Ensuring success in high-risk patient care

What’s the first thing a high-stakes team does before action?

They conduct a team briefing.

Getting ready to start my crew briefing on an MD-11

As a fighter pilot, I never took off without a mission brief. As an airline pilot, my briefings were different, but again, I never got airborne without conducting a crew briefing. As a private pilot, even if flying solo, I prepare a flight briefing, often with the aid of online flight planning resources.

The OR, ER, ICU, and labor floor may look different from a flight deck, but the stakes are the same: lives are on the line, circumstances can change fast, and teams have a greater chance of success when they invest a few moments in getting clarity and alignment about the care they're about to provide.

Why Briefings Matters in Healthcare

A well-run team briefing isn’t about checking a box. Done properly, it creates a shared mental model so the team can adapt together when things don’t go as planned.

And, perhaps just as importantly, a well-executed brief not only aligns the clinical plan but also builds the sense of psychological safety needed for everyone to feel free to speak up when things change or a problem with patient care is perceived.

Briefings also set the stage for continuous learning to occur in your post-care debrief. Here's an example of how that works in aviation. After landing, I take my written flight plan/briefing and circle everything on the flight plan that went as expected with green pen. Everything that happened in the flight that was different than expected gets circled in red. For example, if the actual winds were different than forecast winds, or my takeoff time differed from my plan, they get a red circle. With this method, I know exactly where to invest my time and focus on improving for next time.

This same concept can be used in healthcare. After providing care, if time is limited (and it always seems to be), during your debrief focus on where the execution of the plan differed significantly from the expectations created during your team briefing. Pay particular attention to those events not adequately covered in your briefing or where less than effective performance prevented meeting your plan's expected parameters.

Here’s what a strong healthcare brief should cover:

• Clear Intent – What’s the goal for this case, resuscitation, or delivery? What does success look like for the patient and family?

• Roles & Responsibilities – Role establishment is critical. For example, who’s leading? Who’s documenting? Who’s pushing meds? Who’s managing the airway? Everyone should know their lane before the action starts. It's important to not only understand what your role is, but also to clearly define EVERY team member's role. This allows for clarity when things change, and also drives that all important mutual support for others to step in when needed.

• Plan of Execution – Walk through the steps. “Here’s how we’ll proceed if things go smoothly, and here’s what we’ll do if they don’t.”

• Shared Situational Awareness – Ensure everyone understands the patient’s status, history, risks, and what to watch for. No one is left guessing.

• What-If Scenarios – Talk through the likely complications: “If the airway fails… if we lose the line… if bleeding worsens…” Pre-mortem thinking reduces surprise and builds resilience.

Where Briefings Might Apply

• Operating Room – Before the first incision, confirm intent, roles, risks, and backup plans.

  
  

• Emergency Department – Before intubating or running a code, huddle quickly: assign tasks, state the objective, anticipate complications.

  
  

• ICU – Before rounds, align on priorities for the sickest patients. Before procedures, review the plan and backups.

  
  

• Perinatal Teams – Before a high-risk delivery, brief the team: what’s the goal, what could go wrong, and how will we respond?

  
  

The Key Takeaway

When you take a couple of minutes to align before you act, you buy your team clarity, speed, and resilience when the unexpected hits.

And when the episode of care is complete? Debrief to ensure continuous learning.

That’s how high-reliability teams keep patients safe during high risk care.