Podcast 009: NASA Debriefing Methods

In Podcast by Lou Halamek8 Comments

In this podcast, debrief2learn’s Adam Cheng interviews Dr Lou Halamek from Lucile Packard Childrens Hospital. Over the years, Dr Halamek has spent time at NASA learning how they conduct simulations and debriefings. Here they discuss the NASA style of debriefing, which focuses on performance gaps and improvements, while at the same time de-emphasizing emotions. Dr Halamek described the lessons he learned from NASA debriefings and how they can be applied to healthcare debriefings..

 

Lou Halamek

Lou Halamek

Dr. Halamek is a Professor in the Department of Pediatrics at Stanford University and the Founding Director of the Center for Advanced Pediatric and Perinatal Education. He was a member of the original Board of Directors of the Society for Simulation in Healthcare and the original Editorial Board of Simulation in Healthcare as well as a current member of the Board of Directors of the International Pediatric Simulation Society. He is a practicing neonatologist working in the level IV neonatal intensive care unit at Packard Children's Hospital at Stanford and a Special Consultant to the National Steering Committee of the Neonatal Resuscitation Program of the American Academy of Pediatrics.
Lou Halamek

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Adam Cheng

Adam Cheng

Director, Research and Development at the KidSIM-ASPIRE Simulation Research Program, University of Calgary
Adam Cheng is a Pediatric Emergency Doctor at Alberta Children’s Hospital in Calgary, Canada. As a clinician scientist in the Alberta Children’s Hospital Research Institute, Adam conducts research focusing on cardiac arrest, CPR quality and debriefing. He helped to co-found the Debrief2Learn website.
Adam Cheng
  • Great discussion! Thanks for sharing your insight, Lou.

    • Lou Halamek

      Thanks for the comment, Taylor. I imagine that your military background exposed you to a debriefing methodology that is much different than what has historically been espoused in healthcare. Your perspective is welcome.

  • Suneth Jayasekara

    A really interesting discussion. I started to think about the possible reasons why the NASA astronauts are more open to receiving criticism. I wonder if another factor is that they are training for a future event, and they are not going to space that afternoon, unlike the clinicians who have to effectively leave the sim lab and treat real patients. Therefore any criticism would be a greater threat to the professional identity of the clinician, meaning that setting up a safe learning environment would be more important.

    • Lou Halamek

      Thanks for the comments, Suneth. My direct observations and discussions with astronauts, flight controllers and simulation supervisors at Johnson Space Center in Houston reveal something different. They focus on mission objectives, with the top objective being the safe return of the crew from space. I have been struck by how well they understand that lives are at stake, and how that imbues all that they do with a very high level of gravitas. They actually demand and welcome critique, because they know that, without it, they will not perform at an optimal level and lives will be at risk. I believe that those of us in healthcare can learn much from their approach.

      • Suneth Jayasekara

        Thats really interesting – Thanks very much Lou! Certainly those of us who work in healthcare can learn much from their approach. I’m curious as to why it is that the astronauts are more open to criticism than clinicians? Surely clinicians would understand that lives are at stake as much as the astronauts? Thats why I was wondering if there is some other factor that explains this apparent discrepancy.

    • Lou Halamek

      I think proximity to real life situations is less of an issue, as crews typically continue training to within a few days of launch. While some come from other high-risk fields as accomplished professionals who are at a later stage in their lives and careers (e.g., test pilots from the military who qualify as astronauts), others enter NASA right out of college or graduate school (e.g., engineering students who qualify as flight controllers). Regardless of their background, they all enter the same NASA culture that emphasizes achieving the success of the mission. Mission success is defined as the accomplishment of all mission objectives with the foremost objective being the safe return of the crew. I think that their culture and their intense focus on mission success is the key to their professionalism. Because teams of astronauts and flight controllers train together for months at a time, working alongside one another on a daily basis, all involved not only understand that they bear collective responsibility for the astronauts’ lives but they also develop personal relationships with crew members that further incentivize their desire to train them hard and train them well so that they come home safely.

      In contrast, teams in healthcare are rarely afforded the opportunity to train as frequently and become as tightly knit as teams at NASA. In addition, healthcare professionals rarely have the same type of intimate relationship with their patients. While delivering safe, effective and efficient care to the patient should be the penultimate mission objective, the reality is there are many (sometimes conflicting) agendas in healthcare.

      • Suneth

        Training together daily for months on end, would really build that opportunity for a safe learning container for open and honest feedback. Very difficult to achieve in healthcare where depending on your environment there are potentially hundreds of different staff members you could be working or training with on any given day.

        • Lou Halamek

          That’s part of our challenge. The circumstances that you describe mandate that we take full advantage of every opportunity to train and train effectively, always placing our focus on the success of our mission: the safe, effective and efficient care of our patients. Those circumstances mandate serious culture change in healthcare if we wish to ever approximate the level of safety that has been reached by other high-risk industries.