Elevating VHA Organizational Learning to the Next Plateau

Manny Dominguez, PhD, Deputy Chief Learning Officer at the VHA Employee Education System . (Photo: Department of Veterans Affairs)

Marty Kauchak spoke with Manny Dominguez, PhD, Deputy Chief Learning Officer at the VHA Employee Education System, regarding learning technology developments at his organization.

Dr. Dominguez shared insights on a number of i­ssues, from patient safety to standards to serious gaming for medical learning. Highlights of their December 15, 2014 interview are provided.

MEdSim: Thanks for taking time to speak with MEdSim. This is an opportunity to share with our readers some of your insights presented at the 2014 I/ITSEC’s Veteran’s Health Administration panel discussion: NextGeneration Simulation-based Training Initiatives – and of course, expand on comments generated today.

Manny Dominguez: You are welcome. The takeaways I wanted to communicate with everybody was that here in Orlando our national simulation footprint is taking a foothold right now. The combination of building this National Simulation Center, which the whole VHA is excited about, is a center of excellence for VA medical simulation training across the nation. It will help health care providers become even more proficient in what they do and feel more confident about what they do, thus enhancing patient safety. We have providers that are trained in technologies that have a very “real” feeling – working with state-of-the-art mannequins, virtual technologies and virtual patients. All of these technological advancements they are doing in the end could help the outcome of a patient, because the health care provider received world-class training, with the latest emerging technologies. This will positively impact our most treasured customers, our nation’s veterans. Many of our health care providers are veterans themselves, including myself, so we have a vested interest in seeing medical simulation training having a huge impact. This work is something we’re excited about at the National Simulation Center.

MEdSim: You’re aware patient safety is a major editorial focus of MEdSim?

MD: Patient safety is a huge concern in any health care organization. It is one of our primary concerns because we want our providers to be trained, to be among the best providers in the world. And we want our veterans to get the best care in the world. To do that, safety has to be at the top of our list. Furthermore, it is a “work-backward” kind of thing – to have industry-leading patient safety statistics, you want to make sure your providers are getting world-class training. And to get world-class training you work backwards and ask, “What do I need to do to provide that?” You have hands-on training, mentoring and also mannequin (simulation)-based training, and the best virtual technologies. All of these things have a goal of producing world-class providers. The impact of that is enhanced patient safety and a confident, well trained staff of health care providers.

MEdSim: You must also be collaborating with some of the other panel members who joined you at I/ITSEC?

MD: Yes, Dr. Haru Okuda, SimLEARN’s national medical director, for instance, is a top subject-matter expert. We have a consortium of SMEs across the VA that are doctors and nurses. From a technologist’s perspective, we want to make certain the training solution is robust, looks great, that providers can perform all the functionality available and have access to it from anywhere. There is always the other half, which is putting the health care provider in front of it. So, I want the doctors to come up with the best ideas of how to: create standards, apply this technology and training, how to deploy these best practices to the field, along with inserting content and other objectives.

MEdSim: And your office also has other technical projects in progress including the National Simulation Portal, also called the Simulation Learning, Education and Research Network (SimLEARN) Portal.

MD: Yes. These have been a boon for us because we have been able to technically centralize simulation center operations across the country. We have VA simulation training sites across the country, and now they each have a homepage within the greater centralized SimLEARN Portal (a national simulation training portal). The sim sites can have their own content, scenarios and best practices. And of course we are launching what we call the SimTube, a comprehensive video center of all simulation training videos – hundreds, soon to be thousands – of “how to” videos: how to open a new mannequin from the box and set it up for operation; how to insert a needle; how to perform a surgical procedure, and all the other how-tos, we are building in SimTube for all the providers across the country. Very similar to what you’d see in other industry sites like ESPN, CNN, etc. with their video centers. Ours will be all about medical simulation best practices. SimTube is already up and running and we are about to unveil it!

MEdSim: We’re aware that on a larger scale VHA plans to increase access to VA resources through the VA Virtual Medical Center.

MD: Access is a very broad term. We’re focused on access to education, so patients can gain access to all VA resources to learn about their illness. We want to make it worth their effort to access the center and make it accessible no matter where they are – at home or even using an iPad on the beach. We want that education to come to them, and the same thing for providers. We want providers to come online and share best practices with other providers in a virtual world environment, walking around as an avatar, using VOIP (voice over Internet protocol), IM (instant messaging), gestures etc. They can have meetings and use voice so they can hear each other. They can show images, documents, slides, videos and have “teaching moments’ for their professional colleagues, wherever they are located. We’ll have providers teaching providers. We’ll have providers teaching wellness classes to patients, and even have patients collaborating with other patients that have the same diseases. They can share best practices, the care they are getting and other topics. It’s like building the next VA hospital, only this one is online, with not a regional perspective, but a national perspective. Lots of opportunities with this technology.

MEdSim: And VHA is in the beta phase of this project?

MD: Yes, we’re rolling out the beta product to every region of the country, to a flagship hospital as the first beta customer. We’re expecting them to initially bring in a controlled set of patients and for providers to use it and provide us with feedback. We will then review and make those modifications that they requested. We’re looking for specialization for each region. For example, the Northwest may do behavioral health. Another region may focus on diabetes and hypertension. We want to look at the major reasons why patients are admitted to our facilities and use the Virtual Medical Center to address those issues, educate stakeholders on those issues and seek collaboration on those issues. We want to increase access, educate, collaborate, help improve outcomes and do this in a virtual world modality that speaks to our newest generation of Veteran patients that are very familiar with these technologies.

MEdSim: To follow up further, is VHA pursing standardization in training among the regions with Virtual Medical Center?

MD: That’s one of the primary goals of both the SimLEARN portal and Virtual Medical Centers. With the portal all of these simulation sites across the country will look left and right, and say, “Hey, that’s working really well for them, so let’s use that for our standard.” The next thing is to have standards across the board. So for the first time healthcare providers are seeing resources and best practices across the nation rather than working inside a “silo” in their own sim center. That’s forcing the standards of how we do business. One time they will look at scenarios and curricula and want to use this or that, or replace the old one and soon the whole country is using the same standard. We want to do that same thing with the Virtual Medical Center but in a different modality.

MEdSim: How will these standards intersect with standards under development by associations, accrediting bodies and other entities in the private and public sectors of the health care community?

MD: At the VA we’re doing more and more each day to deal with the folks that need training. But almost 80 percent, the figure I recently read, of doctors in the US at some point or another in their career actually “touch” VA training – that’s an incredible figure. That’s a large number for them to, at some point in their career, complete an internship or other experience where they touch the VA system to get hands-on work, training, online classes etc. We’re actually purchasing and integrating a learning management system (the LMS product TRAIN) for the external world – for those not employed by the VA – but who may have ancillary needs to get VA training to be a volunteer or intern; to complete continuing education or for other purposes. We’re integrating a tool that will allow them to do e-learning and stay proficient in the things the VA needs them to be proficient in, and for the first time capture those metrics.

MEdSim: You are uniquely positioned to see innovations across the health care simulation and training sector. While you’re not a VHA acquisition decision maker, do you have any suggestions for the S&T industry as it develops and refines its product offerings?

One of the things the simulations and training industry needs to continue to be sensitive to is that simulation is one of the most effective ways of training a medical provider of caregiver. One the other hand, it can also be one of the more expensive ways of training someone. (Photo: Department of Veterans Affairs)

MD: One of the things they need to continue to be sensitive to is that simulation is one of the most effective ways of training a medical provider or caregiver, because it can be a virtual environment, a virtual reality for continuous training. On the other hand it can also be one of the more expensive ways of training someone. What they need to understand is yes, simulation can save lives, can help people be proficient. There’s nothing like lifting a mannequin that weighs as much as a human body, putting it on the bed, going through the procedures of making him talk and gesturing and see the mannequin bleeding, having shortness of breath and much more. Nothing beats that virtual experience as a learning modality. Industry needs to modularize how the training is rolled out. Say a serious medical game, it’s good if you can buy one platform and use many, and configure it to different types of genres in training with different types of medical specialties instead of buying a whole new game or infrastructure. The same thing with mannequins.

MEdSim: On the topic of serious games, how is this sector advancing – in light of some of these products you saw at 2014 I/ITSEC?

MD: I think it is still very slow in health care, the slowest it has been in the last few years – it’s been a bit stagnant. We are seeing much more growth in serious games for the defense sectors, drones that are being simulated, learning to drive emergency vehicles and other military trucks. That area is currently expanding a lot more. Health care seems slower to reach because budgets in many sectors are very tight. But here at VHA, we are not slowing down, our nation’s veterans deserve the best and we neither want them to wait or slow down. We’re coming out with our first roll out of probably half a dozen serious medical games and many other leading technologies I just mentioned. We’re completing those now and most of these will be rolled out between January and September 2015. It’s a ton of work, but we are making it happen!