Simulation: Beyond the Bedside

Simulation: Beyond the Bedside

Nancy A. Bardugon, Executive Development Program Manager, Intermountain Healthcare

Nancy A. Bardugon, Executive Development Program Manager, Intermountain Healthcare

In our technologically driven world, we place a high importance on the innovations and advancements we use to clinically treat the patients we serve. However, for practitioners to successfully keep up with the pace of innovation, as well as the widening complexities at all levels of the evolving healthcare landscape, we must also continuously improve how we offer and deliver quality education.

Over the course of my 25-year career as an Intensive Care Unit nurse and nurse leader in healthcare, I have seen the landscape of how education is delivered change dramatically. Historically, training followed the apprenticeship model of “see one, do one, teach one.” With this passive learning model, many trainees finish orientation without ever witnessing or performing procedures necessary for their respective field. To overcome these limitations, healthcare organizations are embracing the active learner methodology of simulation training. This approach to training refers to an organized event utilizing simulation technology to represent realistic representations of their environment to achieve educational goals through experiential learning. The Society for Simulation in Healthcare recognizes simulation as a bridge between classroom learning and real-life experience and describes four distinct roles for simulation—simulation education, simulation-based assessment, simulation-based research, and systems integration.

Simulation provides a way for practitioners to experience high stake situations in a safe environment followed by a debriefing to understand workflow processes, solve problems, and solidify lessons learned. With an increased demand on training hours, limited clinical encounters, and an increased focus on becoming highly reliable organizations, many hospital systems are investing in space and operations to build on-site simulation labs and centers for training. In this setting, caregivers who touch the lives of patients will have a unique opportunity to practice and hone critical technical and communication skills necessary to navigate difficult and critical situations which help keep our employees and patients safe.

"Leadership simulation offers a safe environment to practice difficult conversations and debrief all aspects of each scenario to identify good performance and opportunities to improve"

Healthcare simulation at Intermountain Healthcare began in 2006 at Primary Children’s Medical Center with the opening of on-site simulation lab. Today, Intermountain healthcare has invested in 10 additional simulation labs (including a 10,000 square foot simulation center) supporting caregivers across our organization of 23 hospitals. New nurses in our organization are expected to spend a percentage of their orientation time in the simulation lab where they participate in scenarios that promote teamwork, meaningful communication, and critical thinking. Additionally, many departments now require their employees to attend interdisciplinary team simulation training annually. The most common evaluation response to simulation training we encounter is, “more simulation training please.” Behaviors learned in simulation have been applied at the bedside, thus improving teamwork, outcomes, and engagement. Stories shared have sparked the interest from other areas of the organization to adopt simulation-based training for orientation, quality improvement, environmental testing, and most recently, leadership training.

Recognizing the power of simulation-based learning, in August 2018, Intermountain Healthcare opened its newest simulation center designed specifically for training healthcare executive leaders. This simulation center includes four office spaces, a simulated elevator, and a boardroom. Historically, healthcare leaders often rise to a position of leadership based on a track record of clinical expertise and natural leadership instincts with no expectation for degree or background in business or management. For this reason, curriculum is designed to include realistic scenarios that allow trainees the opportunity to practice skills of trusted leadership such as compelling communication, emotional intelligence, and value driven decision-making. Leadership simulation offers a safe environment to practice difficult conversations and debrief all aspects of each scenario to identify good performance and opportunities to improve. Utilizing trained facilitators to conduct debriefing after the simulated scenario is an essential component of ensuring high quality simulation experiences that translate into knowledge retention and change in practice.

Simulation can be an expensive form of education and may not be appropriate for all learning needs. Simulation programs across the country continue to evaluate incorporating new, appropriate, and evidence-based strategies to expand the reach of our efforts to all caregivers and leaders in their organization. Other methodologies that employ experiential learning such as virtual simulation and the use of augmented reality are being developed at a fast pace to increase access to innovative education as well as lower the cost of service. Leaders and educators must identify the learning needs of their organization and then match the methodology at the lowest cost that will allow for optimal learning and improved performance.

We can expect the rapid pace of change in our profession to continue, so we must be ready to rethink the educational needs of our employees by looking beyond the current needs of today and consider how we will train leaders and clinicians in the future. As technology advances and healthcare customer expectations continue to shift, healthcare administration is realizing the power of simulation-based learning and is seeking opportunities beyond the bedside to support and accelerate learning, thus tapping into people’s commitment and curiosity to learn at all levels of an organization.

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