topic: [[Debriefing]] people: created: 2024-10-27 #on/debriefing | #note/thing [[the answers you get come from the questions you ask]] ##### what is it? This is a [[Debriefing]] approach for a group that can be used when time is short, you have a novice debriefer, you have a large group, or other constraints making Advocacy-Inquiry difficulty. Especially useful in [[In Situ Simulation]] or [[Clinical Event Debriefing workshop]] ##### why does it matter? [[psychological safety]] should be nurtured with both explicit (laying the ground rules, setting the agenda, reactions with validation and normalization, [[first seek to understand]]) and implicit (body, tone, posture) actions by the facilitator. By having a group reflect on what went well and what could be improved, you can get a balanced view of performance in a variety of settings. There are some keys to doing this well. >“four opportunities for improving the art of the plus delta: (a) exploring the big picture vs. specific performance issues, (b) choosing between single vs. double-barreled questions, (c) unpacking positive performance, and (d) managing perception mismatches.” (Cheng et al., 2021, p. 1) ### Big Picture vs Specific Issues: _here I recommend the "dynamic plus/delta" specific to the issue at hand, not a "general" what went well._ ![[CleanShot 2022-08-30 at 20.27.58.jpg]] ### Single vs double-barrel questions ![[CleanShot 2022-08-30 at 20.32.48.jpg]] ### Unpack positive performance Use [[cognitive task analysis]], don't just ask what they did, find out why they did it and figure out how they came to know that is the right thing to do. ![[CleanShot 2024-10-27 at 21.11.19.jpg]] ### Managing perception mismatches Be explicit with permission "I'm hearing that you thought the communication was good, can I provide a different point of view? I saw that more than one person was giving orders I'm thinking this can be confusing, and in several times it required the RN to ask "who's giving the orders here. That's how I saw it, what was going on for you in that moment?" ### Some arguments against using plus-delta People and teams aren't that accurate at self reflection, the memories are not very clear. Global assessment is not the goal, learning is, so the broad questions can prompt more cognition on global assessment than on learning. Use a combination of external (recorded data by the recorder nurse) and internal (how is the team feeling) data for best self assessment. The group can become polarized, with one view dominating. The facilitator needs to push towards a broad way of seeing things, and to allow and explore divergent views. “facilitators help normalize differences in experiences and explicitly appreciate shared self-assessment(s) that seem to stand out or be in the minority.” (Cheng et al., 2021, p. 6) ## Sources: Kainth, R. (2021). Dynamic Plus-Delta: An agile debriefing approach centred around variable participant, faculty and contextual factors. _Advances in Simulation_, _6_(1), 35. [https://doi.org/10.1186/s41077-021-00185-x](https://doi.org/10.1186/s41077-021-00185-x) Cheng, A., Eppich, W., Epps, C., Kolbe, M., Meguerdichian, M., & Grant, V. (2021). Embracing informed learner self-assessment during debriefing: The art of plus-delta. _Advances in Simulation_, _6_(1), 22. [https://doi.org/10.1186/s41077-021-00173-1](https://doi.org/10.1186/s41077-021-00173-1)