Limitations
We report what staff thought, and examined associations between debrief and outcomes. However, debrief does not happen in isolation from the rest of teamwork, culture and leadership, and it is therefore not possible to claim that debrief is the cause of better culture scores. The problem of associations and apportioning effect is common in workplace culture studies, where it is (usually) not possible to conduct experiments in controlled circumstances and changing just one variable at a time.
A large proportion of our respondents worked in theatres, which may have affected the results. Future, studies could include a larger number of staff from a wider clinical setting; however, studying this in a wider context may be more difficult if the researchers do not understand in detail what kind of debrief takes place. A larger study could also have the ability to test specific constructs/questions, with sufficient power to demonstrate a statistical difference.
We used a limited number of outcomes, and this, together with use of composite outcomes, is also a limitation. CCB is a published tool that examines different attributes of NHS organisational culture, whilst the promoter scores capture work engagement from a different angle. There is a myriad of possible outcomes that could be used, with resultant increase in complexity. Nevertheless, our simple and practical approach suggests that debrief, and its quality, matter.