Category Archives: patient safety

Hospital 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.