Dr. Timothy Willett is SIM-one/CNSH's president and CEO (appointed in 2016) and was previously their inaugural director of Research & Development. He is passionate about bringing together the simulation community for mutual support, to improve the quality of simulation across Canada, and to advance the scope of simulation’s uses. He was appointed CEO just before the integration of SIM-one and CNSH, which he was proud to play a role in. With the guidance of the Board of Directors and support of the phenomenal SIM-one/CNSH team, Tim is responsible for the day-to-day operations of the network. Tim received his MD from the University of Ottawa and a Masters of Medical Education from the University of Dundee, Scotland. He has served as a curriculum developer and educational researcher for the University of Ottawa, CRI Critical Care Education Network, and Royal College of Physicians and Surgeons of Canada.

The Simulation Canada nomination said: “SIM-one/CNSH (about to become Simulation Canada) primary target is to advance the use of simulation for system- and team-level applications of simulation to improve patient safety and care quality.”

Moving the Needle on Safety & Quality

SIM-one, the Canadian Network for Simulation in Healthcare (SIM-one/CNSH), is prioritizing advocacy of simulation as a strategy to advance patient safety and care quality in the clinical setting. As a national network, we believe in the incredible potential for simulation, when applied at the team- and system-level, to do good for healthcare.

Within the field of patient safety, there has been much progress in researching and identifying evidence-based best practices for a vast array of clinical processes and medical conditions. These are often published as ‘bundles’ for improvement. However, the full impact of this work remains unrealized. Adverse event rates, the target for which is zero, continue to be unacceptably high; the major barriers to advances in patient safety relate to contextualized implementation, institutional reliability, and safety culture (Baker, 2015).

This is where simulation is showing promise to make a difference. In this context, our understanding of simulation as an educational tool is evolving as an improvement and change tool (Paige et al., 2018). Evidence to support such applications is quickly growing, including justifications for the return on investment and meaningful improvements in patient outcomes, process reliability, system efficiency, and teamwork.

Innovative Applications for Simulation

Some Canadian hospitals and simulation teams are working at the leading edge of system- and team-level applications of simulation. For example, simulation teams at several sites use simulation to develop and test new or high-risk processes and procedures, identifying latent safety threats before the process is even implemented. At some hospitals, such safety threats can be entered into the same reporting system as actual adverse events.

Several hospitals are using simulation through the design, build, and commissioning phases for new clinical spaces, helping to design spaces that are optimized for natural human workflow.

When a safety or quality gap is known, simulations can help to develop and implement remediation strategies. One hospital in Canada implemented a simulation-based module on the early warning signs of sepsis, and has seen a significant reduction in critical care unit admissions for hospital-acquired sepsis, decreased lengths of stay, and decreased mortality - lives have been saved from this intervention. Other hospitals have brought together their human factors and safety/quality teams to better design improvement interventions.

In-situ simulations - simulations that happen in active hospital departments - are becoming more common, and can range from quick skills refreshers (such as a five-minute quality CPR refresher) to full-scale, unannounced mock codes to test system responses to crises and provide team feedback.

At one hospital, a code red response team could not find the patient, who collapsed in a lesser-known corner of the hospital. The hospital then developed a virtual reality game to orient its staff to the full hospital.

One hospital in Toronto used a series of simulations to rehearse their surge response to a mass casualty event, in the months before such an event actually happened. Clinicians spoke of the smoothness and efficiency of their response to the event, and that everyone knew what to do, despite the chaos.

In their critical care unit, one hospital uses “just-in-time” simulations in the morning to simulate a medical crisis that might actually happen that day, based on the patients currently in the unit.

At the team level, simulations are being used to improve and standardize communication at handoff, which is known to be a high-risk point for error. Some hospitals are using simulations to directly address issues of safety culture, such as just culture, organizational hierarchy, and “speaking up.” Simulations are being used to increase appreciation of the risk of errors and how standardized processes can reduce this risk.

At a hospital where nurse attrition in the critical care unit was particularly high, simulations were used during orientation and professional development sessions to improve nurse self-efficacy and feelings of being valued and having organizational support, with the goal to decrease the attrition rate.

Simulations empower patients and caregivers. At one hospital, families of children with newly-diagnosed epilepsy can rehearse their response to a seizure at home, greatly increasing their comfort at discharge. At another, patients equipped with insulin infusion pumps undergo simulations to understand how to properly use them.

Teams are also bringing simulations out of the hospital into the communities they serve. For example, a medical assistance in dying simulation was enacted to raise awareness of the decision-making and clinical processes behind this difficult decision, and to facilitate discussion about this controversial option.

Advocating for Simulation

To expedite the spreading and scaling of hospital-based simulation programs, advocacy has become a focus for our national network.

To this end, three years ago we launched the “National Forum on Simulation for Quality & Safety,” a one-day conference to explicitly celebrate innovations and achievements in this area, to connect leaders and share knowledge, and to raise awareness of these opportunities to key stakeholders, such as government and provincial quality/safety councils. (The next National Forum is May 28, 2019, in Vancouver, British Columbia.)

SIM-one/CNSH is a member-based, non-profit network. It is especially important for us to have members such as the Canadian Patient Safety Institute (CPSI; whose CEO recently joined our Board of Directors) and the Healthcare Insurance Reciprocal of Canada, both of which are major stakeholders and advocates for safety and quality improvement.

We are working with CPSI to integrate simulation into their patient safety improvement strategies, including the recently-launched TeamSTEPPS Canada program. We are in the process of developing additional educational programs around simulation specifically in the hospital setting.

Also in collaboration with CPSI, we have authored a white paper that reviews the accumulating evidence for the impact simulation can have on patient safety and quality improvement, and the scope of applications of simulation. This will be published in 2019.

Finally, we worked with CAE Healthcare to bring their OnBoard program to North America for the first time. This program connects the worlds of aviation and healthcare by engaging healthcare leaders in a day of learning about standardized processes and the role of simulation in aviation, and brief flight training that culminates in the leaders flying a commercial airplane in a full-fidelity flight simulation.

We have seen the difference simulation has made in the healthcare education sector. Yet this is just the tip of the iceberg compared to the positive impacts simulation can have in the clinical setting. This represents another revolution in healthcare, with different applications and purposes than in the education sector. The opportunities to do good are tremendous, and we are excited to be part of it.

Participants at the 2018 SIM Expo in Calgary, Alberta, learn from a live simulation demonstration from corrections officers. Image Credit: Venus Sinson.
Participants at the 2018 SIM Expo in Calgary, Alberta, learn from a live simulation demonstration from corrections officers. Image Credit: Venus Sinson.

The Evolution of Canada’s Simulation Network

SIM-one/CNSH is the member-based, interprofessional national network connecting healthcare simulation centres and professionals across Canada and beyond. We grew out of the integration of SIM-one, which was formerly focussed on advancing simulation in the province of Ontario, and the Canadian Network for Simulation in Healthcare, which had established cross-country links, especially in medicine.

At our last Annual General Meeting, our membership unanimously voted to change our name to Simulation Canada, reflecting the reinvigorated national scope of the network. The new name will be implemented in 2019.

Our vision: Exceptional healthcare through simulation.

Our mission: We advocate and advance simulation to improve healthcare education, patient safety, and quality improvement; and connect all healthcare and human service professions, disciplines, and care delivery sectors.

As a member-based network and community, our strength lies in the diversity and passion of our members, both organizations and individuals. Our members contribute to and benefit from the connections, knowledge, and resources of the network.

Participation and membership are open to individuals, organizations (hospitals, universities, colleges and associations), and simulation businesses, and is not restricted to Canadians. Please visit us at http://www.sim-one.ca/join for more information.

In addition to the National Forum on Simulation for Quality & Safety, we are the proud host of the SIM Expo, Canada’s annual interprofessional simulation conference. We offer foundational and advanced professional development courses in simulation-based education, as well as the Keystones Certificate in Healthcare Simulation.

We also host a number of free, online services that are open to simulationists and health professionals across the globe. This includes the SIM Scenario ExchangeTM for peer-reviewed simulation scenarios and tools, the SIM MarketplaceTM for the buying and selling of gently-used simulation equipment, the SIM Product Directory, and more. 

References

1. Jacques Marescaux, Joel Leroy, Michel Gagner, Francesco Rubino, Didier Mutter, Michel Vix, Steven E. Butner & Michelle K. Smith. Transatlantic robot-assisted telesurgery. Nature, volume 413, pages 379–380 (27 September 2001) www.nature.com/articles/35096636

2.  Intuitive Surgical Investor Presentation - Q3 2018. (August 2018). https://isrg.intuitive.com/static-files/8bbddc9e-579c-47a1-ac91-fabe26e5e278

Originally published in Issue 1, 2019 of MT Magazine.