GNSH Summit Welcome and Introduction: 

Lennox Huang and Pam Jeffries, co-chairs of GNSH, welcomed the participants from 15 countries and highlighted the importance of connecting leaders and thought leaders in healthcare simulation to address the global challenges of health human resources, safety, quality, and planetary health. Virtual greetings from Jayne Smitten, President of SSH were shared with the group.

Opening Remarks by MBRU Provost:

Dr. Alawi Alaheikh-Ali, Chief Academic Officer and Provost of MBRU, expressed his pleasure to hostthe summit and emphasized the need for collaboration and innovation to tackle the common challenges of providing quality, accessible, and affordable healthcare in different contexts.

Keynote speech by Mark Britnell:

Mark Britnell, a global expert on health workforce and systems, delivered a provocative and inspiring keynote on the magnitude and urgency of the health human resources crisis, the potential solutions that exist in different countries and sectors, and the role of simulation, education, and technology in transforming healthcare delivery and productivity. He also challenged the audience to think differently and creatively about how to address the workforce gap and invited them to collaborate on creating a real-time simulation of workforce supply and demand. While here is no definitive answer to how we can address the human resource crisis in healthcare, but the keynote speaker Mark Britnell suggested some possible solutions based on his global experience and research. Some of his suggestions were:

• To position health workforce planning on national wealth creation and productivity, rather than just on health needs and costs.
• To adopt superior models of care that are more efficient, effective, and patient-centered, such as integrated care, clinical improvement science, and virtual care.
• To redesign pathways of care and expand the scope of practice of health workers, using technology, cognitive assistants, and new cadres of workers.
• To demystify the care process and match skills and tasks, rather than jobs and job descriptions, and use simulation to test and train different scenarios.
• To invest more in diagnostics, primary care, and prevention, and empower patients and communities to take more responsibility for their own health.

These solutions are not mutually exclusive, and they require collaboration, innovation, and leadership to implement them. Mark also challenged the audience to think differently and creatively about the future of health workforce and to collaborate on creating a real-time simulation of workforce supply and demand.

Panel Discussion:

Dr. Purva Makhani, facilitated a panel discussion with Dr. Michael Alice Moga and Mark Britnell where insights and perspectives on the health human resources challenges and opportunities were shared in their contexts. They also engaged in a lively dialogue with the audience and answered
questions on topics such as interprofessional education, artificial intelligence, planetary health, and workforce planning. Some of the key learnings from the panel are:

• The importance of values and behaviors in managing people and creating a culture of excellence.
• The benefits of having a balanced appraisal system that includes feedback from clients, subordinates, and peers, as well as performance and financial metrics.
• The challenges of dealing with different generations of professionals who have different expectations and motivations for their work.
• The need to adapt the contract and reward system to the changing needs and preferences of the workforce at different stages of their career.
• The limitations of the current education system and the opportunities for innovation and reform that can better prepare the future health professionals.

AI Session

This session was about the competencies required for the safe, effective and ethical use of AI based tools in clinical settings. The main points were:

• Dr. Miller presented the results of a study that identified six competency domains for clinicians who use AI tools, based on a scoping review and subject matter expert interviews.
• The competency domains were: basic knowledge of AI, social and ethical implications, workflow analysis, AI-enhanced clinical encounters, evidence-based evaluation, and practice-based learning and improvement.
• The study also highlighted the need for organizational and system-level capabilities to support the successful implementation of AI tools in healthcare, such as evidence,
  standards, laws, and policies.
• The session also included reactions from Kellie Bryant and Lennox Huang, who shared their perspectives on the use of AI in academic and healthcare settings, respectively.
• They discussed the opportunities and challenges of using AI for simulation, patient care, research, education, and administration, as well as the ethical, social, and legal implications of AI.
• The session ended with a Q&A session where the participants asked questions about the use of AI for writing, reflection, assessment, and policy development.

Scientific Hot Topics

Guillaume Alinier presented the challenges and gaps in the supply and demand of health workers, and advocated for standardization, accreditation, certification, and ethical codes for simulation educators and practitioners. They argued that professionalizing healthcare simulation would improve the quality and effectiveness of the training and the delivery of care.

Abi Sriharan discussed the factors that influence health workers’ retention and motivation, and suggested some strategies to improve work policies, culture, and leadership. She also highlighted the research gaps and the need for context-specific solutions to address the burnout, stress, and turnover of health workers.

Guillaume mentioned the importance of professionalizing simulation education and following the standards and guidelines developed by various societies and organizations. He also invited the participants to contribute to the SSH dictionary and the healthcare simulation standards of best practice.

The meeting ended with some questions and comments from the participants, and a suggestion to continue the collaboration and discussion in future sessions.

The intersection of Implementation Science and AI

This plenary led by Dr. Michael Alice Moga covered the intersection of implementation science and AI in healthcare, and how to use simulation and agile methodologies to facilitate the connection between research and practice. The main points discussed were:

• The current challenges and gaps in the healthcare system, and the need for a new approach to problem-solving and innovation that involves the frontline providers and users.
• The concept of a learning organization and how it can foster continuous improvement and adaptation to new solutions.
• The different types of problem definition, problem solving, and problem management frameworks, such as design thinking, design sprint, and agile scrum, and how they can be applied to healthcare settings.
• An example of using a modified design sprint methodology to address a clinical problem of delayed chest compressions in infants with open chest after cardiac surgery, and how it resulted in a low-cost and user-centered solution that improved performance and engagement.
• The potential and challenges of AI in healthcare, and the need for a different process of implementation that starts with identifying and defining the problem, forming a multidisciplinary team, analyzing the current system, assessing the utility and cost of the AI model, and integrating it into the existing workflows and quality improvement processes.
• A brief introduction to a design sprint exercise that the participants were asked to do in groups, where they had to choose an implementation phase and brainstorm how simulation could offer a solution within that space.

Day Two – Saturday, November 11, 2023

Welcome

Lennox and Pam recapped the events of the previous day and welcomed participants to Day 2 of the summit. The focus of the day was to begin to explore ways in which simulation can address key challenges in healthcare.

Stories of the Human Resource Crisis

Desiree Diaz facilitated a session with Lennox Huang and Purva Makhani on stories of the human resource crisis.

• Lennox Huang, the chief medical officer of the Hospital for Sick Children in Toronto, shared his personal stories of the challenges and crises that his hospital faced during the COVID-19 pandemic, such as cyberattacks, staff burnout, waiting lists, and health inequalities.
• Lennox Huang shared his personal story of working in a pediatric hospital in Canada and the challenges he faced during the COVID-19 pandemic and a recent cyberattack.
• He also talked about the importance of using simulation to improve health outcomes, address health inequalities, and engage the workforce.
• Purva Makhani, the chief medical officer of Hull University Teaching Hospitals NHS Trust in the UK, echoed the similar challenges and crises that his hospital faced, and also shared
  some of the strategies and initiatives that they are implementing to address the workforce, funding, and public health issues.
• Purva shared her personal story of working as a chief medical officer in a hospital in the UK and the challenges she faced with the waiting lists, the emergency department, the workforce shortages, and the strikes.
• She also talked about the importance of reimagining, reengaging, and remediating the workforce and using digital innovation and simulation to support that.
• The meeting ended with a Q&A session where the participants asked questions about the simulation models, the funding, the public health, and the workforce diversity.

Industry Panel

Lucas Huang – Laerdal, Miles Sprott – 3B Scientific, Hugo Azevedo – Nasco

• The meeting was about the challenges and opportunities for simulation in healthcare, from the perspectives of industry partners and academic organizations.
• The industry partners shared their experiences and insights on how simulation can be used to solve problems, optimize processes, and improve outcomes in various contexts, such as prehospital care, telemedicine, system simulation, and manufacturing.
• The academic organizations discussed the gaps and barriers that they face in implementing simulation, such as funding, accessibility, equity, dissemination, policy, and evaluation.
• The participants also exchanged ideas and suggestions on how to collaborate and leverage each other’s strengths, such as by influencing stakeholders, sharing best practices, developing open source solutions, and creating evidence-based standards.

Simulation Societies Panel

Desire Diaz – INACSL, Collette Laws-Chapman – ASPiH, Erica Hinojosa – Sim Ghosts, Francisco Maio Matos – SESAM

• The meeting was a panel discussion among representatives of different simulation societies, moderated by MBRU.
• The panelists shared their reflections on the previous session about the global health workforce crisis and how simulation can help address it.
• The panelists also discussed the value of coming together as a global simulation community and the challenges and opportunities they face in their respective regions and organizations.
• The panelists expressed their interest in collaborating with each other and with GNSH on various initiatives, such as standards, accreditation, advocacy, research, and education.
• The panelists answered some questions from the moderator and the audience, such as the feasibility of the affiliate model, the role of technology and AI, the barriers to publication, and the integration of simulation in the curriculum.

Breakout Summary

• The meeting was about a leadership simulation workshop where the participants had to work in groups on three topics: productivity, new models of care, and managing a motivated
  workforce.
• Each group had to present their ideas for using simulation to address the challenges and opportunities in these areas.
• The presentations were followed by feedback and comments from the facilitators and other groups.
• The meeting also had a visit from the president of the university and the CEO of the system, who greeted the participants and shared some insights on the healthcare transformation.

Planetary Health

• Pam Jeffries introduced and moderated the closing plenary about planetary health and climate change, and how the health sector can address these issues.
• Chris Hanley, the director of the Grand Challenge on Climate Change, Human Health and Equity at the National Academy of Medicine, presented the goals and activities of his program, which include decarbonizing the US healthcare sector, creating a global roadmap for systems transformation, developing a research and innovation hub, and engaging with community leaders and strategic partners.
• He also shared some resources and tools that are available for free on the NAM website, and invited the participants to join the movement in climate and health and planetary health that will launch in 2024.
• He showed a video that featured Dr. Cecilia Sorensen, an emergency medicine physician and a climate doctor, who explained how climate change affects health and how health
  systems can adapt and become more resilient.
• Chris Hanley shared that simulation is a critical tool for training health professionals to effectively provide care in a changing climate. He showed a video of a simulation workshop
  at Columbia Medical School, where participants learned how to diagnose and treat heat stroke, a condition that is becoming more common due to rising temperatures. He also mentioned that the Global Consortium for Climate and Health Education, which he directs, is a network of health professional training schools that have pledged to train their students on climate and health issues.
• The participants shared their experiences and ideas on how to integrate planetary health and climate health into their curriculum, simulation, and policies, and asked some questions to
  Chris.

Participants discussed potential future collaborations and actions where simulation could impact planetary health including the following:

• Join the movement in climate and health and planetary health that will launch in 2024 and sign up for the list serve to stay updated.
• Check out the resources and tools on the NAM website and the global consortium for climate health education website to learn more about how to integrate planetary health and climate health into the curriculum, simulation, and policies.
• Share stories and best practices of how to reduce the carbon footprint and increase the resilience of the health sector and the simulation field.
• Consider the environmental and social impacts of the choices and actions in the simulation field, such as the use of resources, the disposal of waste, the transportation of equipment, and the accessibility and equity of services.
• Explore a network initiative aimed at repurposing older simulation equipment and technology.

The conference closed with a summary of our past two days from Pam and Lennox, thanks to all the participants and in particular our local organizer Ralf Krage. Dr. Amer Ahmad Sharif, CEO of Dubai Health and president of MBRU came to greet the participants and thank GNSH for holding the summit in Dubai. Dr. Sharif shared how our summit coincided with system transformation for healthcare in Dubai and how he saw simulation playing a huge role in the future of healthcare.