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World Debriefing Day
Participating Organization Form
First name
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Last name
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Email
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Healthcare organization name
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Your role/title:
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Organization Type?
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Academic Institution
Hospital/Health System
Quality/Safety Organization
Professional Society/Organization
Vendor/Industry Partner
Other
Country
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State/Province/Region
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Does your healthcare organization currently conduct debriefings for quality and safety purposes?
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Yes
No
Unsure
Can we consider listing your organization publicly as a “Participating Organization”? (Listings are at our discretion. This does not create a legal partnership, joint venture, or agency relationship. Selecting "Yes" confirms that you have permission.)
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Yes
No
Unsure at this time (email info@ahdq.org, if "Yes" in the future)
If "yes" to the listing question above, which preferred public website URL link should be used? (Skip question if 'No' or 'Unsure' to the above).
How is your organization planning to participate in World Debriefing Day? (Select all that apply)
Do at least one 2-minute clinical debrief on Feb 22-23
Encourage teams organization-wide to do a 2-minute debrief on Feb 22-23
Pick a "debrief trigger" with unit champions for the day (e.g. 1st case, 1st admission)
Share information internally (eg, email, newsletter, intranet, daily safety briefing)
Post on social media using #WorldDebriefingDay
Have a leader promote participation (eg, CNO, CMO, CQO, unit leader)
Other (Get creative & share what works!)
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