Simulation impacting Healthcare

Eliminate all preventable medical errors by every healthcare team in every hospital and in every corner of the world.  

Deliver best practices for any clinical challenge

Every week, every individual in healthcare focuses on finding ways to

  • deliver safer and better quality of care in a shorter amount of time 
  • do so with better utilization of resources (medicine, equipment, staffing)
  • do so at a lower cost
  • build high functioning resilient teams

Background

During the 2018 GNSH Summit in Amsterdam,  working groups were established for the most common and harmful issues facing healthcare systems today:  Sepsis, Medication Errors, and Healthcare Associated Infections.  The various working groups were tasked to come up with a solution that could be presented to the leadership of healthcare systems and convince them that their solution would be a successful approach to help address the specific issues.

As each working group proposed their strategy to the hospital leadership in attendance, the feedback from leadership was not what was expected.  Expectations from the group were having to provide detailed metrics, costs, return on investments, guarantees for success, etc.  But in fact, we got a very human and compassionate request.  

  1. There is a desire to do the right thing, so a sensible approach is preferred over an elaborate approach
  2. Any implemented strategy needs to address multiple issues
  3. Time is a huge commodity … weekly … 30 minutes … that is what can be supported

While the focus around clinical issues is core, there is a more fundamental issue facing every healthcare team.  Each healthcare team is different, and the issues they face are unique to them and them alone.  The reality is that only the teams themselves have the ability implement sustainable change: decide as a team to appropriately implement best practices, decide as a team to engage with patients and their families, decide as a team (this include the healthcare institution) to support full transparency when issues do happen, and decide as a team  how their process of care can be optimized to deliver the safest and most effective patient care.

Our Strategy … the 30 Minute Weekly Challenge

A 10-15 minute focused simulation (built around a specific clinical challenge) followed by 15- 20 minutes of structured debriefing (a reflective review by each team member, understanding the patient impact, and how to make the systems in their healthcare institution better) 

Cummutavely (every year)

  • every team will have spent 26 hours team building (26 hours of CE for every team member)
  • each individual team member will have spent 4 hours reflecting on what they could have done better
  • each individual team member will have spent 4 hours understanding the patient impact (safety and compassion)
  • each individual team member will have spent 4 hours thinking and sharing of how the system could be better

… now multiply that by number of staff in each and every healthcare organization …

  • generally 4 staff for every patient bed
  • for a 250 bed hospital
    • 4000 hours focused on patient safety
    • 8000 hours on process improvement
    • 26,000 hours of team building

 Proposed “Religion”  framework … patient safety in Healthcare

  • every week all teams experience the same clinical challenges around the globe
  • to be discussed freely, along with ways to do better

Conceptual Overview

  1. Present each healthcare team with a clinical challenge
    • the teams have 10-15 minutes to address the challenge
    • ideally done inSitu
    • ideally with all team members (of a single healthcare team)
  2. Debrief (reflective review)
    • the team spends around 5 minutes to each share their views of what worked well and what did not
    • each team member should  present an equal amount of time
  3. Debrief (Patient & Family Impact)
    • play the patient story (3-4 minutes)
    • remind the healthcare team members the impact of mistakes to patients and their families
  4.  Debrief (Review Processes, Procedures, & Resources)
    • review the policies and procedures, potential risk to patients, possible improvements
    • review equipment, medication, and staff resources and potential risk to patients
  5. Localize each scenario
    •  by area within the healthcare system (ED, ICU, OR, LDR, Risk Management, Legal, etc)
    • by geographic region (country, demographic profile, resources

What is needed for each case (52 cases … year 1)

Case Background

(The Clinical Challenge)
  • Patient History (Labs, Imagery, Scenario Setting)
  • Outline script for confederates (to play their roles of mother, father, sibling, friend, stranger, ems, etc)
  • Broad outline of best practices for the case
    • checklist
    • clinician video
  • Simulator setup/configuration (Laerdal, CAE, Gaumard, Tellyes, others)
    •  download to auto configure simulator with physiological setup and appropriate labs
    • instructions for manual configuration/setup

Clinical Knowledge

(Latest Best Practices for facilitator and team if deemed necessary)
  • References to evidence based best practices based on the latest literature
  • References to the applicable PSMF APSS

Debriefing Guidelines

(How to guides)
  • Successful ways to effectively conduct a reflective review (video+checklist)
  • Successful ways to engage care team with discussing the patient impact (video+checklist)
  • Successful ways to review processes, procedures, staffing resources, medication resources, equipment resources (video+checklist)
  • Successful ways to spot trends and present something actionable to leadership (video)

Problem identification_presentation