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Use Simulation Training to Boost Safety Culture

Tami Swartz, June 4, 2009

Many hospitals and medical schools offer some variation of simulation-based training in which medical and nursing students learn clinical techniques of suturing and administering medication by using lifelike mannequins. This strategy of helping clinicians develop skills on mannequins before treating actual patients is nothing new, but some hospitals are taking things to the next level by tying simulation to a newer concept: a culture of safety.

With the involvement of multiple levels of clinicians and nonclinicians in simulation centers designed with patient rooms, physician rooms, and nurses' stations, hospitals now use simulation training to improve patient safety through communication and teamwork.

Patient safety starts with teamwork
When the 450-bed Dartmouth-Hitchcock Medical Center (DHMC) in Lebanon, NH, renovated its second floor, hospital leaders made part of it into an 8,000-square-foot simulation center. The center is equipped with six patient rooms, an ICU, mannequins, and a nurses' station.

"It's a mini hospital," said George Blike, MD, quality and patient safety officer at DHMC and medical director at its Patient Safety Training Center. Having hospital leadership support the idea of investing in a simulation center is important to Blike. He said it can be tough to convince people that the answer is not always more production space, but rather more space to make production better.

"It's a place where people can learn how to learn," he said, emphasizing how quickly medicine changes. "The day you finish your training is the day you start becoming incompetent." He added that the center helps fight such complacency and keeps staff members entrenched in new methods and technologies.

"People learn technical skills here, but they are also learning peer communication," said Blike. "It's not just medical students and residents, but 7,000 staff who need and want to maintain their skills."

Patient safety begins with learning simple behaviors, such as how to brief and debrief, said Blike. He noted that a surgical safety checklist—something most hospitals use—is simply a way to ensure teams are briefing and debriefing. Simulation, he said, is all about enforcing these behaviors.

"That's a good habit to instill in people," Blike said. "That's what shifts culture ... they're learning how to have a [type of] behavior that is useful in every single patient encounter. Hopefully, it is unleashing and moving people over time toward being more reflective practitioners."

At the Tulane Center for Advanced Medical Simulation and Team Training in New Orleans, medical director James Korndorffer Jr., MD, FACS, is hoping Tulane's months-old center will benefit the medical students at Tulane University's School of Medicine, as well as staff members at the Tulane Medical Center. As with DHMC's simulation center, students and professionals use simulation training with a focus on teamwork. Using an incomplete team for simulation doesn't make good sense, said Korndorffer.

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