Are Safety-II concepts used in debriefing?
This explored the language and framings used in open access debriefing videos, to ascertain whether the questioning probes deeper into S-I (focus on failure/error) or S-II (focus on normal work, variability, success) questioning.
Note: Only 7 videos met inclusion for transcription/evaluation.
They note that learning from success isn’t “uncommon or novel”, but it’s more about the degree of focus and the beliefs about performance.
Results
· “The overwhelming majority (91%) of all negatively focused specific or follow-up utterances by facilitators favored Safety-I exploration, with the inclusion of 1 exploration of Safety-II”
· “Of all that were positively focused, however, 50% explored Safety-II and 50% explored Safety-I. It is not surprising that most review of negative performance aspects was mapped as exploration of Safety-I”
· “It is beneficial that 1 instance was broadened to explore Safety-II, as well. However, of all of the explorations of positive performance (of which there were far fewer than explorations of negative to start), only 50% included exploration of Safety-II”
· “There is undoubtedly much to learn from the study of Safety-I concepts. The less commonly focused on and emphasized Safety-II concepts, however, offers additional and different opportunities for learning and improvement, which remain disproportionately unexplored by the facilitators”
· “Unfortunately, there are multiple examples of positive performance aspects in the videos that were mentioned by participants but then not discussed further. There were the expected “great job” and other reinforcing accolades of agreement that something “went well” but without subsequent exploration into why”
· That is, people regularly recognised successful performance (‘great work’), but unlike errors and failures, often failed to dig deep into why success was achieved
· “there is a common emphasis on exploration of negative performance and Safety-I. It is wonderful to acknowledge and point out examples of positive performance but we must do better to intentionally discuss these positive aspects, analyze why, and deepen learning from these aspects to ensure they are reproduced in the future”
· Interestingly, they found that none of the Safety-II concepts and terms “were explicitly named, taught about, or included in the discussion. Development of more common use of Safety-II language, frameworks, and tools to guide debriefings is another area of opportunity to support the inclusion of Safety-II exploration in future debriefings”
Ref: Bentley, S., Meshel, A., & Bajaj, K. (2025). Open-access healthcare debriefing videos need to incorporate more Safety-II learnings. Advances in Simulation, 10(1), 21.
Study link: https://link.springer.com/article/10.1186/s41077-025-00345-3
SafetyInsights.org 