Photo by Matt Morse
IHI Project Director Allison Perry is a passionate advocate for the value of improving patient safety through using simulation. Since 2010, she’s been running simulation workshops “to give people hands-on experience with addressing the patient safety issues they find most challenging.” In the following interview, Perry counters some misunderstandings about simulation and talks about the power of this unique form of interactive learning. Perry will be leading a simulation session during the IHI Immersion program (in Boston from July 29–August 2, 2019).
What are some common misunderstandings about simulation?
There are a few false assumptions about simulation:
Myth #1 — It’s only for running drills or task training.
It’s true that simulation can provide excellent opportunities to practice technical skills, like central line insertion or managing complications like shoulder dystocia during childbirth. Teams can also use it to practice the kinds of skills that we know matter to patient safety, like communication and teamwork. We’ve shown people how to use simulation to practice using TeamSTEPPS, for example. At this past year’s IHI Patient Safety Congress, we had a pre-conference session in which we demonstrated simulation strategies that could lead their organization along a journey to becoming a high-reliability organization.
Myth #2 — Simulation requires expensive equipment.
When I first started doing simulation, I thought you needed the latest and greatest equipment. Over the years, I’ve learned that you don’t need much to run a compelling and educational simulation. There are creative and inexpensive ways to use simulation for learning. A lot of organizations, for example, will set up what they call a “Room of Errors” during Patient Safety Awareness Week. They’ll set up a room, sometimes with a mannequin, and the goal when you walk into the room is to identify the patient safety error or potential error. Some may be easy to identify, but some are harder to find. There might be a syringe under the bed or a dirty glove left behind. The patient chart in the room might list an allergy, but also an order for that same medication. The possibilities are endless.
We’ve done simulation demonstrations in busy exhibit halls that were literally just two people sitting at a table and having a conversation. I remember one scenario involved a conversation between a patient safety officer and the parents of a newborn following a medical event. This was the first time we demonstrated how to use simulation to prepare for having difficult conversations. The meeting attendees observing the discussion were so engaged in the demonstration, they started to pull chairs up to listen. It was an emotional conversation to participate in and to watch. That’s one of the reasons we always debrief with both the participants and the observers.
Myth #3 — Only certain professionals can benefit from using simulation.
All kinds of teams and individuals can benefit from using simulation. Simulation is essentially taking time to practice doing challenging things.
Beyond the individual level, any organization could learn from using simulation to practice responding to workplace violence or disaster preparedness. A few years ago, we saw many teams using simulation during the Ebola outbreak. That was great, but wouldn’t it be even better if everybody had the chance to practice their protocols prior to an outbreak, flood, forest fire, hurricane, or other natural disaster? Even a larger than normal number of flu cases can be overwhelming if you’re not prepared.
It’s like anything we do in life or in our work. It’s like playing an instrument — the more you practice, the more you improve your technique. I wish I could’ve done simulation before becoming a parent. There are definitely things I would have done better!
If I know, for example, that I need to have a difficult conversation in my personal life or at work, I’ll call a colleague or a friend and say, “I need to practice how I’m going to say this. Could I run this by you?” People use simulation all the time and they don’t realize it. It’s essentially doing something and then feeling like, “I’ve done this before. I know how it went. I feel more prepared.”
In the past, you’ve talked about how health care simulation programs and patient safety teams aren’t often working together. How can they combine their efforts to improve patient care?
It surprised me when I first learned that safety and simulation collaborations are not that common. Anecdotally, however, I’m now seeing more simulation teams being approached to help with improvement projects. “We need to improve our code team response. Can you help us run a simulation?” But they mostly seem to be one-offs. It’s a good first step, but often the improvement teams aren’t aware of all that simulation can do, and the simulation folks don’t fully recognize how much they can help improve patient safety.
My advice is to have a cup of coffee with your counterpart. Find out what their goals are. Tell them about your goals. Everybody is trying to do what they’re tasked to do, and there is competition for resources, but you might find you have some common ground.
Editor’s note: This interview has been edited for length and clarity.
You may also be interested in:
IHI Immersion (July 29–August 2, 2019), a five-day program at the IHI headquarters in Boston, MA, USA. You’ll learn about improvement methods directly from IHI experts and get a sneak peek into IHI operations.
Include Simulation in Your Improvement Plans
IHI Patient Safety Essentials Toolkit