The Debrief: Where the Real Learning Happens in High-Consequence Industries

The procedure is over. The meeting ends. The shift change happens. People pack up, walk out, maybe share a few quick comments on the way to the elevator—and that’s it.

But that moment, right there, is the real opportunity for learning that will improve performance for next time. When that opportunity is used, it’s called the debrief—and in too many industries where the consequences for poor performance can include injury and death, the debrief is rushed, informal, or skipped entirely.

In military commercial and general aviation, I learned a long time ago that a structured debrief is the single most effective way to accelerate learning and improve performance. Even after a long career as a military and commercial pilot, I debrief every one of my general aviation flights as a private pilot. And, I'm still learning - both how to be a better pilot, how to conduct better debriefs, and how to teach others to debrief effectively.

I debrief after every flight in this airplane

After 25 years of helping healthcare organizations improve their safety and quality performance, I know without a doubt that institutions that implement a disciplined debrief improve their quality, safety, and efficiency. And, that debriefing can be done in a way that fits the pace of healthcare.

Whether it’s the end of a surgery, the close of a clinic day, the conclusion of a meeting, or the handoff at shift change, here’s how to adapt the proven aviation framework to healthcare.

Step 1: Set the Tone by Creating a Sense of Psychological Safety

If the first words out of someone’s mouth sound like criticism, or hint at assigning blame,you’ve already lost your team and you'll get no benefit from the time spent debriefing

Debriefs must start in an environment where honesty and learning matter more than ego or blame. Especially blame.

To avoid blame and criticism, an effective technique is to start with the positives.

Open the debrief by asking a specific member of the team, "What did we do well today?"

After you get a response, ask other members of the team what they thought went well. Where needed, dig a little deeper and probe for the specific action that led to the good outcome. For example, if someone says, "I think we communicated effectively," you might follow up with this question, "What specifically, did we do today that made our communication effective?" You'd look for an answer that sounds something like, "We verbally acknowledged your instructions... so you could be sure that we heard you."

Covering the positives first helps create a sense of safety and avoids the tendency to criticize.

Then, and only then does the person leading the debrief ask, "What could we improve?" An effective technique is for the leader to ask...

“I'll go first. What’s one thing I could have done today to better support you?”

This simple question models accountability and sets the tone for open dialogue when discussing the improvements in performance that must be made. These sorts of questions keep the focus on performance improvement, not finger-pointing.

Step 2: Review the Execution (Truth Over Assumptions)

In aviation, every flight has clearly defined objectives—and every shift, procedure, or meeting in healthcare should too.

To get the most advantage from a debrief, the team must know what actually happened during the case, the shift, or the meeting? Our memories are tricky and it's best to stick to the facts—times, vitals, handoff steps, and decision points.

If you need to reconstruct the event you're debriefing, it's most effective to go phase-by-phase for clarity:

• Pre-op / Pre-shift preparation

• Initial assessment / handoff

• Key interventions or decision points

• Complications or unexpected events

• Closing tasks / documentation / discharge

During your reconstruction, identify Focus Points—the two or three moments that matter most for learning and improvement.

Step 3: Analyze (Find the Root Cause)

Here’s where the learning happens. it is not enough just to accept general, non-specific statements about performance in a debrief. When someone say something like, "Our decision making was good," you must always ask “Why?” until you uncover the earliest contributing factor.

A useful model to follow is: Perception → Decision → Execution

• Perception: What did I percieve was happening at that moment? Was my perception accurate? If not, what did I/we miss?

• Decision: Based on my perception of the situation, did I/we make an appropriate decision? If not, why not? What did I/we not do in our decision making process?

• Execution: Was it a skill issue, a communication gap, or a missed checklist item?

Then consider the human factors: fatigue, task saturation, distractions, assumptions, or stress.

Step 4: Learning & Action (What Will We Do Differently?)

Every debrief should end with clear, specific takeaways by answering the question, "What will I/we do differently next time?" This answer must be as specific, objective, and detailed as possible. Speaking in generalities will not improve performance.

Without this step, a debrief risks becoming just a difficult conversation instead of a useful and proven tool for change.

How to Do a Quick Debrief

healthcare providers are always short on time. So, if you're doing a quick huddle before heading home—this simple acronym keeps you on track:

S – Set the Tone: Model accountability, ensure psychological safety.

E – Execution Review: Stick to facts, not assumptions.

A – Analysis: Ask “Why?” until you find the root cause.

L – Learning: End with clear action items for next time.

Why This Works in Healthcare

Aviation doesn’t leave performance to chance—neither should those in medicine.

A short, focused, and honest debrief:

• Improves clinical decision-making

• Reduces repeat errors

• Strengthens team trust

• Keeps patient safety at the center of the work

A senior pilot once said,“Whenever we talk about a pilot who has been killed in a flying accident, we should all keep one thing in mind. He called upon the sum of all his knowledge and made a judgment. He believed in it so strongly that he knowingly bet his life on it. That his judgment was faulty is tragic... Every instructor, supervisor, and contemporary who ever spoke to him had an opportunity to influence his judgment, so a little bit of all of us goes with every pilot we lose.” 

This could have just as easily been said about an unwanted outcome in healthcare. If so, it might have sounded like this: “Whenever we talk about a patient who lost their life due to a series of medical mistakes, we should all keep one thing in mind. The team that provided the care to that patient called upon the sum of all their knowledge and skill and made a judgment about what to do next. The team believed so strongly they were doing the right thing at the right time, that, in effect, they were betting the patient's well being on their actions. That their judgment was faulty is tragic... Every CMO, CNO, attending, charge nurse, nurse manager, and peer who ever worked with members of that team had an opportunity to influence their judgment. A little bit of all of us goes with every patient we lose.” 

Every debrief is a chance to make tomorrow’s care safer.