Mirette Dube, Sue Barnes, Theresa Cronin, Cherie Serieska, Erica Meunier, AnnaMaria Mundell, Jennifer Semaka, Tara Fusilli, Dan Duperron, Rob Ritchie, Ayan Mack, Darren Steidl, Mark Allen, Alyshah Kaba and Marlene Donahue describe Alberta’s simulation success and community value.
Have you heard of the largest provincial simulation program in Canada “eSIM”? eSIM stands for Educate, Simulate, Innovate and Motivate and is the Alberta Provincial Simulation Program which was founded in 2009.
Our Geographical Location
Within a geographical area of 661,848 square km (AHS, 20191), Alberta Health Services (AHS) is the single health authority for the Canadian province of Alberta. AHS delivers medical care to greater than 650 facilities including 106 acute care hospitals, clinics, 25,653 continuing care beds/spaces, five stand-alone psychiatric facilities, 2,723 addiction and mental health beds and 243 community palliative and hospice beds. AHS has over 110,000 direct employees, and close to 10,300 physicians with care provided to 4,067,175 citizens. Service accountability zones are broken down into five geographical areas North, Edmonton, Central, Calgary and South (Figure 1).
The eSIM program began over 10 years ago and has grown rapidly since inception. Beginning as a grass roots program supporting uni-professional and multi-professional sims and just one hospital-based simulation lab, eSIM now support an estimated 23,000 learners per year across the province of Alberta (2018) (Figure 2). The provincial team resides within the Quality and Healthcare Improvement portfolio and consists of 17 simulationists, an education and booking coordinator, three biomedical engineers, a medical director, a research scientist, and leadership team including administrative support.
Simulation Lab Build(s) and Development
eSIM are leaders in the design and development of simulation labs across the province.
Starting out in 2009 with one simulation lab, this program currently facilitates the operation of over ten state-of-the-art simulation labs; eSIM’s footprint continues to grow. Once eSIM acquires a new space, they lead the development and mentorship of the lab and teams that use it.
With strategy, marketing, education on the proven benefits of simulation-based education (SBE) and systems focused simulation, eSIM is well situated to accommodate the thousands of learners using simulation across the province. The team has worked to collaborate with new build and project committees, is well connected with senior leaders and physicians, media, philanthropy, patients and families, and many clinical (i.e. nurses, respiratory therapists, allied health, etc.) and non-clinical teams (i.e. protective services, porters, unit clerks, etc.). They work with the health trust fundraising programs to acquire funds for lab equipment and mannequins and present various demonstrations for media. eSIM currently owns and maintains over 150 high fidelity mannequins!
Responding to a vast physical expanse of the province, the mobile simulation program was launched in 2011. Many of these mobile simulations involve one or two team members travelling out to rural areas of Alberta, meeting new teams, and mentoring them in SBE and simulation curriculum. Site requests came from rural hospitals, health community clinics and urgent care environments. Subsequent growth has continued to now include service areas such as the prison system (i.e. corrections centers), school boards, doctor’s offices and clinics. The program owns nine fleet vehicles to support a mobile simulation program reaching all areas of the province (see Figure 1).
"The future is about meeting people where they are, understanding their needs and building strong teams so that they can provide the best care to Albertans despite their geography," eSIM Simulationist.
Focusing on Team Training
eSIM takes pride in its Interprofessional approach to team training with hundreds of teams across the province. Creating a culture of true interprofessional collaboration (IPC) defined as learning about, from and with each other; means that everyone involved in the actual work environment is represented in the simulation scenario development, facilitation and debriefing. Our philosophy is that no one profession can accurately embody that of another, and so having all professions represented is key to building a culture of IPC.
Teamwork improves patient safety and supports individual and team learning across the continuum of care including all areas within critical care, medicine, clinics, advanced care planning teams, mental health, corrections centers, labor and delivery, post-partum and many more! With the task of supporting so many learners and teams from all facets of healthcare, eSIM uses a formalized online booking process for mannequins, lab space and location, mobile requests, simulationists support requests and collecting program statistics.
Focusing on Systems Integration
eSIM has also grown to be leaders in systems integration simulation and debriefing (Dube, M et al, 20192, 3) using simulation to test the processes, environments and systems in which we work. These simulations can be utilized at any point in time although are often being used to proactively identify systems issues including latent threats to patient safety prior to a process or new space being used by care teams.
The use of systems integration simulations led to an influx of demand for large scale systems-based projects for eSIM. There was an undeniable benefit to rehearsing highest impact and highest frequency changes with healthcare teams to test and assess multiple new builds, and processes (i.e. Patient care protocols, pathways) through simulation and debriefing. These simulations created another means for front line providers, leaders, provincial networks, and quality and safety experts to realize the benefits of simulation. This is a valuable tool to engage frontline teams to identify safety issues, problem solve together, and improve patient safety proactively in a safe environment.
Simulation Debriefing Course
The flagship simulation course offered across the province is called ‘WISE” which stands for Workshop in Simulation Education. The course provides an introduction to core simulation concepts and principles to novice and intermediate simulation educators. WISE is an interactive and immersive course delivering a mix of didactic, small group and simulation-based activities. Participants are introduced to topics including experiential learning, creating realism in simulation, pre-briefing, debriefing (Eppich WJ, Cheng A, 20154) frameworks effective teamwork skills, and scenario development.
Following WISE, simulationists mentor course graduates in SBE including pre-briefing, scenario design, learning mannequin operation, and debriefing. The goal of WISE and mentorship is competence and independence in SBE. The provincial team of 17 simulationists facilitate this course six to eight times/year on average and a total of 1,288 staff have attended over the past 10 years. The mentorship program is designed to train simulation facilitators to operate their programs independently with support as needed from eSIM. This model has been successful in building capacity for simulation across the province of Alberta. eSIM mentors team members from all healthcare backgrounds and roles in SBE and is proud of their hundreds of independent end-users.
eSIMs rapid growth hasn’t come without growing pains and lessons learned. With such a large program there is a constant need to balance supply and demand to all sites and centers across the program. Program evaluation, for a program of this size, has been challenging as eSIM continues to improve provincial reporting. One strategy is to embed simulation session reporting in the eSIM provincial booking system for end-users. eSIM captures hazards and near misses that impact patient safety in their organizations’ Safety Learning and Reporting system. For new curriculum, simulation initiatives and projects, eSIM continues to evolve in developing a provincial strategy for implementation and evaluation.
Although having simulation space provided teams the ongoing ability to have a secured space for simulations, the simulation community quickly realized that facilitating simulations in a team’s actual work environment, (i.e. in situ), was the gold standard whenever a clinical space was available. In a live clinical environment teams have an improved ability to learn knowledge, skills and teamwork, their environment specific workflow, and practice in the most realistic environment. With eSIM’s program growth, in situ simulation provided a greater number of teams to practice on any given day at individual sites. This hasn’t minimized lab use as the realities of facilitating simulations in an actual patient room continue to be variable on any given day. There continues to be the reality that many clinical units are at full patient capacity and are unable to accommodate an in-situ simulation space.
In situ simulation has increased the demands for in situ simulation labs as with clinical leaders understanding the value of having a simulation learning space embedded for staff and easily accessible on their units. eSIM supports several new requests related to these in situ labs and how best to align our services, equipment and overall support.
Our Good News
The good news is that there is no forecasted slow down at eSIM! It’s not a fluke that simulation has grown so rapidly in Alberta. The eSIM team is packed with highly engaged, passionate and talented team members who continue to push the limits of innovation (Kaba A, Dube M, Charania I, Donahue M, 20185). There are new programs and project requests coming in daily and there are many units that have just made simulation their “way of doing business”. From engaging families and patients in healthcare design, training their teams, testing new spaces and processes, facilitating orientations of new staff, to supporting staff who need skills updates- eSIM is at the forefront of many education, engagement, and implementation strategies across the province of Alberta.
About the Authors:
The authors are all current or former members of the eSIM team in Alberta, Canada. The team has varied clinical and non-clinical backgrounds including:
Respiratory Therapist (Mirette Dube RRT, MSc); Nursing (Sue Barnes RN, Cherie Serieska RN, Erica Meunier RN), AnnaMaria Mundell RN, Jennifer Semaka RN, Tara Fusilli RN, Ayan Mack RN, Alyshah Kaba PhD, Marlene Donahue RN; Biomedical Engineering (Dan Duperron, Darren Steidl); Engineering and Operational Excellence (Mark Allen); Paramedic (Rob Ritchie) and Simulation Coordinator and Data (Theresa Cronin BSc).
Addendum Highlight Article Written by Members of the eSIM team: Goals, Recommendations and the How-To Strategies for Developing and Facilitating Patient Safety and System Integration Simulations: https://journals.sagepub.com/doi/full/10.1177/1937586719846586
1. Alberta Health Services statistics obtained from: https://www.albertahealthservices.ca/about/about.aspx. Last accessed on June 21, 2019.
2. Dube M, Reid J, Kaba A, Cheng A, Eppich W, Grant V and Stone K. PEARLS for Systems Integration: A Modified PEARLS Framework for Debriefing Systems-Focused Simulations. Simulation in Healthcare: May 21, 2019- Volume Publish Ahead of Print Issue. Available at: https://journals.lww.com/simulationinhealthcare/Abstract/publishahead/PEARLS_for_Systems_Integration__A_Modified_PEARLS.99530.aspx
3. Dube M, Shultz J, Barnes S, Pascal B, Kaba A. Goals, Recommendations, and the How-To Strategies for Developing and Facilitating Patient Safety and Systems Integration Simulations. Health Environments Research and Design Journal 2019; DOI 10.1177/1937586719846586. Available at: https://journals.sagepub.com/doi/full/10.1177/1937586719846586
4. Eppich WJ, Cheng A. Promoting Excellence and Reflective Learning in Simulation (PEARLS): development and rationale for a blended approach to healthcare simulation debriefing. Simul Healthca 2015;10(2):106-115.
5. Kaba A, Dube M, Charania I, Donahue M. Collaborative practice in action: Building interprofessional competencies through simulation-based education and novel approaches to team training. Health Education and Care 2018; 3(2): 1-9.
Originally published in Issue 3, 2019 of MT Magazine.