By: Victoria Brazil (@SocraticEM)
Imagine your health service is about to spend millions (if not billions) of dollars on a new hospital. Effective physical design and streamlined workflows will be essential for a new facility where patient care is high quality, efficient and safe. Excellent planning and design from architects will be necessary, but not sufficient. Without the involvement of clinicians and other staff in testing our spaces and our plans, we risk a classic disconnect between ‘work as imagined’ versus ‘work as done’. Some have argued that “It’s time for the mandatory use of simulation and human factors in hospital design”.
Question: How might simulation help this preparation phase?
Answer: In more ways that you think…
1) Rehearsal of planned patient journeys, care processes and physical staff workflows
This is not healthcare simulation as many know it: i.e., as an educational tool. Instead, this is careful simulation design, delivery, and data collection to test our planned spaces and processes. There doesn’t have to be any kind of life-threatening emergency. There might be tabletop scenarios, VR simulation, simulated patient actors, or simple cardboard room mockups (reminiscent of The Founder – simulation to design a McDonalds kitchen).
Learning objectives are organisational, not individual. We need a comprehensive simulation testing strategy, not merely an event. Iterative testing and involving ‘end users’ is vital if we are applying a design thinking-Informed simulation to test, evaluate, and modify new clinical Infrastructure. And we must plan meticulous data collection to inform our evaluation of the spaces and processes, and to identify latent safety threats, such as in this example of a new trauma resuscitation bay.
What matters is clarity about our objectives: What are we testing? Why?, and How will be know what ‘good’ looks like?
I discussed some of these issues on a podcast with the authors of two helpful publications on this topic. Their detailed advice here is compulsory reading for anyone asked to participate in safe opening of new facilities.
Colman et al. Simulation-based clinical systems testing for healthcare spaces: from intake through implementation.Advances in Simulation (2019)
Kaba & Barnes. Commissioning simulations to test new healthcare facilities: a proactive and innovative approach to healthcare system safety. Advances in Simulation (2019)
2) Shaping the culture of teams planning to work in the new facility.
New hospitals are much more than new buildings and new clinical guidelines. The staff teams will make or break the functioning of any new hospital. Teams provide the critical link between the skills of individual team members and optimal patient outcomes. Simulation can help this process too.
Simulation can be considered a moment of ‘cultural compression’; reinforcing ideology about our professions, our work, and transferring relevant social values, beliefs and practices. An established simulation programme “can have a profound impact on the relational aspects of care and the development of a collaborative culture, with perceived tangible impacts on teamwork behaviours and institutional systems and processes.”
So engaging our healthcare teams in simulations to test new spaces and processes is more than transactional. If properly designed, signposted and debriefed, simulation can help shape the culture of teams before hospitals open, and embed a culture of continuous improvement. Simulation activities can help build social capital as teams form, and promote psychological safety.
Simulation probably should be mandatory before hospital opening, but does require expertise to enable those positive outcomes. Educators are well placed to work with the various stakeholders to make this a reality.
Acknowledgement: I’d like to acknowledge the team at Woodlands Health Singapore who are busy planning their own hospital opening, using a liberal dose of simulation, and who have prompted my thinking on this topic …
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