Beware of Simulation Posers!

You may be a simulation poser if you say or do three or more of the following things…..

1. You say something like “In simulation all of the learning occurs during the debriefing.”
Appraisal: Not true. You are lying, uniformed, or not creative.
Not even close. If you believe this you are not paying attention to other learning opportunities that participants of simulation can avail themselves to. Think about the status changes of a simulator in response to proper or improper treatment. Think about participant to participant potential interactions. Think about the potential for instructor participant interactions that may contribute to learning. The potentials are practically limitless! For more see this blog post.

2. You claim there is a magic ratio of simulation time to debriefing time. “for every 15 minutes of simulation you must debrief for 45 minutes…. Etc.”
Appraisal: Rubbish.
No such thing exists. In fact if you think about this it is utterly ridiculous given the number of variables that exist that may potentially influence the debriefing time. Things like the topic, number of learners, experience level of the learners, number of faculty, experience of the faculty and on and on. Just stop saying it and the perception of your (simulation) IQ will raise by 10.

3. You espouse that during simulation encounters the students and faculty must be separated by something like a glass wall.
Appraisal: Lack of creative thinking.
While there are a lot of god reasons to design simulations that physically isolate the faculty from the participants, there are as many compelling reasons to have faculty in the same room at even at times interact ……. (agghhhast) with the participants. Think about the possibilities. Faculty side by side with students could engage in coaching and formative assessment or more easily conduct pause and discuss or pause and reflect type of learning encounters that can be more awkward when on the other side of the wall!

4. You say the simulator should never die during a simulation.
Appraisal: Wrong
‘Nuff Said on this one.

5. Simulations must have every aspect designed to be as real as possible.
Appraisal: Simply Crap.
Trying to create the ultra real environment can lead to increased time to set up, clean up and otherwise make the simulation less efficient. Worse yet creating a lot of simulated artifact can actually lead to increased confusion. How? Read this blog post on the cognitive third space of simulation. Simulations should be designed and outfitted to provide enough realism that enables the accomplishing of learning objectives. Everything else is a waste of time, money and/or people resources (ironically the same things you probably say that you don’t have enough of).

6. You say during simulations participants must/will suspend disbelief.
Appraisal: Ridiculous.
Out of the other side of your mouth you probably babble about adult learning theory……
If we are educating seriously smart adults, we don’t want them to think the plastic simulator is real. Seriously. I like to think of a more mature understanding of the situation that gives the participates a bit more credit for their lifetime of cerebral accomplishments. How about a message like…. “We have created this learning encounter using simulation for you so we can work together to help you become a better healthcare provider. Some of what you are going to experience will seem realistic and some will not. But we promise to make the best use of your time, treat you with dignity and respect, as we help you learn and practice.” Now that’s how adults talk. (Mic drop)

7. You claim one debriefing model is far superior to another. Or one has been validated.
Appraisal: Crap that gets sold at debriefing training programs.
If you are saying this, you probably don’t use a structure to your debriefing, don’t believe in learning objectives, or you only know one model of debriefing.
Truth is there are a bunch of good debriefing models in existence. You would do well to learn a few. Different models of debriefing are like tools in the toolbox. Some are good for certain topics, learners and situations and some for others.

8. You state that you should always use video while debriefing.
Appraisal: Industry sponsored rubbish.
You have drank some serious kool-aid, have had the wrong mentor, or an improper upbringing if you believe this. Further, if your make your participants watch the entire simulation on video, you should receive a manicure with a belt sander. Lastly if you say you use the video to solve disputes about what a student did or didn’t do, you may be hopeless.
Video can be a tool that can be strategically used to enhance debriefings at times. But more often video playback gets used as a crutch to make up for a lack of quality debriefing skills and to fill time.
There is also a misguided belief that students want to watch their videos. They don’t. They hate it. They think they look fat and their hair doesn’t look good.
Harnessing the power of a good debriefing is hard work and requires skill. But active reflection and guiding students towards a self-discovery of what they did well and what they need to change for the future is serious active learning. The more you can do that, the more the learning will occur. Watching a video of a simulation is like watching a bad movie. I always find it fascinating that simulation programs will spend a fortune putting in a video system that could film a Hollywood movie, but wont invest even a fraction of that cost into development of the faculty.

9. You use the terms “High and Low Fidelity Simulations” when you are referring to the use of a high technology simulator in your simulations.
Appraisal: You are feeding into the biggest industry sponsored word there is. In fact, the word fidelity is so perverse it should be banned. See additional blog post here on banning the “F” word.
The highest fidelity human simulator I know is a real person playing the role of a standardized or simulated patient. Everything else is overall, lower fidelity.
Seriously folks….. Somewhere along the way industry labeled a couple of simulators high fidelity because they had a feature or two that approximated that of a human. The label stuck and continues to perpetuate great confusion throughout the community of simulation, in practice and in the literature as well. Some centers even name their room like this!!!

Sadly, this crazy definition even made its way into the simulation dictionary of the Society for Simulation in Healthcare (which is otherwise excellent I might add). Do high technology simulators have some very cool and very useful high-technology features? Absolutely! But real like a person, ie high fidelity? Not so much.

The next time you think your SimMan or HPS is a high-fidelity simulator try doing a knee exam and compare it to a real person. Better yet, lock yourself in a room with either or both of them, and hold a 30-minute conversation. Then send me a note to the how the fidelity strikes you.

10. You tell your institution you will make a profit with your new simulation center.
Appraisal: Your setting yourself up for trouble
It just doesn’t happen very much. Everyone has a “business plan” and tries to justify the costs and appeasing finance people with rows and rows of imagined potential revenue sources that often include internal and external components. Somehow, some way, they just never seem to all pan out. Most simulation programs are a cost center to the institution to whom they are sponsored by. They are an important investment, but not a profit motivated investment for the institution. It is far better to focus on the value statement that you are brining to your institution(s) then to trying to convince your boss’s boss that the institution will get rich off of your program. Focusing on the value you produce that is aligned with your institutions mission may help you grow support for your program and as well as help you keep your job a little bit longer.

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The First Four Steps of Healthcare Simulation Scenario Design

How can you make your scenario design process more consistent and efficient? One way is by following a step-by-step method to create your masterpieces!

In this post I cover the first four steps of a proven scenario design process.
There are four core steps that must be done in order. After the first four are accomplished you can branch out and be a little bit more variable in your approach to scenario design.

4 Success Steps, business concept

Step One: Pick A Topic

Picking a topic may seem like common sense but there is a lot to think about.

In healthcare simulation we have many topics to choose from. But in step one we want to a little bit specific and figure out that the major topic is that will be covered. We may be cover the teaching of physiologic, diagnostic or treatment where people are going to be making critical decisions, ordering medications, and other therapy, or perhaps our primary focus going to be on team training, teamwork, communications, team leadership. You get to pick!

Step Two: Define the Learner(s)

This is really important because in order to go to the next step which is designing the learning objectives we have to understand our learner population. For example, what do you expect of a fourth-year medical student what you expected them in terms of being able to evaluate and treat a simulated patient that is complaining of chest pain? Now contrast that to if your learners are medical students that are in the second year of medical school and haven’t had any clinical experience. In other words, we can take the same topic but as applied to two different populations, our expectations and what we are going to be evaluating from them is very different.

Step Three: Designing  the Learning Objectives

This is where you want to go into detail, great painstaking detail, about what you’re trying to accomplish with the simulation scenario. It is very important to take time on this step. Many people tend to gloss over this step which can create confusion later.

Let’s take a topic example. Let’s say asthma in the emergency department. When you think about asthma in the emergency department there could be many sub topics or areas from which to choose. It could be focused on competence of managing a minor asthma attack, or it could be a first-ever asthma attack, or it could be management of chronic asthma, or it could be major could be a life-threatening situation.

Carefully consider what do we want this learner group that we have defined in step two. Do you want them to diagnose? To treat? To critical compare and contrast it to other cases of shortness of breath in an acute patient? You get to choose!

Perhaps we want to focus on the step-by-step history presentation or the physical exam or maybe we want to see the learners perform treatment. Or maybe we want to see the overall management or the critical thinking that goes on for managing asthma in the emergency department. There are many possibilities, largely driven by your intended learner group demographics.

So, in other words were taking the big topic of asthma and we are going to cone it down to answer the question of what exactly we want our learners to accomplish by the end of the scenario. We can’t just assume that what is supposed to happen in the real clinical environment will or should happen in the simulation environment. That rarely works. We actually want to later engineer the story and situation to allow us to be able to focus on the learning objectives.

Step Four: Define the Assessment Plan

How are you going to assess that each objective defined in step three was accomplished? That is the fundamental thought process for step four.

What are you going to be watching for when you the creator of this simulation scenario are watching the participants do their thing? What are you going to be focusing your attention on that you’re going to bring into the debriefing? What are you picking up on that you might be filling out assessment tools?

Define your assessment plan with specificity of what you’re looking for. This is different than designing the assessment tools that could come later. Or perhaps not at all. It is important that you remember every simulation is an assessment of sorts. See Previous Blog Post on this!

This doesn’t mean that every simulation needs assessment tool like a checklist, rating scale or formal grading scheme. It simply is referring to consideration of how to focus the facilitating faculty member, or teacher, or whatever you call them, who are observing the simulation. Remember, that to help the learner(s) of the simulation get better, the faculty need to be focused on certain things to ensure that the goals of the scenario are accomplished for our selected learner group, associated with the topic we chose in step one.

Lastly, what I want to point out to you is that you should notice something missing. The story!

The story comes later. Everybody wants to focus on the story because the story is fun. It’s often related to what we do clinically. It’s replicating things that are fun that brings in the theatrics of simulation! But what we really want to do is bring the theatrics of simulation to cause the actors on the stage (the participants) to so some activity. This activity gives us the situation to focus our observations on the assessment of the performance. This in turn allows us to accomplish the learning objectives of the scenario and help the participants improve for the future!

Until next time, Happy Simulating!

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Five Tips for Effective Debriefing

There is no doubt that debriefing is an important part of simulation-based education efforts. Further, to do a good debriefing is not necessarily easy. Practice, self-reflection and getting training can help dramatically.  Seeking out help form experts and experienced people can be invaluable. Also, there are many resources in which to learn more about debriefing. I encourage you to take advantage of them!

Here are just five random tips in no particular order to help you increase the effectiveness of your debriefing!

5tIPS

  1. Know what the goal(s) are. Be specific.

Too many times simulation scenarios are executed and the faculty member just kind of winging it during the debriefing. It is far more effective a strategy to be keenly aware of what the learning outcomes and goals are prior to the simulation. This will allow you to focus your thoughts and ideas on helping the participants get better during the simulation which can be carried forward to your debriefing efforts. If you are attempting to have the debriefing constrained to the learning objectives for the simulation it is often easier to organize the information and get across the salient points that are needed to achieve the learning outcomes. It is particularly important to remember that you can’t teach everything with every scenario. The participant brain can only take in or process so much information in any one setting. In this case think of a sponge completely saturated with water, that can’t take any more!

  1. Have a framework or structure in mind

Having a structure to your debriefing ahead of time, or perhaps adopting a model of debriefing can help you significantly overcoming the challenging parts of debriefing. Some of the challenges occur in organizing the information. There are a number of debriefing models out there for consideration of adoption. There is no reason to believe that one is better than the other. I highly recommend that you learn several models and become comfortable with them. What you’ll find is some models work better than others in varying situations based on s number of factors such as the experience and expertise of the debriefer, the subject matter that is the focus of the simulation, as well as the level of the learners.

  1. Involve all the learners

If you are debriefing a group of students a challenging task can be involving all the learners. Often times there will be one or two learners who engage in a dialogue with the debriefer and without conscious effort and skill it is easy to continue the dialogue and allow the other members of the participating team to feel potentially marginalized. Often times this dialogue occurs with the person that was in the “hotseat”. Making a conscious effort during the debriefing to include all of the students in a meaningful way can significantly create more learner engagement. Further, if you are running multiple scenarios I believe that engaging all the learners encourages them to pay closer attention if they are in an observation role for subsequent scenarios.

  1. Pull the ideas, don’t push the facts

I like to think of the debriefing as the time when we explore the learners thought processes. If we are transmitting information or pushing facts to them the situation can become more of a lecture. In fact I see many novice debriefers break into song and start delivering a mini lectures during attempts at debriefing. It is important to remember that when you are pushing the facts to the participants it limits the amount of assessment that you can do in terms of their understanding of the material and what you need to do to create deeper learning. So, if you find yourself making many declarative statements, pullback, and start to ask some questions. Encourage critical thinking, self reflection and ensure you are helping to create linkages of what went well during the scenario and why it was good, along with allowing the participants to discover and identify what they should do differently if they were to face a similar situation in real life or another simulation to improve.

  1. Create a summary of the take home points

Novice debriefers tend to struggle with creating an adequate summary. Also, Beware. This is another time that is at risk for the debriefing turning into a mini lecture. It is helpful to have a list of the major take-home points associated with the scenario. You can contextually adapt the summary to the performance that occurred during the simulation scenario even if you have the summary points written out prior to the simulation occurring. It is important to remember that during a debriefing many areas can be covered and touched upon. Learner should be engaged to identify the major learning points that they experience in the simulation, as well as understanding how the simulation was relevant to helping them become better healthcare providers.

So, this was intended to be five random tips on how to improve the effectiveness of your debriefing strategy. I hope that you found them useful!

Now, go forth and do great debriefings extra mission point

 

Until next time,

Happy Simulating!

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Don’t be Confused! Every Simulation is an Assessment

 

Recently as I lecture and conduct workshops I have been asking people who run simulations how often they do assessments with their simulations. The answers are astounding. Every time there are a few too many people reporting that they are performing assessments less than 100% of the time that they run their simulations. Then they are shocked when I tell them that they do assessments EVERY TIME they run their simulations.

While some of this may be a bit of a play on words there should be careful consideration given to the fact that each time we run a simulation scenario we must be assessing the student(s) that are the learners. If we are going to deliver feedback, whether intrinsic to the design of the simulation, or promote discovery during a debriefing process, somewhere at some point we had to decide what we thought they did well and identify areas for needed improvement. To be able to do this you had to perform an assessment.

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Now let’s dissect a bit. Many people tend to equate the word assessment with some sort of grade assignment. Classically we think of a test that may have some threshold of passing or failing or contribute in some way to figure out if someone has mastered certain learnings. Often this may be part of the steps one needs to move on, graduate, or perhaps obtain a license to practice. The technical term for this type of assessment is summative. People in healthcare are all too familiar with such types of assessment!

Other times however, assessments can be made periodically with a goal of NOT whether someone has mastered something, but with more of a focus of figuring out what one needs to do to get better at what they are trying to learn. The technical term for this is formative assessment. Stated another way, formative assessment is used to promote more learning while summative assesses whether something was learned.

When things can get even more confusing is when assessment activities can have components or traits of both types of assessment activities. None the less, what is less important then the technical details is the self-realization and acceptance of simulation faculty members that every time you observe a simulation and then lead a debriefing you are conducting an assessment.

Such realization should allow you to understand that there is really no such thing as non-judgmental debriefing or non-judgement observations of a simulation-based learning encounter. All goal directed debriefing MUST be predicated upon someone’s judgement of the performance of the participant(s) of the simulation. Elsewise you cannot provide and optimally promote discovery of the needed understanding of areas that require improvement, and/or understanding of the topic, skills, or decisions that were carried out correctly during the simulation.

So, if you are going to take the time and effort to conduct simulations, please be sure and understand that assessment, and rendering judgement of performance, is an integral part of the learning process. Once this concept is fully embraced by the simulation educator greater clarity can be gained in ways to optimize assessment vantage points in the design of simulations. Deciding the assessment goals with some specificity early in the process of simulation scenario design can lead to better decisions associated design elements of the scenario. The optimizing of scenario design to enhance “assess-ability” will help you whether you are applying your assessments in a formative or summative way!

So, go forth and create, facilitate and debrief simulation-based learning encounters with a keen fresh new understanding that every simulation is an assessment!

Until Next Time Happy Simulating!

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Three Things True Simulationists Should NEVER Say Again

From Wiktionary: Noun. simulationist (plural simulationists) An artist involved in the simulationism art movement. One who designs or uses a simulation. One who believes in the simulation hypothesis.

Woman taping-up mans mouth

 

After attending, viewing or being involved in hundreds if not thousands of simulation lectures, webinars, workshops, briefings and conversations there are a few things that I hear that make me cringe more than others. In this post I am trying to simmer it down to the top three things that I think we should ban from the conversations and vocabularies of simulationists around the globe!

1. Simulation will never replace learning from real patients!: Of course it wont! That’s not the goal. In fact, in some aspects simulation offers some advantages over learning on real patients. And doubly in fact, real patients have some advantages too! STOP being apologetic for simulation as a methodology. When this is said it is essentially deferring to real patients as some sort of holy grail or gold standard against which to measure. CRAAAAAAAZY……   Learning on real patients is but one methodology by which to attack the complex journey of teaching, learning and assessing the competence of a person or a team of people who are engaged in healthcare.  All the methodologies associated with this goal of education have their own advantages, disadvantages, capabilities and limitations. When we agree with people and say simulation will never replace learning from real patients, or allow that notion to go unchallenged, we are doing a short service to the big picture of creating a holistic education program for learners. See previous blog post on learning on real patients. 

2. In simulation, debriefing is where all of the learning occurs!: You know you have heard this baloney before. Ahhhhhhhhhhhhh such statements are purely misinformed, not backed up by a shred of evidence, kind of contrary to COMMON SENSE, as well as demeaning to the participants as well as the staff and faculty that construct such simulations. The people who still make this statement are still stuck in a world of instructor centricity. In other words, “They are saying go experience all of that…… and then when I run the debriefing the learning will commence.” The other group of people are trying to hard sell you some training on debriefing and then make you think it is some mystical power held by only a certain few people on the planet. Kinda cra’ cra’ (slang for crazy) if you think about it.

When one says something to articulate learning cannot occur during the simulation is confirming that they are quite unthoughtful about how they construct the entire learning encounter. It also hints at the fact that they don’t take the construct of the simulation itself very seriously. The immersive experience that people are exposed to during the simulation and before the debriefing can be and should be constructed in a way that provides built in feedback, observations, as well as experiences that contribute to a feeling of success and/or recognition of the need for improvement. See previous blog post  on learning beyond debriefing

3. Recreation of reality provides the best simulation! [or some variant of this statement]: When I hear this concept even eluded to, I get tachycardic, diaphoretic, and dilated pupils. My fight or flight nervous system gets fully engaged and trust me, I don’t have any planning on running. 😊

[disclaimer on this one: I’m not talking about the type of simulation that is designed for human factors, and/or critical environmental design decisions or packaging/marketing etc. which depend upon a close replication to reality.]

This is one of the signs of a complete novice and/or misinformed person or sometimes groups of people! If you think it through it is a rather ludicrous position. Further, I believe trying to conform to this principle is one of the biggest barriers to success of many simulation endeavors. People spent inordinate amounts of time trying to put their best theatrical foot forward to try to re-create reality. Often what is actually occurring is expanding the time to set up the simulation, expanding the time to reset the simulation and dramatically increasing the time to clean up from the simulation. (All of the after mentioned time intervals increase the overall cost of the individual simulation, thereby reducing the efficiency.) While I am a huge fan of loosely modeling scenarios off of real cases in an attempt to create an environment with some sense of familiarity to the clinical analog, I frequently see people going to extremes trying to re-create details of reality.

We have hundreds and thousands of design decisions to make for even moderately complex scenarios. Every decision we make to include something to try to imitate reality has the potential to potentially cause confusion if not carefully thought out. It is easy to introduce confusion in the attempts to re-create reality since learners engage in simulation with a sense of hyper-vigilance that likely does not occur in the same fashion when they are in the real clinical learning environment. See previous blog post on cognitive third space.

If you really think about it the simulation is designed to have people perform something to allow them to learn, as well as to allow observers to form opinions about the things that the learner(s) did well, and those areas that can be improved upon. Carefully selecting how a scenario unfolds, and/or the equipment that is used to allow this performance to occur is part of the complex decision-making associated with creating simulations. The scenario should be engineered to exploit the areas, actions, situations or time frames that are desired focal points of the learning and assessment objectives.  Attention should be paid to the specifics of the learning and assessment objectives to ensure that the included cache of equipment and/or environmental accoutrements are selected to minimize the potential of confusion, create the most efficient pathway that allows the occurrence of the assessment that contributes improving the learning.

Lastly, lets put stock into the learning contract we are engaging in with our learners. We need to treat them like adult learners. (After all everybody wants to throw in the phrase adult learning principles…. Haha).

Let’s face it: A half amputated leg of a trauma patient with other signs and symptoms of hemorrhagic shock that has a blood-soaked towel under it is probably good enough for our adult learners to get the picture and we don’t actually need blood shooting out of the wound and all over the room. While the former might not be as theatrically sexy, the latter certainly contributes to the overall cost (time and resource) of the simulation. We all need to realistically ask, “what’s the value?”

While my time is up for this post, and I promised to limit my comments to only three, I cannot resist to share with you two other statements or concepts that were in the running for the top three. The first is “If you are not video recording your scenarios you cannot do adequate debriefing”, and the second one is “The simulator should never die.” (Maybe I’ll expand the rant about these and others in the future 😉).

Well… That’s a wrap. I’m off to a week of skiing with family and friends in Colorado!

Until next time,

Happy Simulating!

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Filed under Curriculum, debriefing, scenario design, simulation

Don’t Let the Theory Wonks Slow Down the Progress of Healthcare Simulation

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Those of us in the simulation community know well that when used appropriately and effectively simulation allows for amazing learning and contributes to students and providers of healthcare improving the craft. We also know there is very little published literature that conclusively demonstrates the “right way to do it”.

Yet in the scholarly literature there is still a struggle to define best practices and ways to move forward. I believe it is becoming a rate limiting step in helping people get started, grow and flourish in the development of simulation efforts.

I believe that part of the struggle is a diversity of the mission of various simulation programs ranging from entry level students to practicing professionals, varying foci on individualized learning incompetence, versus and/or team working communications training etc. Part of the challenges in these types of scholarly endeavors people try to describe a “one-size-fits-all“ approach to the solution of best practices. To me, this seems ridiculous when you consider the depths and breadth of possibilities for simulation in healthcare.

I believe another barrier (and FINALLY, the real point of this blog post 🙂  is trying to overly theorize everything that goes on with simulation and shooting down scholarly efforts to publish and disseminate successes in simulation based on some missing link to some often-esoteric deep theory in learning. While I believe that attachments to learning theory are important, I think it is ridiculous to think that every decision, best practice and policy in simulation, or experimental design, needs to reach back and betide to some learning theory to be effective.

As I have the good fortune to review a significant number simulation papers it is concerning to me to see many of my fellow reviewers shredding people’s efforts based on ties to learning theories, as well as their own interpretations on how simulation should be conducted. They have decided by reading the literature that is out there (of which there is very little, if any, conclusive arguments on best practices) has become a standard.

My most recent example is that of a paper I reviewed of a manuscript describing an experimental design looking at conducting simulation one way with a certain technology and comparing it to conducting the simulation another way without the technology. The authors then went on to report the resulting differences. As long as the testing circumstances are clearly articulated, along with the intentions and limitations, this is the type of literature the needs to appear for the simulation community to evaluate and digest, and build upon.

Time after time after time more recently I am seeing arguments steeped in theory attachments that seem to indicate this type of experimental testing is irrelevant, or worse yet inappropriate. There is a time and place for theoretical underpinnings and separately there is a time and place for attempting to move things forward with good solid implementation studies.

The theory wonks are holding up the valuable dissemination of information that could assist simulation efforts moving forward. Such information is crucial to assist us collectively to advance the community of practice of healthcare simulation forward to help improve healthcare globally.  There is a time to theorize and a time to get work done.

While I invite the theorist to postulate new and better ways to do things based on their philosophies, let those in the operational world, tell their stories of successes and opportunities as they are discovered.

Or perhaps it is time that we develop a forum or publication of high quality, that provides a better vehicle for dissemination of such information.

So…… in the mean time….. beware of the theory wonks. Try not to let them deter from your efforts to not only move your own simulation investigations forward, but to be able to disseminate and share them with the rest of the world!

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FIVE TIPS on effectively engaging adult learners in healthcare simulation

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True Systems Integration for Hospital Based Simulation Programs

Businessman is using tablet pc and selecting integrationHospital based simulation programs serve a different need than their counterparts housed in schools of medicine and nursing. The stakeholders, the mission, the program assessment and development of curriculum vary significantly. Not to over-generalize but the overall mission of the school focused simulation programs is based around having them integrated into the education processes that contribute to the development of successful students who will be called graduates. Many times, these students end up taking licensing, certifying or other high-stakes examinations that can serve as a convenient data set to assess the impacts of programs.

The mission of hospital, or health-system based programs can be more complex in terms of alignment within the organization. There is a myriad of possibilities within the healthcare delivery environment that can drive the objectives of simulation programs. Examples range from employee training and education; quality, safety or risk based; or perhaps focusing on facilities engineering perspectives. With all of these possibilities the potential strategies for measurement markers to evaluate the success of the program can become blurry, and at times harder to have ready access to the necessary information.

In an era of healthcare cost reductions that we are experiencing now in the United States and many other areas of the world there is significant pressure coming from many different sides to reduce costs and at the same time improve the quality of care. Thus, to prevail in this era of medicine any entity within healthcare delivery system that costs money to operate (like simulation programs) needs to ensure it is providing value to the hospital or system which supports it.

Determining such value can be very challenging. While there are a couple of examples in the literature of isolated value calculations (such as central line training) the utility of such reports is limited in isolation. In total they are only a minute part of the safety problems associated with the delivery of care in the hospital.

Determining the best value of a hospital based program can be achieved through a series of needs assessments that require the simulation leadership to establish relationships in the hospital leadership teams or C-Suites outside of folks involved in education. The true needs assessment comes from participating in a deep understanding of the existing problems, challenges, solutions and successes that the c-suite is incurring to execute the mission of the hospital. This information is often housed in offices of risk management, quality or patient safety.

Integration with the risk management team can better position the simulation program to understand the legal risks from errors and litigation that is currently facing the hospital. Identifying trends and subject matter that could benefit from simulation training can emerge.

Quality offices generally have significant amounts of information regarding the initiatives that the hospital should be, or is focusing on to better provide care to patients. Such initiatives are often based on measurement programs from payers (insurance companies, whether private of government such as Medicare) that result in significant financial risks and/or benefits for the organization. Thus, identifying simulation solutions that could benefit the initiative in some form or fashion can result in value creation for the program.

Patient Safety Offices (sometimes under, or aligned with quality offices) house much of the data on mistakes, small and large, and in some cases near misses, that are occurring in an institution. Such data will also have information on trends, as well as if there was harm transferred to the patient.

Access to this data over time can help to identify the true needs of organization, and help direct a value-based implementation of the simulation efforts. Importantly though, a careful analysis of this data can also help the simulation program recognize what is not likely to bring as much value to the organization.

Two things are important when considering such integration efforts. The first is, even though there is a new era of transparency emerging regarding patient safety, the information is sensitive. To achieve true integration the simulation program leadership needs to establish relationships across the organization. Ideally you desire not only access to the data, but also a presence that positions themselves closer to the core of the analysis and decision making. Many simulation programs remain peripheral to such processes and thus experience a contractor-vendor type of relationship instead of one more akin to an active partner. It takes time, trust and effort to develop such relationships.

Secondly, a dispassionate evaluation of the data that is achieved from the needs analysis is necessary with regard to properly interpreting the value provided by the simulation program. Many simulation programs are born of a passion to simulate, a passion of the first faculty members, and an attachment to legacy programs that have been running for years. For true alignment within an complex organization and surviving future value analysis initiatives (ie. Remaining supported and funded) a program needs to take a hard look at its existing programs and ensure they are pegged to the overall “true” needs of the institution at large.

While this post is not representative of all the possible strategies to integrate a simulation program, it is meant to give insight into a few examples of possibilities, and articulate the depth of the relationships that should be developed.

 

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Recreating Reality is NOT the goal of Healthcare Simulation

Discussing the real goals of Healthcare Simulation as it relates to the education of individuals and teams. Avoiding the tendency to put the primary focus into recreating reality, and instead providing the adequate experience that allows deep reflection and learning should be the primary focus. This will help you achieve more from your simulation efforts!

 

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Simulation Programs, Hospitals and Health Systems: Where is the organizational fit?

Some excerpts taken from a plenary speech I delivered in Taipei, Taiwan recently to healthcare leaders and education directors. It is important that simulation programs position themselves within complex healthcare systems to be able to deliver maximal benefit to the organization. High performing simulation programs need to deliver more than educational resources to the organization.

 

 

 

 

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Filed under hospital, patient safety