into routine practice within the ED:
- Practice and clinical process improvement
- Emotional regulation and wellbeing activation
- Strengthening of relational co-ordination
- Junior workforce support
- Increased nursing-led facilitation
- Improved reporting of quality and safety actions
Background
Clinical Debriefing is becoming standard practice in healthcare after critical incidents but evidence describing how CD programs are implemented, experienced, and sustained in real-world emergency department settings remains limited. Much of the existing literature has focused on describing debriefing frameworks with comparatively few studies examining the mechanisms through which CD becomes embedded in routine practice, or the contextual factors that enable or constrain its use.
In particular, there is a paucity of qualitative studies exploring staff experiences of established CD programs, limiting understanding of how debriefing functions beyond initial implementation and how it is perceived by multidisciplinary teams over time. Understanding benefits, ensuring psychological safety and determining effective implementation strategies still needed further exploration.
The Queensland Children's Hospital (QCH) is a tertiary paediatric centre managing approximately 75 000 emergency presentations annually and employing over 345 staff. In response to the request from staff for structured approach post-event support following critical events, the QCH ED CDP was developed. Debriefing is facilitated by a trained senior ED nurse or doctor and is conducted within minutes-hours following a clinical event, with a target duration of 15 minutes.
Debriefs are multidisciplinary and inclusive, inviting participation from all staff involved in the event, including nursing, medical, allied health, ward' s persons, administrative staff, paramedics, and subspecialty teams. A scripted format is used, focusing on team performance through a 'what went well' and 'what could be improved' framework, identification of follow-up actions, and provision of brief psychological first aid. Since implementation in 2020, 124 debriefs have been conducted over six years, with 1086 recorded staff attendances.
This post-implementation qualitative evaluation examined the real-world performance of a CDP in a paediatric ED using the theoretical framework of Context-Mechanism-Outcome (CMO). By delineating contextual conditions, the mechanisms activated within teams, and the observable effects on people and practice, the findings provide an account of how the program was enacted, embedded, and sustained within an ED, and demonstrates features that can be incorporated in other departments looking to launch CD in their workplace.
Methods
This was a single site, descriptive qualitative project using semi structured interviews. The research received ethics approval (HREC/24/QCHQ/104558). All participants reviewed participant information and signed written consent before the interviews. Staff were recruited via expressions of interest and included nursing, medical, surgical, intensive care and paramedic staff. Purposeful and snowball sampling were used. Sessions were arranged by email and undertaken in August-November 2025.
The semi-structured, one-on-one interviews were conducted by the primary investigator using a piloted interview guide, and audio-recorded via Microsoft Teams. Recruitment ceased when no new themes emerged (data saturation).
Transcripts were generated by Microsoft Teams. The research team conducted thematic analysis and deductively developed themes until consensus was reached. Bias was mitigated by qualitative strategies including bracketing and member checking.
Context-Mechanism-Outcome (CMO) was used to structure the reporting of implementation factors. Representative quotations were collated, and barriers, enablers, and opportunities were organised within the themes and subthemes.
Discussion
This project looked at experiences of staff during implementation of a CDP in an ED to interpret factors conducive to sustained adoption, multidisciplinary participation, and acceptability. It succeeded through contextual conditions such the emotional gravity of emergency care, which amplified motivation for participation. Implementation formalised an already perceived but unmet need for meaning making and processing.
Organisational endorsement operated as a critical enabler by strengthening resource allocation and signalled that time spent debriefing was sanctioned rather than discretionary work. Short-term workflow disruption was reframed as an investment in long-term workforce sustainability. Debriefing became normalised because pressures were approached proactively, moving CD from an aspirational concept to enacted practice.
Timing as a mechanism became generative when staff reframed CD as integral rather than competing with patient care. Adaptative redistribution of workload and workarounds demonstrate that time scarcity was a mindset and situationally negotiable.
Extending invitations across specialties and hierarchies created interprofessional buy-in and normalised attendance. Staff legitimation functioned as a relational mechanism, reinforcing shared ownership and reshaping professional reasoning to collective learning.
Cognitive containment was a psychological mechanism resulting from consistent and predictable facilitation structure whilst clear boundaries between operational and emotional discussion reduced ambiguity. For facilitators, the CD design enhanced confidence and safety, while for participants it rendered intense experiences discussable and interpretable, and allowed controlled reflection.
Implementation outcomes reflect how debriefing generated layered effects across staff practice, wellbeing, and collegiality. It activated learning, emotional stabilisation and relational strengthening simultaneously. It became not only a tool for case review, but a process through which clinical reasoning, wellbeing, and team culture were co-produced and progressively normalised into everyday ED practice.
CD enabled collective appraisal of events, reducing narrative fragmentation and reconstructing shared clinical understanding. Emotional processing became embedded as a by-product of implementation. Relational co-ordination outcomes indicate that CD reshaped team dynamics and interprofessional trust, strengthened mutual respect, clarified roles, and reinforced shared commitment to high-quality care.
Junior workforce support emerged as a key outcome and illustrated that debriefing may shape how clinicians are socialised into high-acuity environments. Increased nursing-led facilitation signals a redistribution of authority and capability, indicating that scaffolding with a structured template can democratise leadership.
Barriers were more specifically identified, leading to opportunities for refinement and targeted adaptation of the CDP. These included more deliberate activation of Safety-II learning, and refinement for heterogeneous professional roles, particularly among non -clinical staff.
These findings suggest that Queensland Health departments looking to implement debriefing must move beyond endorsing it in principle to deliberately structuring the conditions that enable its activation and normalisation. It validates that carefully created programs are psychologically safe, and have important benefits for staff, teamwork, and junior staff care.
Improvements in clinical practice, teamwork, and performance suggest plausible benefits for patient safety as well as long term workforce capacity.
References
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Key contact
Dr Katie Reeves
Paediatric Emergency Physician
Queensland Children's Hospital