Diaz-Navarro Cristina, Jones Bridie, Pugh Gethin, Moneypenny Michael, Lazarovici Marc, Grant David J
Health Education and Improvement Wales, Cardiff, UK.
Cardiff and Vale University Health Board, Cardiff, UK.
Adv Simul (Lond). 2024 Jul 17;9(1):30. doi: 10.1186/s41077-024-00300-8.
Simulation educators are often requested to provide multidisciplinary and/or interprofessional simulation training in response to critical incidents. Current perspectives on patient safety focus on learning from failure, success and everyday variation. An international collaboration has led to the development of an accessible and practical framework to guide the implementation of appropriate simulation-based responses to clinical events, integrating quality improvement, simulation and patient safety methodologies to design appropriate and impactful responses. In this article, we describe a novel five-step approach to planning simulation-based interventions after any events that might prompt simulation-based learning in healthcare environments. This approach guides teams to identify pertinent events in healthcare, involve relevant stakeholders, agree on appropriate change interventions, elicit how simulation can contribute to them and share the learning without aggravating the second victim phenomenon. The framework is underpinned by Deming's System of Profound Knowledge, the Model for Improvement and translational simulation. It aligns with contemporary socio-technical models in healthcare, by emphasising the role of clinical teams in designing adaptation and change for improvement, as well as encouraging collaborations to enhance patient safety in healthcare. For teams to achieve this adaptive capacity that realises organisational goals of continuous learning and improvement requires the breaking down of historical silos through the creation of an infrastructure that formalises relationships between service delivery, safety management, quality improvement and education. This creates opportunities to learn by design, rather than chance, whilst striving to close gaps between work as imagined and work as done.
模拟教育工作者经常被要求针对重大事件提供多学科和/或跨专业模拟培训。当前关于患者安全的观点侧重于从失败、成功和日常变化中学习。一项国际合作促成了一个易于理解且实用的框架的开发，以指导对临床事件实施适当的基于模拟的应对措施，将质量改进、模拟和患者安全方法整合起来，以设计适当且有影响力的应对措施。在本文中，我们描述了一种新颖的五步方法，用于在任何可能促使医疗环境中基于模拟学习的事件之后规划基于模拟的干预措施。这种方法指导团队识别医疗保健中的相关事件，让相关利益攸关方参与进来，就适当的变革干预措施达成一致，找出模拟如何能对这些措施有所贡献，并分享经验教训而不加重“二次受害者”现象。该框架以戴明的深刻知识体系、改进模型和转化模拟为基础。它与医疗保健领域当代的社会技术模型相一致，强调临床团队在设计适应和变革以实现改进方面的作用，同时鼓励开展合作以提高医疗保健中的患者安全。对于团队来说，要实现这种适应能力以达成持续学习和改进的组织目标，需要通过创建一个将服务提供、安全管理、质量改进和教育之间的关系正规化的基础设施来打破历史上的壁垒。这创造了通过设计而非偶然进行学习的机会，同时努力缩小设想中的工作与实际完成的工作之间的差距。
