Abstract:

Simulation is a tool that is often used for healthcare training and education. In addition to the clinical application, simulation can serve as a vehicle for the evaluation of system-based processes. System-focused simulation, also referred to as process-oriented simulation, can be accomplished through Simulation-Based Clinical Systems Testing (SbCST), and Simulation-based Hospital Design Testing (SbHDT).

System-focused simulations use systems engineering, human factors, and risk management principles to explore and achieve excellent clinical care, enhanced patient safety, and improved outcome metrics across a healthcare system. SbCST is conducted in situ to evaluate clinical system and care processes prior to occupancy to mitigate risks whereas SbHDT simulations are conducted in the pre-construction phase of design development to evaluate the built environment to improve safety and optimize efficiency. 

The goal is to identify, and address discoveries of latent conditions or systems hazards that impede the ability to provide safe and efficient care in a proactive fashion, allowing corrective action before these conditions and/or weaknesses could harm or impact an actual patient care event. These discoveries may be found during intentional probes (SbCST, SbHDT), or serendipitous discovery (the objective of the simulation did not anticipate a system-level gap).

There are many benefits to system-focused simulation such as preventing harm, increasing effectiveness, improving efficiency, supporting safety, streamlining processes, decreasing errors, and controlling costs. In order to integrate systems-focused simulations into a program, it is necessary to overcome barriers and challenges: support from senior executives, buy-in of stakeholders, avoiding a disruption to patient care during in-situ sessions, availability of equipment, and the intensity of resources. 

Facilitators need to be trained to design, implement, and assess these system-focused simulations, which generally require modifications to the typical debriefing framework used with a clinically based educational simulations. These debriefings involve facilitating the identification of latent conditions and exploring potential active failures. Developing a structure to report findings and outcomes as well as a communication process so that key stakeholders are informed is the key to sustainment of a robust program.

This presentation will discuss how and why to use system-focused simulations, explore the barriers and facilitators impacting teams interested in this format, and describe a reporting structure used by a Simulation Center that has achieved accreditation in Systems Integration by the Society of Simulation in Healthcare (SSH). In addition, participants will be shown examples of systems-focused simulations and their findings and outcomes, as well as the impact on patients and healthcare providers.

Learning Objectives:

1. Define the intent of systems-focused simulations including Simulation-Based Clinical Systems Testing and Simulation-Based Hospital Design Testing with particular reference to their role in improving clinical practice and patient safety.
2. Describe the benefits and challenges to designing and integrating systems-focused simulations into a simulation program.
3. Identify an outcome reporting system strategy to share findings with stakeholders.