All too often it is easy to be stuck in a mindset which can create tunnel vision. One of those time frames in the simulation world can come from an overall short-sightedness, into the usefulness, power, wisdom and change that can result from well-run simulation efforts. Many people have heard the adage “with simulation is within the debriefing that all the learning occurs.” While phrases like this are meant to underscore the importance of the debriefing following a simulation if they are taken too literally they can result in a lack of recognition of total value of the simulation program investments and contributions.
This phenomenon is prevalent when evaluating the impact of simulation programs as part of patient safety efforts in healthcare systems in hospitals. In-situ simulation programs, or mock code evaluation programs are of unquestionable value to those of us who are in leadership in patient safety roles. Undoubtedly learning can occur during the simulation itself as I discussed in a previous blog post. Further, we all recognize the value of learning that can occur during well-run debriefing sessions. Lastly and perhaps most importantly great value can come from the information obtained during the simulation.
Scenario and debriefing sessions involved in in situ and other simulation programs that occur with practicing professional’s as participants have their limitations. First, and most practically is the operational recognition that healthcare professionals can only be kept “off-line” for a certain period of time to accomplish the simulation and debriefing. Secondly, some topics may be more sensitive than others and are not appropriate to be addressed directly with individuals during a debriefing that involves peers, as well as other healthcare colleagues. This point may be considered when evaluating the political and perceptions of your in-situ programs as received by the staff. Lastly, when you execute such a simulation there is only so much that can be absorbed at one point in time before cognitive overload becomes a significantly limiting factor.
Thinking traditionally from a “simulationist” point of view, is easy to think that all of the learning that will be recognized comes from the performance of the simulation combined with debriefing. With structure, planning and a systems-based approach to the simulation efforts, data can be gathered and analyzed to help a given hospital, or health system, understand the capabilities and limitation of their various clinical delivery systems. This can be invaluable learning for the system itself, which can then be incorporated into a plan of change to improve safety or in other cases efficiency in the delivery of care.
The given plan of change may incorporate additional educational efforts, policy, procedure or process changes that will be made in a more informed way than if the data from the simulation was not available. To garner such useful information at a systems-based level it is important that the curriculum integration be developed with consistent measurement strategies, objectives and tools that will allow meaning information to accrue.
A well planned, needs based targeted implementation strategy will create larger value than the simulation efforts occurring in a silo not connected to a larger strategic plan of improvement. If you think about a simulation event it is easy to picture small groups of people learning a great deal from the participation in the scenario or program. Simulation has the unique capability to abstract information to help provide insight into aspects of the patient care that both go smoothly as well as identify opportunities for improvement simultaneous with deployment of useful learning.
Once these opportunities are catalogued and recognized, a transformation of greater scale can take place through careful planning and implementation of further patient safety efforts with defined targets. Partnering with your risk management or patient safety colleagues to work on the integration plan can be valuable for increasing leadership buy-in for supporting your simulation efforts.
So I challenge you! If you are running relations in situ make sure that you keep in mind that your educational efforts during the simulation scenario are part of a bigger picture of increasing the safety and/or efficiency for providing care to patients, thus bringing a higher return on investment for the simulation efforts that you are conducting.
Until next time…… Happy Simulating!
Many people design scoring instruments for simulation encounters as part of an assessment plan. They are used for various reason ranging from a tool to help provide feedback, research purposes, to high stakes pass/fail criteria. Enhancing the ability for assessment tools to function as intended may often be closely linked to scenario design.