Szabo Rebecca A, Molloy Elizabeth, Allen Kara J, Francis Jillian, Story David
Department of Critical Care, Melbourne Medical School, The University of Melbourne, Melbourne, VIC, 3052, Australia.
Department of Obstetrics and Gynaecology, Melbourne Medical School, The University of Melbourne, Melbourne, Australia.
Adv Simul (Lond). 2024 May 20;9(1):21. doi: 10.1186/s41077-024-00294-3.
There is limited research on the experiences of people in working to embed, integrate and sustain simulation programmes. This interview-based study explored leaders' experiences of normalising a simulation-based education programme in a teaching hospital. Fourteen known simulation leaders across Australia and North America were interviewed. Semi-structured interviews were analysed using reflexive thematic analysis sensitised by normalisation process theory, an implementation science theory which defines 'normal' as something being embedded, integrated and sustained. We used a combined social and experiential constructivist approach. Four themes were generated from the data: (1) Leadership, (2) business startup mindset, (3) poor understanding of simulation undermines normalisation and (4) tension of competing objectives. These themes were interlinked and represented how leaders experienced the process of normalising simulation. There was a focus on the relationships that influence decision-making of simulation leaders and organisational buy-in, such that what started as a discrete programme becomes part of normal hospital operations. The discourse of 'survival' was strong, and this indicated that simulation being normal or embedded and sustained was still more a goal than a reality. The concept of being like a 'business startup' was regarded as significant as was the feature of leadership and how simulation leaders influenced organisational change. Participants spoke of trying to normalise simulation for patient safety, but there was also a strong sense that they needed to be agile and innovative and that this status is implied when simulation is not yet 'normal'. Leadership, change management and entrepreneurship in addition to implementation science may all contribute towards understanding how to embed, integrate and sustain simulation in teaching hospitals without losing responsiveness. Further research on how all stakeholders view simulation as a normal part of a teaching hospital is warranted, including simulation participants, quality and safety teams and hospital executives. This study has highlighted that a shared understanding of the purpose and breadth of simulation is a prerequisite for embedding and sustaining simulation. An approach of marketing simulation beyond simulation-based education as a patient safety and systems improvement mindset, not just a technique nor technology, may assist towards simulation being sustainably embedded within teaching hospitals.
关于人们在努力嵌入、整合和维持模拟项目方面的经历的研究有限。这项基于访谈的研究探讨了教学医院中领导者将基于模拟的教育项目常态化的经历。对澳大利亚和北美的14位知名模拟领导者进行了访谈。使用由常态化过程理论激发的反思性主题分析对半结构化访谈进行了分析，常态化过程理论是一种实施科学理论，将“常态”定义为某种被嵌入、整合和维持的事物。我们采用了社会和经验建构主义相结合的方法。从数据中生成了四个主题：（1）领导力，（2）创业心态，（3）对模拟的理解不足会破坏常态化，（4）相互竞争目标的紧张关系。这些主题相互关联，代表了领导者对模拟常态化过程的体验。重点关注影响模拟领导者决策和组织认可的关系，使得最初作为一个离散项目的模拟最终成为医院日常运营的一部分。“生存”的话语很强烈，这表明模拟达到常态化、被嵌入和维持仍然更多是一个目标而非现实。像“创业”这样的概念被认为很重要，领导力的特征以及模拟领导者如何影响组织变革也很重要。参与者谈到试图为了患者安全将模拟常态化，但也强烈感觉到他们需要灵活且创新，并且当模拟尚未“常态化”时就意味着这种状态。除了实施科学之外，领导力、变革管理和创业精神都可能有助于理解如何在教学医院中嵌入、整合和维持模拟，同时又不失去响应能力。有必要进一步研究所有利益相关者如何将模拟视为教学医院的正常组成部分，包括模拟参与者、质量与安全团队以及医院管理人员。这项研究强调，对模拟的目的和广度达成共同理解是嵌入和维持模拟的先决条件。将模拟作为一种患者安全和系统改进思维方式而非仅仅一种技术或工艺进行推广的方法，可能有助于模拟在教学医院中得以可持续地嵌入。
