Standardized patient safety program changes culture of hospital

Ottawa Hospital’s Simulation Patient Safety Program a successful initiative across entire institution
“One day, Dr. Viren Naik calls me and says, ‘Glenn, we’re going to create a hospital-wide in situ program.’ And I said, ‘Yes! That’s brilliant! Why didn’t I think of that!'” exclaims Dr. Glenn Posner as he speaks to SIM-one in his office on the first floor of the University of Ottawa Surgical Skills and Simulation Centre (uOSSC).
In addition to the Simulation Patient Safety Program, the Ottawa Hospital houses one of the largest simulation centres in North America – the University of Ottawa Surgical Skills and Simulation Centre (uOSSC). It includes multiple simulation, surgical skills, exam, and conference rooms available for use by all healthcare professionals. “It is the only centre in Canada with the level of accreditation from the Royal College we have,” adds Dr. Posner.

A uOSSC simulation room

As SIM-one walks through the long, jigsaw-like hallways of the uOSSC, Dr. Posner talks about the history and future goals of the Ottawa Hospital’s Simulation Patient Safety Program, shares his thoughts on simulation use for healthcare, and gives advice on establishing a successful patient safety program within an institution. His full interview is below.
Hear more from Dr. Posner at the 2016 National Forum on Simulation for Quality & Safety on Monday, May 30, 2016 in Toronto. For details and registration, visit the″ target=”_blank”>2016 National Forum website.
Q1: What is the Simulation Patient Safety Program at the Ottawa Hospital?
This program is an in situ initiative that runs across the entire hospital. The idea originated in 2014, but it took about six months to get buy-in from stakeholders and everyone else who would be impacted by the program. It ended up being a huge success. We went from a goal to have at minimum two simulations per month, to as much as two per day in the fall of 2015.
Q2. What is unique about this program?
What is truly unique about it is its large-scale, coordinated effort across the entire institution. Where the Ottawa Hospital has been innovative is in its vision to change the culture of the entire institution. This takes form in debriefing, improving communication, using a standardized evaluation process, and offering continuing medical education credits for physicians. I don’t know of any other institution that has a coordinated in situ program for their hospital of all departments.
Q3. What are some of the goals of the program?
First, to maintain momentum. Continue to run in situ simulations in experienced departments, including ambulatory and emergency settings, operating rooms, OB/GYN, and medicine wards. We’re also looking to determine which divisions to target next, especially in general surgery. Second, begin running codes in new areas of the hospital to assess teams in different situations. Third, take the show on the road by bringing family health teams outside of the Ottawa Hospital and into the community. Finally, build capacity among non-physicians, such as nurses, who can debrief and create a safe learning environment within their teams.
Q4. What is the most important aspect of simulation that helps improve patient safety and quality of care?
Interprofessional education. The most important part of any simulation is the debrief; the conversations that take place after a simulation. This is when decisions are made such as what could have been done better. It is crucial for healthcare professionals to be comfortable with speaking and bringing up any concerns they have if we’re going to improve safety and quality of care.
Q5. What advantages does a simulation program like yours offer for hospitals?
Aside from reduction of costs and adverse events, engagement among employees is improved. Simulation promotes interprofessional education, which in turn promotes respect and communication among staff.
Q6. Why are some individuals and organizations still hesitant to adopt simulation?
It’s not easy in this day and age. Finances are a major concern. We’ve been thankful for RBC’s support in keeping the program running for at least the next four to five years. Another difficulty is getting buy-in from everyone who will be affected by the simulation program. Convincing people of the long-term benefits is challenging as we don’t have direct correlation between simulation and patient safety. Here at the Ottawa Hospital, we’re very lucky that the hospital appreciates the value of simulation and believes in its success.
Q7. What are some of the pros of in situ simulation?
First – no more excuses! If something goes wrong during an in situ simulation, all arguments such as lack of or missing props disappear because individuals are working with their actual team. Second, latent safety threats can be better identified with in situ. These are the things you wouldn’t have known about if you hadn’t run the simulation. For example, realizing that the call bell is missing in a patient’s room. With traditional simulation, all you can really identify is knowledge.
Q8. What are some of the cons of in situ simulation?
One of the biggest downsides of in situ simulation is disrupting a healthcare professional’s day. I feel guilty about calling a code on a team that was in the middle of actively taking care of patients. At the end of a scenario, I’m always very apologetic and respectful of people’s time. It’s also difficult to leave my own patients to run simulation training.
Another major concern is that what you can talk about for an hour at the sim centre, I really only got two minutes during in situ. So the debrief part often gets cut short.
Q9. Keeping simulation in mind, where do you see medicine going in next few years?
At the bottom of it all, what we’re trying to achieve is efficiency. It’s about being great on limited resources – working with what you have to go above the bare minimum. This is not easy and it will take a lot of difficult conversations. I think the deep core of my program is really to promote respect for each other through interprofessional education. Because the only way we’ll go from safety to quality is when nurses are comfortable speaking up to surgeons, and in turn, receive the respect they deserve. Respect for each other is a must.
Q10. Finally, what is your advice to those wishing to establish a simulation patient safety program within their institution?
Faculty development is absolutely crucial. You must identify your champions, who will take the time to become excellent with scenario development and debriefing. Getting equipment is also key, but don’t think you need the fancy kinds. You can get cheaper versions and use standardized patients. Then, it’s really not that expensive to run a simulation once a month in your department. As long as you get buy-in from stakeholders, explain the purpose of your program, it doesn’t take much. Who knows – maybe one day you’ll also go from running a simulation twice per month to twice a day!

An obstetrician and gynecologist, Dr. Posner is the medical director of the Ottawa Hospital’s Simulation Patient Safety Program and a simulation educator for the Royal College of Physicians and Surgeons of Canada. Dr. Posner obtained his doctor of medicine and master of surgery degree (MDCM) from McGill University and completed his residency training at the University of Ottawa, where he’s been running simulations since 2001. Dr. Posner also holds a master of education from the University of Cincinnati in Ohio.

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