Building a Culture: In Situ Simulations Open New Facilities (1090-002290) (Research Abstract Professor Rounds: Group 7)
Start time: Friday, January 29, 2021, 1:00 PM End time: Friday, January 29, 2021, 2:00 PM Session Type: Research Abstracts (Completed Studies)
Opening new healthcare facilities can be daunting due to challenges in systems processes, integration, environmental design and effectiveness. Interprofessional teams from every department participated in 14 different clinical simulations with the aims of: 1) identifying gaps in processes and systems, 2) determining issues in the physical environment hindering patient care, and 3) improving the confidence and competency of staff working in the new environment and in newly formed teams. The goal of building a Culture of Continuous Improvement was a priority for the leadership of each new facility (Hoeft & Pryor, 2010). A partnership with the healthcare system and a clinical simulation department of a major university was made through a Memorandum of Understanding to improve and develop the simulations, operationalize learning events, and evaluate outcomes. The healthcare system’s Lean Management coaches assisted in project planning, management, and throughput of simulations.
Prior to the opening of three hospitals, each facility completed simulations in situ. All facilities opened in an 18 month period, allowing for rapid cycling changes in operational processes using the Plan-Do-Check-Act (PDCA) process. Staff members completed pre/post, facility designed surveys. Fourteen different simulations were developed using INACLS Standards of Best Practices (INACSL, 2016). Each scenario was designed to create collaboration or cause staff to access systems or processes in the environment. The electronic medical record team created charts to ensure simulations included documenting. Debriefing was conducted using Plus Delta debriefing model. A scribe in each debriefing captured outcomes and started the PDCA process to ensure root cause of issues were addressed and sustainable process solutions were implemented. Value-Stream Maps (VSM) were completed pre/post simulations. Standard workbooks were developed and revised as the new teams came together through simulation.
A total of 280 participants were involved in the simulations across the three hospitals. Facilities 1 and 2 were used to validate processes and lead to the use of Project Management to coordinate the simulation activities. Facility 3 participants (n=106) were surveyed. Pre-survey (n=42) responses, based on 1-10 scale, for confidence level/or comfort with: 1) processes and workflow average score was 5.6, 2) ability to provide safe quality care in the new environment average 6.9, and 3) working with new peers and teams averaged 7.24. Post-survey responses (n=16) were obtained immediately after the event, with average scores of 6.6, 8.44 and 8.84. A follow-up survey was administered approximately 2 weeks after the simulation with n=25 response showing sustained improvement. During the final simulation debrief, a total of 343 comments and opportunities for improvement were collected from the staff. These led to 29 VSM changes from pre to post simulation.
The use of simulation prior to opening the new facilities has the capability to improve the staff members confidence in working with new team members, accessing systems and processes and providing safe, quality patient care. Creating a culture of continuous improvement and allowing staff the opportunity to practice patient care, access systems, and work in new teams can create excellence in patient care and lead to great outcomes. The project team needs to further evaluate if the identified gaps found during the simulations correlate to established successful throughput times, high HCAHPS and Press Ganey scores, and zero harm incident already established at the three new facilities. Further evaluation will also need to be completed to see if the culture remain sustained and if this model of simulation and process improvement will have replicated positive results as other new facilities are built.