Training in Teams To Get To Higher Reliability

This week, GBMC took a significant step forward in our ability to make our care more reliable with the opening of our new Simulation Lab in the South Chapman Building.  Such technology is not frequently found at community medical centers. 

Kudos to the GBMC Foundation, who led the effort to raise $650,000 to make the idea for a simulation training lab a reality.  In particular, we appreciate the financial support from the LaVerna Hahn Charitable Trust, The Middendorf Foundation, and The Women's Hospital Foundation.

The notion of training as a team in a simulated environment is a huge step forward and is a critical part of our movement towards higher reliability, one of the underlying tenets of patient safety.

Commercial aviation – a field which we in healthcare often learn a lot from – has for years been using the simulation environment for training staff in preparing for low frequency, high-risk eventualities.  They don’t have a pilot simulation lab, they have “team” simulation labs where a pilot, co-pilot and other staff train together.  One of the reasons why Sully and his co-pilot were able to safely put their airplane down in the Hudson River ("Miracle On The Hudson”, January 2009) and everyone on board managed to escape without serious injuries was because they trained for eventualities. Although they didn’t plan for that exact scenario, they practiced and understood that time was of the essence in a high risk situation.

It takes a team to get it right for every patient, every time. Our teams now have the ability to train in a simulated patient environment to be ready for the real life situation.  

There’s an old adage in the medical profession “See One, Do One, Teach One”, where seeing, doing and teaching are all essential steps to one gaining new skills.  If it was your mother receiving care from a new medical professional you wouldn’t like that the trainees watched the procedure one time and then did it in real life. You’d much prefer that they began their learning in a simulated environment and not on an actual patient. 

Some staff have actually been utilizing the Simulation Lab already, and Nursing Education recently finished bringing new nursing graduates through the lab helping ready them for the beginning of their clinical experience.  Medical residents are planning time in the lab as well.

The lab includes five adult, two infant and one child mannequins – each with different functionalities designed to test various skills and simulate a wide range of real-life medical conditions.  

New graduates and Nursing Support Technicians for example can get basic and refresher training in skills such as starting IVs, taking blood pressure and monitoring other vital signs.  Some of the mannequins can simulate a patient’s chest rising and falling, shortness of breath and varying pulses. The “top of the line” mannequin, known affectionately among the training staff as “3G Man”, is almost lifelike.  His eyes blink, he sweats and drools, and staff can administer medications to him.  3G Man will also respond appropriately to actions taken by staff, so if they make a mistake – which is OK to do in the simulation training environment – he will respond accordingly and his condition will deteriorate.

The lab also features a dedicated Labor and Delivery Room, in which various mother and baby scenarios can be practiced.  The mother mannequin actually resembles a pregnant woman, and staff can administer an epidural and common drugs that would typically be found in a birthing situation.  Newborn baby and young infant  mannequins are also included to allow for various childbirth and Neonatal Intensive Care Unit (NICU) scenarios.

Our Maternal Newborn Health staff, through the Kaiser Perinatal Patient Safety Program, will also be training in Crew Resource Management (CRM) through a program called TeamSTEPPS - Team Strategies and Tools to Enhance Performance and Patient Safety.

The TeamSTEPPS program aims to provide higher quality, safer patient care by:

• Producing highly effective medical teams that optimize the use of information, people, and resources to achieve the best clinical outcomes for patients
• Increasing team awareness and clarifying team roles and responsibilities
• Resolving conflicts and improving information sharing and eliminating barriers to quality and safety.

TeamSTEPPS was developed by the Department of Defense Patient Safety Program in collaboration with the Department of Health & Human Services’ Agency for Healthcare Research and Quality.

The underlying concept of TeamSTEPPS is called Crew Resource Management (CRM), in which the belief is that team members all know their role and know who their leader is, but also understand that they are protected by the organization’s Just Culture and can speak openly in order to get the best possible outcome in an emergency.

Congratulations and thank you to all who made our simulation center a reality! The GBMC HealthCare system continues to improve and gets closer to our vision!

What do you think about the use of simulated training in teams? Please share your comments below.