For Product Updates and Information   -   SIGN UP HERE

Using Simulation to Build High Performance Teams

Share this article:           


How building better teams through simulation can address a root cause of patient harm

 

If you look at healthcare organizations who are leaders in delivering safe, patient-centered care, there’s a common thread. They place a premium on creating great teams.1 Across healthcare, these teams represent thousands of doctors, nurses, anesthesiologists, and others who, despite vastly different skill sets and training, come together every day, assume their roles at the patient’s bedside, and perform nothing short of miracles in giving back patients their lives.

 

Laerdal is honored to support many of these teams as they train today to outperform themselves tomorrow. Using simulation, these teams can push, test, and come to know themselves in ways that give them a profound edge before they encounter a real patient.

 

Preventable medical error in U.S. hospitals accounts for an estimated 250,000 patient deaths and over 1 million injuries annually.2 The majority of these cases can be attributed to a breakdown in teamwork and communications.3 Great teams know this, and so teamwork is where they focus—not just on refining individual skills but on instilling the skills necessary to excel within teams.4

 

We thank those institutions that place a premium on creating high performance teams in healthcare. Below we share some trends and findings based on our clients’ experiences in the hopes of supporting your organization’s patient safety initiatives,

 

Improving patient safety is a team sport.

John M. Eisenberg, MD, former Director, Agency for Healthcare Research and Quality
 
 

Multidisciplinary team training is just starting to enter the healthcare curriculum

 

 

3g_dark_skin_action

 

 

Teamwork and communication are latecomers to medical education. Many institutions, however, have resolved to change in light of recent patient harm statistics. Leading medical schools are beginning to re-tool their programs to teach doctors the importance of teamwork and communications.5 And, many nursing schools are beginning to overlay Quality and Safety Education for Nurses (QSEN) across their curricula, which has a large teamwork and collaboration component. 

 

 

Historically medical education has served a singular purpose: to produce experts licensed in their clinical field. Only recently have major institutions challenged whether that licensure qualifies experts to work effectively within a team.7 Findings show that multidisciplinary team training leads to better teamwork and communications, especially in emergency or time-critical situations. It’s a paradox in healthcare that the many disciplines that must come together daily to treat patients all train separately during school and during continuing education. The following takes a deeper look at why this is a problem.

 

 

The math behind multidisciplinary healthcare teams

 

The realities of hospital operations are that rigidly assigned teams are a rarity.8 Teams are often based on who’s on schedule, the nature of the case at hand, and so on. Consider this real world example: a patient suffers an obstetrics emergency. The hospital has 208 staff members that make up the 6 disciplines necessary to form the critical event team that will respond.9 How many team combinations are possible?

 

The answer is 381,000,000. That’s how many team combinations in this hospital could come together to respond to a single obstetrics emergency. 81 x 50 x 16 x 12 x 14 x 35 = 381,000,000. See the table below.

 

 
 

Position

Number in Unit

Obstetricians

81

Labor and Delivery Nurses

50

Anesthesiologists

16

Neonatal Nurse Practitioners

12

Scrub Technicians

14

Certified Registered Nurse Anesthetists

35

Total Staff

208

Total Combination of Teams Possible!

381,000,000

 

How many team combinations could come together in your organization to respond to a patient emergency? The numbers can be staggering.

 

Multidisciplinary teams don't have to be permanently assigned to be great teams!

 

Traditional team training in healthcare assumes that teams must train together to achieve high performance.10 The math above shows that this is impractical. And, patient harm data show us that a team of experts does not automatically make an expert team.11

 

Organizations that build great teams approach the problem by focusing on the cognitive and interpersonal competencies that create great teams regardless of what combination of people is assigned to a case.12 These organizations train their staff in team “systems” like TeamSTEPPS®, Crew Resource Management (CRM), or ones they've developed on their own. And, they reinforce that system through process design and carefully communicated expectations. Everyone is trained to conduct teamwork and communications to the same standard. This becomes especially critical in emergency situations where inconsistencies in approach and expectations can manifest themselves in the form of confusion, delay in action, and even a complete breakdown in team performance. The result for the patient can be disastrous.

 

Simulation is a proven means for improving team performance and patient outcomes

 

Medicine has traditionally relied on a “see one, do one” approach to learning and experience.13 Didactic learning in this context focuses on imparting knowledge. Simulation-based learning makes that knowledge come alive in a setting created to mimic real clinical encounters and lifelike experiences where teamwork counts.14

 

As a high-stakes/high-risk industry, healthcare is still a relative newcomer to using simulation to improve team performance. Aviation and the military are among the pioneers in using simulation as a prerequisite to building effective teams. And, the evidence is clear in those sectors that simulation leads to improved team effectiveness, better mission outcomes, and reduced risk. Where the same techniques have been applied in healthcare, the results have been very much the same.

 

simman-carry

 
 

According to a study published in BMJ Quality & Safety, simulation-based team-training can improve team communications, coordination and cooperation. And, such training has led to improved patient safety outcomes. Thirteen studies published between 2011 and 2012 reported statistically significant changes in teamwork behaviors, processes, and/or the team's ability to respond to emergencies. Ten studies reported significant improvement in clinical care processes or patient outcomes, including mortality and morbidity—all as a result of implementing a team training program.15

 

In this context, simulation affords teams benefits that didactic learning can’t deliver. One is the opportunity for deliberate practice, i.e., quality practice, not just quantity. Another is the chance to debrief and truly understand the strengths and weaknesses in a team’s behavior. Furnished with all this, providers leave the simulation better equipped for future patient care. 16

 

Focus on the simulation, not the simulator

 

That may come as surprising advice from one of the world’s leading providers of patient simulators. But, it’s been validated time and time again that focusing first on your training and education objectives and not on which simulator to choose is the best path to success.

 

Imagine a situation where you are trying to train a multidisciplinary team in the fundamentals of applying TeamSTEPPS®, CRM), or possibly the QSEN competencies. If your training and education objective is to ensure that the learners are all comfortable applying sound communications and teamwork tools, an advanced simulator may not add to the experience. In fact, it could detract from it. We have seen great team training occur using a basic manikin or even a task trainer.

 

If, however, you wanted to give that same multidisciplinary team the experience of applying their newfound communications and teamwork skills in a real world setting where they will be measured against their patient’s response to emergency interventions, a high fidelity simulator is essential. So will be an appropriately written scenario and a video capture system for debriefing.  

 

Allow the problem you are trying to resolve and your desired result determine your choice of a simulator, not the other way around.

 

 nurse-comp_7270f

 

In situ simulation can make your choices easier and your success greater

 

In situ simulation means conducting simulation on location in your team’s own care setting using the same staff, protocol, processes and equipment that your team uses every day. In situ simulation allows teams to review and reinforce their skills and problem-solve, all the while identifying hazards and deficiencies in their systems and environment.17

 

One of the fundamental obstacles that our clients often say they face is the lack of infrastructure to house and support a large simulation program. In situ simulation proves that a large infrastructure is not essential – and a large infrastructure is never a substitute for simulation best practices.

 

In situ simulation promotes training efficiency since it occurs during the actual workday, utilizing staff while they are on duty without the need to backfill or schedule training days. And, it can be conducted with minimal resources and investment beyond what’s essential to get the job done. The most important resource needed? A local champion.

 

Consider looking at your team training objective in the context of what your teams experience at the patient’s bedside.  Identify the teamwork and communications deficiencies that occur routinely then and there. Looking at problems this way from an in situ perspective and then creating an in situ simulation in response can be an effective means for gaining the results you want to achieve – in the very place where you want the learning applied.

 

We can help you turn your team of experts into an expert team

 

Perhaps you are a Department Head, or an Educator, or a Risk Manager. Whatever your role, we want to help you be a simulation champion.  Simulation, especially in situ simulation, can yield significant results.18 Studies show that in situ simulation has yielded marked results in areas like obstetrics19,20, pediatrics21, trauma care22, neonatal resuscitation,23 and even new clinician orientation.24

 

Laerdal’s mission is helping save lives. One way we do this is by equipping providers with the best possible means for conducting simulation where the challenges to improving patient safety most often occur: among and within teams and in your real world environment.  If you need help, please contact us.

 

 

References

  1. Teamwork a Key Feature of Patient Safety Improvement Program. Navigating the Health Care System: Advice Columns from Dr. Carolyn Clancy, October 2, 2012. Agency for Healthcare Research and Quality, Rockville, MD.
  2. Medical error—the third leading cause of death in the US BMJ 2016; 353:i2139 doi:  (Published 03 May 2016)  
  3. Leonard, M., Graham, S., & Bonacum, D. (2004.)  The Human Factor: The Critical Importance of Effective Teamwork and Communication in Providing Safe Care.  Quality & Safety in Health Care, 13 (Suppl 1), i85-i90. doi:10.1136/qshc.2004.010033
  4. Teamwork Helps Doctors with Patient Safety: Dr. Bob Wachter, February 15, 2011, Medpage Today’s KevinMD.com 
  5. Medical Schools Reboot for 21st Century: Julie Rovner, April 9, 2015, Health News from NPR
  6. The QSEN Institute
  7. Medical Schools Reboot for 21st Century: Julie Rovner, April 9, 2015, Health News from NPR
  8. Riley, W., Lownik, E., Parotta, C., Miller, K., & Davis, S. (2011) Creating High Reliability Teams in Healthcare through In Situ Simulation Training. Adm. Sci. 2011, 1(1), 14-31; doi:10.3390/admsci1010014
  9. Idem
  10. Idem
  11. James, John T., A New, Evidence-based Estimate of Patient Harms Associated with Hospital Care, Journal of Patient Safety. September 2013 - Volume 9 - Issue 3 - p 122–128
  12. Teamwork and Communication Working Group. Improving patient safety with effective teamwork and communication: Literature review needs assessment, evaluation of training tools and expert consultations. Edmonton (AB): Canadian Patient Safety Institute; 2011.  See also: Medical Teamwork and Patient Safety: The Evidence-Based Relationship, Agency for Healthcare Research and Quality
  13. McCaghie, W., Issenberg, B., Cohen, E., Barsuk, J., Wayne, D., June 2011, Does Simulation-based Medical Education with Deliberate Practice Yield Better Results than Traditional Clinical Education? A Meta-Analytic Comparative Review of the Evidence, Acad Med. 2011 Jun; 86(6): 706–711.
  14. Aggarwal R, Mytton OT, Derbrew M, Hananel D, Heydenburg M, Issenberg B, et al., (2010) Training and simulation for patient safety., Qual Saf Health Care. 2010 Aug;19 Suppl 2:i34-43. doi: 10.1136/qshc.2009.038562
  15. Weaver, S. J., Dy, S. M., & Rosen, M. A. (2014). Team-training in healthcare: A narrative synthesis of the literature. BMJ Quality & Safety, 23(5), 359-372. doi:10.1136/bmjqs-2013-001848
  16. Aggarwal R, Mytton OT, Derbrew M, Hananel D, Heydenburg M, Issenberg B, et al., (2010) Training and simulation for patient safety., Qual Saf Health Care. 2010 Aug;19 Suppl 2:i34-43. doi: 10.1136/qshc.2009.038562
  17. Patterson, D., Blike., George, Nadkarni, M, (2008) In Situ Simulation: Challenges and Results. Advances in Patient Safety: New Directions and Alternative Approaches (Vol. 3: Performance and Tools). Agency for Healthcare Research and Quality (US); 2008 Aug.
  18. Riley, W., Lownik, E., Parotta, C., Miller, K., & Davis, S. (2011) Creating High Reliability Teams in Healthcare through In Situ Simulation Training. Adm. Sci. 2011, 1(1), 14-31; doi:10.3390/admsci1010014
  19. Riley W1, Davis S, Miller K, Hansen H, Sainfort F, Sweet R. (2011) Didactic and simulation nontechnical skills team training to improve perinatal patient outcomes in a community hospital. Jt Comm J Qual Patient Saf. 2011 Aug;37(8):357-64
  20. Gardner, R., Walzer, T., Robert, S., Raemer, D., (2008) Obstetric Simulation as a Risk Control Strategy: Course Design and Evaluation. Simulation in Healthcare: The Journal of the Society for Simulation in Healthcare: Summer 2008 - Volume 3 - Issue 2 - pp 119-127
  21. Couto TB1, Kerrey BT, Taylor RG, FitzGerald M, Geis GL. (2015) Teamwork skills in actual, in situ, and in-center pediatric emergencies: performance levels across settings and perceptions of comparative educational impact. Simul Healthc. 2015 Apr;10(2):76-84. doi: 10.1097/SIH.0000000000000081
  22. Miller D1, Crandall C, Washington C 3rd, McLaughlin S. (2012) Improving teamwork and communication in trauma care through in situ simulations. Acad Emerg Med. 2012 May;19(5):608-12. doi: 10.1111/j.1553-2712.2012.01354.x
  23. Rubio-Gerung, S., Utet, P., Touzet, S., et al.  In Situ Simulation Training for Neonatal Resuscitation: An RCT, Pediatrics, September 2014, VOLUME 134 / ISSUE 3
  24. Olejniczak EA1, Schmidt NA, Brown JM. (2010) Simulation as an orientation strategy for new nurse graduates: an integrative review of the evidence. Simul Healthc. 2010 Feb;5(1):52-7. doi: 10.1097/SIH.0b013e3181ba1f61
 
 


Recently Viewed

Featured Products and News

The Colles Fracture Reduction Trainer is an ideal training tool for learners looking to gain confidence in the reduction of Colles’fractures occurring at the distal end of the radius.
Minimize downtime and maximize education with Worry-Free Simulation, an exclusive, limited time upgrade promotion from Laerdal Medical for existing customers to enjoy considerable savings while also avoiding any training disruption.
3B Scientific, a leading manufacturer and marketer of medical simulation products and anatomical models for healthcare education, announces today that it has reached an agreement to acquire Lifecast Body Simulation.
On behalf of the National Sea Rescue Institute's Training, Lifeguarding and Drowning Prevention Departments, we would like to extend our deepest gratitude to you and your company for your incredibly generous donation of the inflatable CPR manikins.
Suitable for all levels of training, the Hand & Wrist Injection Trainer allows trainees and clinicians to practice and teach injections in five different locations within the hand and wrist.
a smart, universal AED training device for more efficient BLS, First Aid, and Community CPR programs
ORSIM is the specialist flexible bronchoscope simulator with the widest range of realistic difficult upper airways.
3B Scientific anatomy models just got better with the new 3B Smart Anatomy app.
Creating simulation that allows for safe and reliable training is a mission that all of us at Limbs & Things stand by.
The 3B Scientific Birthing Simulator P90 PRO has been developed for the skill training in normal deliveries, in complicated deliveries and in obstetric emergencies.
SimBaby™ with Tracheostomy is a 9-month-old pediatric simulator with a controllable tracheostoma. It allows you to train for specific learning objectives on initial assessment and treatment, in addition to realistically simulating tracheostomy care.
Obesity continues to be a hot topic among our customers and when speaking with you it seems that there is a growing need to rescue bariatric patients.
Survival Technology is proud to announce the new partnership with Kyoto Kagaku
The first Patient Communication Simulator that sees, listens, and responds using artificial intelligence (AI). ALEX is an untethered, on-the-go patient simulator
For most women, pregnancy is a time of anticipation and change. Emotions of joy and anxiety collide as hormone levels increase to accommodate new life. But, for some women, the fear of miscarriage is ever-present.
As the global source of the official resuscitation science and education guidelines used by training organizations and healthcare professionals, the 2020 American Heart Association Guidelines for CPR and ECC deliver the latest resuscitation science education available to ensure the highest quality of care of improved outcomes.
Provide CPR training from anywhere
The Pool Rescue Manikin is a revolutionary new product designed to innovate the way lifeguard training is conducted. This product brings together different elements of lifeguard training, allowing trainees to seamlessly practice different techniques without needing to switch between different equipment or live volunteers. We think that this lifeguard training manikin is the ideal tool for all leisure centres, swimming pools and clubs.
A variant model of our popular Man Overboard manikin, the Helicopter Winch Manikin was designed in consultation with the experts at Bristow Helicopters UK to provide a solution for training horizontal lifts from the water.
Each year, more than 700 women die in the United States from pregnancy related complications; the highest number compared with other high-income countries.
Medication errors cause at least one death every day and injure approximately 1.3 million people annually in the United States
iSimulate just released a free Point of Care Training Kit to the app store. It simulates multiple point-of-care devices in one and works on mobile phones. The app simulates the following devices for Point of Care training:
Simulation is not only about technology - simulation is about techniques, skills, and also insights into communication, teamwork, and leadership.
During the COVID-19 pandemic, identifying the signs of sepsis is more important than ever. Yesterday was World Sepsis Day. Learn more about sepsis
Trainer for hemorrhage control on upper extremity with realistic wound and bleeding simulation. Improve pre-hospital patient care training with instructional and hands-on training of hemorrhage control with wound packing and tourniquet application
SimMom and MamaBirthie combined provides an impactful simulation toolkit, which can be used at different stages of the Circle of Learning to support a complete learning experience.
Implement skills development training in donning and doffing PPE in a way that allows clinicians to practice until confident and competent. This e-learning course and scenarios for peer-to-peer skills enables healthcare providers to train effectively with minimal facilitators required.
The Coronavirus disease (COVID-19) has created a healthcare crisis that has put a major training burden on hospitals, emergency medical services, and long-term care facilities, among others.
High-tech mannequins are being used to help local doctors prepare for a possible surge of patients with COVID-19 symptoms.
The Laerdal Airway Management Trainer realistically simulates an







adult airway, and the lifelike upper torso and head can be used







to demonstrate and practice intubation, ventilation and suction







techniques. In addition it can be used to demonstrate upper airway







bronchoscopy and bronchoscopy guided endotracheal intubation.
The Airway is intended for single use and are non-cleanable.






It is to be disposed after one CPR class (training session), if mouth-to-mouth ventilation has been performed.






This is also recommended if the Laerdal Manikin Face Shield has been used during the CPR training.






The Airway is intended for single use and are non-cleanable.






It is to be disposed after one CPR class (training session), if mouth-to-mouth ventilation has been performed.






This is also recommended if the Laerdal Manikin Face Shield has been used during the CPR training.
SimCapture allows you to effectively manage, record, and assess simulation training, both on-site and in-situ. Capture audio, video, annotations, patient monitors, and simulator data in a single web-based interface.
The Norwegian Prime Minister announced today together with Laerdal Medical’s Chairman and CEO Tore Laerdal, a new emergency ventilator that will double the amount of ventilators in Norway.
During the COVID-19 outbreak the World Health Organisation (WHO) has released the following






























information about environmental cleaning.
The Advanced Catheterization Trainer Set contains both the Male and Female Catheterization Trainers, a pelvic shell & stand for each separate module, and two water systems.
The new Little Baby QCPR and Resusci Baby QCPR manikins are designed to deliver quality infant CPR training through real-time and summative performance feedback.
To limit spread of virus during CPR training we advise all users of products from Laerdal,






to study this Knowledgebase article
The Emergency Evacuation Manikin was designed in response to the growing demand for a manikin suitable for emergency evacuation training within care homes and other health care settings.
Over the past few years, escape rooms have become an increasingly popular educational and training tool. Used originally as a fun social activity, escape rooms are now being used as a means to drive learning.
SimBaby with Tracheostomy is a 9-month-old pediatric simulator with a controllable tracheostoma. It allows you to train for specific learning objectives on initial assessment and treatment, in addition to realistically simulating tracheostomy care.
Increased realism with a simulated AED and defibrillator monitor
The training and education benefits of using simulation in a clinical environment have been proven across healthcare. Learners who participate in simulation training see improvements in retention, skills acquisition, and confidence compared to those who experience only didactic training.
The Little Anne QCPR manikin helps instructors improve the quality and efficiency of bystander CPR training while adding a fun and engaging element for learners.

Now available with a QCPR Race game to help make learning “stick,�? plus a QCPR Classroom app for training large groups, Little Anne QCPR brings CPR training to the next level.
Achieving student engagement is a fundamental challenge in any form of education, especially when the student is a beginner or is someone refreshing their skills. If you are an instructor in Cardiopulmonary Resuscitation (CPR), you've likely struggled to keep people engaged - especially when teaching laypeople.
Our newly improved Catheterization Trainer Range facilitates the teaching of urethral and suprapubic catheterization for all levels of training.
With realistic chest stiffness, hand placement sensor, and the new SkillReporter app, Resusci Baby QCPR offers a new level of precision training for treating babies in cardiac arrest.
Little Baby QCPR is a realistic and affordable BLS manikin for pediatrics. By utilizing gamified learning and objective feedback, Little Baby QCPR improves training quality, learner engagement, and classroom efficiency.
Staff in every sector need training to effectively handle heavier people.
Official Distributor South Africa