Simulation educators are often requested to provide multidisciplinary and/or multi-professional simulation training in response to a critical incident that has resulted in a significant adverse event. This raises the question: Should we adopt a systematic approach to designing simulation-based interventions after key events in healthcare environments?
“Simulation is a learning tool that supports development through experiential learning by creating or replicating a particular set of conditions which resemble real life situations; it should provide a safe environment where participants can learn from their mistakes without any danger to patients, allowing individuals to analyze and respond to these realistic situations, with the aim of developing or enhancing their knowledge, skills, behaviors and attitudes”. Simulation-based education and training has a crucial role in improving the quality and safety of care for patients; however, we should not assume that training will solve all issues surrounding critical incidents. Simulation not only provides opportunities for training and debriefing on safety behaviors, but can also play a significant role in improving healthcare systems.
Who needs to be involved in the process?
Healthcare systems are inherently complex, and a collaborative approach has the benefit of providing multiple perspectives on a given system, leading to better understand all processes, their connections and impact of potential changes. Those part of the system under review, and taking part in the intervention (including teams with expertise in simulation and quality improvement), should help understand the problem and design future improvements. These might include doctors, nurses, allied healthcare professionals, ancillary staff, administrative staff, managers, patients, user groups, and educators. A stakeholder analysis must identify these people before an intervention is designed. Its potential impact on all individuals and teams involved is explored, including groups who may be negatively affected as a result of the intervention or change.
What needs to be done?
The individuals and teams that will contribute to intervention design should explore the system. This will help focus the response and determine how best to use simulation expertise. Energy or QI utilizes a number of different approaches and techniques to facilitate understanding the system and inform the design of change, for instance process mapping. Simulation may be a powerful tool during process mapping, as it allows us to immerse ourselves in the process, allowing the integration of learning and change without disrupting clinical practice.
How will simulation contribute?
Simulation can take many forms depending on location, modality and fidelity. Before developing a simulationbased response, we should consider collaboratively how to best utilize simulation expertise. Simulation may assist with one or more of the following: testing the system, providing education and training (by itself or in the context of blended learning), or contributing to event debriefing, i.e. facilitation of shared reflective practice and system-focused collaborative learning from the original key event.
How should we share the learning?
While following the above steps, learning can be derived from each stage of the framework and its entirety, i.e. from the key event, stakeholder analysis, greater understanding of the system by using improvement techniques, changes carried out and their evaluation.
This learning must be fed back to the teams and stakeholders involved as well as disseminated to the wider departments and organization where appropriate, including patient safety teams. This might translate into organizational change, as lessons learned in the planning and delivery of the simulation intervention are adapted to different environments. Such interventions carry a risk of exacerbating the second victim phenomenon. It is therefore paramount to ensure the psychological safety of all individuals and teams involved during the trigger event.
This guidance introduces applicable quality improvement principles, considers how simulation-based methodologies could be most beneficial in each context and presents a new way to combine QI and simulation approaches synergistically. Furthermore, it aligns with contemporary socio-technical models in healthcare, which emphasize the role of clinical teams in designing adaptation and change for improvement. The psychology of change framework also highlights the importance of activating clinicians’ agency as a key element to advancing and sustaining collaborative improvement. The approach should benefit health and care teams preparing for, or responding to, adverse events, as well as promoting the concept of learning from everyday work.
Dr. Ben Chouchaoui
Operations Manager
WIDL Inc.
July 1, 2023
Monday – Friday
8:00 am – 5:00 pm
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Disclaimer - Dr. Chouchaoui and WIDL do not do engineering services regulated by PEO (Professional Engineers Ontario). If you need services as such please contact PEO for referrals to an engineer who does such.
