Our Story: Building the Largest Geographical Provincial Simulation Program in Canada

Mirette Dube, Sue Barnes, Theresa Cronin, Cherie Serieska, Erica Meunier, AnnaMaria Mundell, Jennifer Semaka, Tara Fusilli, Dan Duperron, Rob Ritchie, Ayan Mack, Darren Steidl, Mark Allen, Alyshah Kaba and Marlene Donahue describe Alberta’s simulation success and community value.

Have you heard of the largest provincialsimulation program in Canada “eSIM”? eSIM stands for Educate, Simulate,Innovate and Motivate and is the Alberta Provincial Simulation Program whichwas founded in 2009.

Figure 1: Alberta Health Services: eSIM Centres and Mobile Visits. All Images: eSIM.

Our Geographical Location

Within a geographical area of 661,848 squarekm (AHS, 20191), Alberta Health Services (AHS) is the single healthauthority for the Canadian province of Alberta. AHS delivers medical care togreater than 650 facilities including 106 acute care hospitals, clinics, 25,653continuing care beds/spaces, five stand-alone psychiatric facilities, 2,723addiction and mental health beds and 243 community palliative and hospice beds.AHS has over 110,000 direct employees, and close to 10,300 physicians with careprovided to 4,067,175 citizens. Service accountability zones are broken downinto five geographical areas North, Edmonton, Central, Calgary and South(Figure 1).

Our Growth

The eSIM program began over 10 years agoand has grown rapidly since inception. Beginning as a grass roots programsupporting uni-professional and multi-professional sims and just onehospital-based simulation lab, eSIM now support an estimated 23,000 learnersper year across the province of Alberta (2018) (Figure 2). The provincial teamresides within the Quality and Healthcare Improvement portfolio and consists of17 simulationists, an education and booking coordinator, three biomedicalengineers, a medical director, a research scientist, and leadership teamincluding administrative support.

Figure 2: eSIM Annual Participants by Zone.

Simulation Lab Build(s) and Development

eSIM are leaders in the design anddevelopment of simulation labs across the province.

Starting out in 2009 with one simulationlab, this program currently facilitates the operation of over tenstate-of-the-art simulation labs; eSIM’s footprint continues to grow. Once eSIMacquires a new space, they lead the development and mentorship of the lab andteams that use it.

With strategy, marketing, education on theproven benefits of simulation-based education (SBE) and systems focusedsimulation, eSIM is well situated to accommodate the thousands of learnersusing simulation across the province. The team has worked to collaborate withnew build and project committees, is well connected with senior leaders andphysicians, media, philanthropy, patients and families, and many clinical (i.e.nurses, respiratory therapists, allied health, etc.) and non-clinical teams(i.e. protective services, porters, unit clerks, etc.). They work with thehealth trust fundraising programs to acquire funds for lab equipment andmannequins and present various demonstrations for media. eSIM currently ownsand maintains over 150 high fidelity mannequins!

Mobile Simulation

Responding to a vast physical expanse ofthe province, the mobile simulation program was launched in 2011. Many of thesemobile simulations involve one or two team members travelling out to ruralareas of Alberta, meeting new teams, and mentoring them in SBE and simulationcurriculum. Site requests came from rural hospitals, health community clinicsand urgent care environments. Subsequent growth has continued to now includeservice areas such as the prison system (i.e. corrections centers), schoolboards, doctor’s offices and clinics. The program owns nine fleet vehicles tosupport a mobile simulation program reaching all areas of the province (seeFigure 1).

"The future is about meeting people where they are, understanding their needs and building strong teams so that they can provide the best care to Albertans despite their geography," eSIM Simulationist.

eSIM Family: eSIM owrns and operates over 150 high fidelity mannequins.

Focusing on Team Training

eSIM takes pride in its Interprofessionalapproach to team training with hundreds of teams across the province. Creatinga culture of true interprofessional collaboration (IPC) defined as learningabout, from and with each other; means that everyone involved in the actualwork environment is represented in the simulation scenario development,facilitation and debriefing. Our philosophy is that no one profession canaccurately embody that of another, and so having all professions represented iskey to building a culture of IPC.

Teamwork improves patient safety andsupports individual and team learning across the continuum of care includingall areas within critical care, medicine, clinics, advanced care planningteams, mental health, corrections centers, labor and delivery, post-partum andmany more! With the task of supporting so many learners and teams from allfacets of healthcare, eSIM uses a formalized online booking process formannequins, lab space and location, mobile requests, simulationists supportrequests and collecting program statistics.

Focusing on Systems Integration

eSIM has also grown to be leaders insystems integration simulation and debriefing (Dube, M et al, 20192,3) using simulation to test the processes, environments and systemsin which we work. These simulations can be utilized at any point in timealthough are often being used to proactively identify systems issues includinglatent threats to patient safety prior to a process or new space being used bycare teams.

The use of systems integration simulationsled to an influx of demand for large scale systems-based projects for eSIM.There was an undeniable benefit to rehearsing highest impact and highestfrequency changes with healthcare teams to test and assess multiple new builds,and processes (i.e. Patient care protocols, pathways) through simulation anddebriefing. These simulations created another means for front line providers,leaders, provincial networks, and quality and safety experts to realize thebenefits of simulation. This is a valuable tool to engage frontline teams toidentify safety issues, problem solve together, and improve patient safetyproactively in a safe environment.

Simulation Debriefing Course

The flagship simulation course offeredacross the province is called ‘WISE” which stands for Workshop in SimulationEducation. The course provides an introduction to core simulation concepts andprinciples to novice and intermediate simulation educators. WISE is aninteractive and immersive course delivering a mix of didactic, small group andsimulation-based activities. Participants are introduced to topics includingexperiential learning, creating realism in simulation, pre-briefing, debriefing(Eppich WJ, Cheng A, 20154) frameworks effective teamwork skills,and scenario development.

Following WISE, simulationists mentorcourse graduates in SBE including pre-briefing, scenario design, learningmannequin operation, and debriefing. The goal of WISE and mentorship iscompetence and independence in SBE. The provincial team of 17 simulationistsfacilitate this course six to eight times/year on average and a total of 1,288staff have attended over the past 10 years. The mentorship program is designedto train simulation facilitators to operate their programs independently withsupport as needed from eSIM. This model has been successful in buildingcapacity for simulation across the province of Alberta. eSIM mentors teammembers from all healthcare backgrounds and roles in SBE and is proud of theirhundreds of independent end-users.

Operating Room Simulation to practice and test a low frequency, high risk delivery procedure.

Growing Pains

eSIMs rapid growth hasn’t come withoutgrowing pains and lessons learned. With such a large program there is aconstant need to balance supply and demand to all sites and centers across theprogram. Program evaluation, for a program of this size, has been challengingas eSIM continues to improve provincial reporting. One strategy is to embedsimulation session reporting in the eSIM provincial booking system forend-users. eSIM captures hazards and near misses that impact patient safety intheir organizations’ Safety Learning and Reporting system. For new curriculum,simulation initiatives and projects, eSIM continues to evolve in developing aprovincial strategy for implementation and evaluation.

Although having simulation space providedteams the ongoing ability to have a secured space for simulations, thesimulation community quickly realized that facilitating simulations in a team’sactual work environment, (i.e. in situ), was the gold standard whenever aclinical space was available. In a live clinical environment teams have animproved ability to learn knowledge, skills and teamwork, their environmentspecific workflow, and practice in the most realistic environment. With eSIM’sprogram growth, in situ simulation provided a greater number of teams topractice on any given day at individual sites. This hasn’t minimized lab use asthe realities of facilitating simulations in an actual patient room continue tobe variable on any given day. There continues to be the reality that manyclinical units are at full patient capacity and are unable to accommodate anin-situ simulation space.

In situ simulation has increased thedemands for in situ simulation labs as with clinical leaders understanding thevalue of having a simulation learning space embedded for staff and easilyaccessible on their units. eSIM supports several new requests related to thesein situ labs and how best to align our services, equipment and overall support.

Our Good News

The good news is that there is no forecasted slow down at eSIM! It’s not a fluke that simulation has grown so rapidly in Alberta. The eSIM team is packed with highly engaged, passionate and talented team members who continue to push the limits of innovation (Kaba A, Dube M, Charania I, Donahue M, 20185). There are new programs and project requests coming in daily and there are many units that have just made simulation their “way of doing business”. From engaging families and patients in healthcare design, training their teams, testing new spaces and processes, facilitating orientations of new staff, to supporting staff who need skills updates- eSIM is at the forefront of many education, engagement, and implementation strategies across the province of Alberta.

About the Authors:

The authors are all current or formermembers of the eSIM team in Alberta, Canada. The team has varied clinical andnon-clinical backgrounds including:

Respiratory Therapist (Mirette Dube RRT,MSc); Nursing (Sue Barnes RN, Cherie Serieska RN, Erica Meunier RN), AnnaMariaMundell RN, Jennifer Semaka RN, Tara Fusilli RN, Ayan Mack RN, Alyshah KabaPhD, Marlene Donahue RN; Biomedical Engineering (Dan Duperron, Darren Steidl);Engineering and Operational Excellence (Mark Allen); Paramedic (Rob Ritchie)and Simulation Coordinator and Data (Theresa Cronin BSc).

Addendum Highlight Article Written byMembers of the eSIM team: Goals, Recommendationsand the How-To Strategies for Developing and Facilitating Patient Safety and SystemIntegration Simulations:https://journals.sagepub.com/doi/full/10.1177/1937586719846586

References

1. Alberta Health Services statisticsobtained from: https://www.albertahealthservices.ca/about/about.aspx. Lastaccessed on June 21, 2019.

2. Dube M, Reid J, Kaba A, Cheng A, EppichW, Grant V and Stone K. PEARLS for Systems Integration: A Modified PEARLSFramework for Debriefing Systems-Focused Simulations. Simulation in Healthcare:May 21, 2019- Volume Publish Ahead of Print Issue. Available at:https://journals.lww.com/simulationinhealthcare/Abstract/publishahead/PEARLS_for_Systems_Integration__A_Modified_PEARLS.99530.aspx

3. Dube M, Shultz J, Barnes S, Pascal B, Kaba A. Goals, Recommendations, and the How-To Strategies for Developing and Facilitating Patient Safety and Systems Integration Simulations. Health Environments Research and Design Journal 2019; DOI 10.1177/1937586719846586. Available at: https://journals.sagepub.com/doi/full/10.1177/1937586719846586

4. Eppich WJ, Cheng A. Promoting Excellenceand Reflective Learning in Simulation (PEARLS): development and rationale for ablended approach to healthcare simulation debriefing. Simul Healthca2015;10(2):106-115.

5. Kaba A, Dube M, Charania I, Donahue M. Collaborative practice in action: Building interprofessional competencies through simulation-based education and novel approaches to team training. Health Education and Care 2018; 3(2): 1-9.

Originally published in  Issue 3, 2019 of MT Magazine.