Patient Safety Advocate Dr. Timothy Willett

Dr. Timothy Willett is SIM-one/CNSH's president and CEO (appointed in 2016) and was previously their inaugural director of Research & Development. He is passionate about bringing together the simulation community for mutual support, to improve the quality of simulation across Canada, and to advance the scope of simulation’s uses. He was appointed CEO just before the integration of SIM-one and CNSH, which he was proud to play a role in. With the guidance of the Board of Directors and support of the phenomenal SIM-one/CNSH team, Tim is responsible for the day-to-day operations of the network. Tim received his MD from the University of Ottawa and a Masters of Medical Education from the University of Dundee, Scotland. He has served as a curriculum developer and educational researcher for the University of Ottawa, CRI Critical Care Education Network, and Royal College of Physicians and Surgeons of Canada.

The Simulation Canada nomination said:“SIM-one/CNSH (about to become Simulation Canada) primary target is to advancethe use of simulation for system- and team-level applications of simulation toimprove patient safety and care quality.”

Movingthe Needle on Safety & Quality

SIM-one, the Canadian Network forSimulation in Healthcare (SIM-one/CNSH), is prioritizing advocacy of simulationas a strategy to advance patient safety and care quality in the clinicalsetting. As a national network, we believe in the incredible potential forsimulation, when applied at the team- and system-level, to do good forhealthcare.

Within the field of patient safety, therehas been much progress in researching and identifying evidence-based bestpractices for a vast array of clinical processes and medical conditions. Theseare often published as ‘bundles’ for improvement. However, the full impact ofthis work remains unrealized. Adverse event rates, the target for which iszero, continue to be unacceptably high; the major barriers to advances inpatient safety relate to contextualized implementation, institutionalreliability, and safety culture (Baker, 2015).

This is where simulation is showing promiseto make a difference. In this context, our understanding of simulation as aneducational tool is evolving as an improvement and change tool (Paige et al.,2018). Evidence to support such applications is quickly growing, includingjustifications for the return on investment and meaningful improvements inpatient outcomes, process reliability, system efficiency, and teamwork.

InnovativeApplications for Simulation

Some Canadian hospitals and simulationteams are working at the leading edge of system- and team-level applications ofsimulation. For example, simulation teams at several sites use simulation todevelop and test new or high-risk processes and procedures, identifying latentsafety threats before the process is even implemented. At some hospitals, suchsafety threats can be entered into the same reporting system as actual adverseevents.

Several hospitals are using simulationthrough the design, build, and commissioning phases for new clinical spaces,helping to design spaces that are optimized for natural human workflow.

When a safety or quality gap is known,simulations can help to develop and implement remediation strategies. Onehospital in Canada implemented a simulation-based module on the early warningsigns of sepsis, and has seen a significant reduction in critical care unitadmissions for hospital-acquired sepsis, decreased lengths of stay, anddecreased mortality - lives have been saved from this intervention. Otherhospitals have brought together their human factors and safety/quality teams tobetter design improvement interventions.

In-situ simulations - simulations thathappen in active hospital departments - are becoming more common, and can rangefrom quick skills refreshers (such as a five-minute quality CPR refresher) tofull-scale, unannounced mock codes to test system responses to crises andprovide team feedback.

At one hospital, a code red response teamcould not find the patient, who collapsed in a lesser-known corner of thehospital. The hospital then developed a virtual reality game to orient itsstaff to the full hospital.

One hospital in Toronto used a series ofsimulations to rehearse their surge response to a mass casualty event, in themonths before such an event actually happened. Clinicians spoke of thesmoothness and efficiency of their response to the event, and that everyoneknew what to do, despite the chaos.

In their critical care unit, one hospitaluses “just-in-time” simulations in the morning to simulate a medical crisisthat might actually happen that day, based on the patients currently in theunit.

At the team level, simulations are beingused to improve and standardize communication at handoff, which is known to bea high-risk point for error. Some hospitals are using simulations to directlyaddress issues of safety culture, such as just culture, organizationalhierarchy, and “speaking up.” Simulations are being used to increaseappreciation of the risk of errors and how standardized processes can reducethis risk.

At a hospital where nurse attrition in thecritical care unit was particularly high, simulations were used duringorientation and professional development sessions to improve nurseself-efficacy and feelings of being valued and having organizational support,with the goal to decrease the attrition rate.

Simulations empower patients and caregivers.At one hospital, families of children with newly-diagnosed epilepsy canrehearse their response to a seizure at home, greatly increasing their comfortat discharge. At another, patients equipped with insulin infusion pumps undergosimulations to understand how to properly use them.

Teams are also bringing simulations out ofthe hospital into the communities they serve. For example, a medical assistancein dying simulation was enacted to raise awareness of the decision-making andclinical processes behind this difficult decision, and to facilitate discussionabout this controversial option.

Advocatingfor Simulation

To expedite the spreading and scaling ofhospital-based simulation programs, advocacy has become a focus for ournational network.

To this end, three years ago we launchedthe “National Forum on Simulation for Quality & Safety,” a one-dayconference to explicitly celebrate innovations and achievements in this area,to connect leaders and share knowledge, and to raise awareness of theseopportunities to key stakeholders, such as government and provincialquality/safety councils. (The next National Forum is May 28, 2019, inVancouver, British Columbia.)

SIM-one/CNSH is a member-based, non-profitnetwork. It is especially important for us to have members such as the CanadianPatient Safety Institute (CPSI; whose CEO recently joined our Board ofDirectors) and the Healthcare Insurance Reciprocal of Canada, both of which aremajor stakeholders and advocates for safety and quality improvement.

We are working with CPSI to integratesimulation into their patient safety improvement strategies, including therecently-launched TeamSTEPPS Canada program. We are in the process ofdeveloping additional educational programs around simulation specifically inthe hospital setting.

Also in collaboration with CPSI, we haveauthored a white paper that reviews the accumulating evidence for the impactsimulation can have on patient safety and quality improvement, and the scope ofapplications of simulation. This will be published in 2019.

Finally, we worked with CAE Healthcare tobring their OnBoard program to North America for the first time. This programconnects the worlds of aviation and healthcare by engaging healthcare leadersin a day of learning about standardized processes and the role of simulation inaviation, and brief flight training that culminates in the leaders flying acommercial airplane in a full-fidelity flight simulation.

We have seen the difference simulation hasmade in the healthcare education sector. Yet this is just the tip of theiceberg compared to the positive impacts simulation can have in the clinicalsetting. This represents another revolution in healthcare, with differentapplications and purposes than in the education sector. The opportunities to dogood are tremendous, and we are excited to be part of it.

Participants at the 2018 SIM Expo in Calgary, Alberta, learn from a live simulation demonstration from corrections officers. Image Credit: Venus Sinson.

The Evolutionof Canada’s Simulation Network

SIM-one/CNSH is the member-based,interprofessional national network connecting healthcare simulation centres andprofessionals across Canada and beyond. We grew out of the integration ofSIM-one, which was formerly focussed on advancing simulation in the province ofOntario, and the Canadian Network for Simulation in Healthcare, which hadestablished cross-country links, especially in medicine.

At our last Annual General Meeting, ourmembership unanimously voted to change our name to Simulation Canada,reflecting the reinvigorated national scope of the network. The new name willbe implemented in 2019.

Our vision: Exceptional healthcare throughsimulation.

Our mission: We advocate and advancesimulation to improve healthcare education, patient safety, and qualityimprovement; and connect all healthcare and human service professions,disciplines, and care delivery sectors.

As a member-based network and community,our strength lies in the diversity and passion of our members, bothorganizations and individuals. Our members contribute to and benefit from theconnections, knowledge, and resources of the network.

Participation and membership are open toindividuals, organizations (hospitals, universities, colleges andassociations), and simulation businesses, and is not restricted to Canadians.Please visit us at http://www.sim-one.ca/join for more information.

In addition to the National Forum onSimulation for Quality & Safety, we are the proud host of the SIM Expo,Canada’s annual interprofessional simulation conference. We offer foundationaland advanced professional development courses in simulation-based education, aswell as the Keystones Certificate in Healthcare Simulation.

We also host a number of free, online services that are open to simulationists and health professionals across the globe. This includes the SIM Scenario ExchangeTM for peer-reviewed simulation scenarios and tools, the SIM MarketplaceTM for the buying and selling of gently-used simulation equipment, the SIM Product Directory, and more.

References

1. Jacques Marescaux, Joel Leroy, MichelGagner, Francesco Rubino, Didier Mutter, Michel Vix, Steven E. Butner &Michelle K. Smith. Transatlantic robot-assisted telesurgery. Nature, volume 413,pages 379–380 (27 September 2001) www.nature.com/articles/35096636

2.  Intuitive Surgical Investor Presentation - Q3 2018. (August 2018). https://isrg.intuitive.com/static-files/8bbddc9e-579c-47a1-ac91-fabe26e5e278

Originally published in  Issue 1, 2019 of MT Magazine.