Coffee and cases (C&C) – perceptions of helicopter emergency medical service teams towards a quality improvement project aimed at enhancing organisational learning from team debriefs: A qualitative focus group study

Objective To explore how helicopter emergency medical services (HEMS) clinicians perceived a quality improvement (QI) project, aimed at enhancing knowledge creation and dissemination from routine clinical debriefs know as Coffee and Cases (C&C), to influence organisational learning, including the creation, sharing, accessibility and application of knowledge. Methods This qualitative descriptive study was underpinned by a constructivist-relativist paradigm. Four semi-structured focus groups were conducted with HEMS clinicians ( n = 30) between December 2023 and January 2024. Data were transcribed verbatim, deidentified and analysed inductively using thematic network analysis in the style of Attride-Stirling. Results ‘Organisational learning’ was identified as the global theme, reflecting participants’ perceptions that the QI project strengthened learning through improvements in ‘Education’, ‘Accessibility’ and ‘Calibration’, the three organising themes. Within ‘Education’, participants described enhanced knowledge generation, greater engagement with the debrief process, opportunities for incidental learning and reinforcement of key knowledge and practices. Within the organising theme ‘Accessibility’, they reported improved access to learning for staff who are unable to attend debriefs and wider distribution of educational content across HEMS bases and beyond the service. Within ‘Calibration’, participants noticed improved moderation of discussions and vetting of learning points, as well as benefits for clinical practice, sharing of local operational knowledge, governance, standardisation and safety. Overall, participants viewed the initiative as improving the creation, sharing, accessibility and application of knowledge arising from clinical debriefs across the organisation. Conclusions Participants perceived the improved C&C process to strengthen organisational learning by enhancing the generation, dissemination, accessibility and application of knowledge arising from routine clinical debriefs. These findings suggest that the value of routine debriefing depends not only on the quality of the discussion itself, but also on how learning is deliberately captured, shared and embedded across the organisation.