Documentation framework for healthcare simulation quality improvement activities

Introduction Medical simulation methodology is increasingly being utilised beyond the traditions of education to evaluate patient care workflows, processes, and systems within the health context. A literature review of healthcare facility testing showed that individual clinical departments and singular patient flow processes had been tested under a variety of simulated conditions, such as virtual environments, table top exercises, and live simulation exercises. Each method demonstrated strengths and weaknesses in finding active or latent system failures [1–4]. With the building of our new healthcare facility, it was decided that live (physical) testing of the environment using a medical simulation methodology was the best approach to bridge the gap from architectural plans, to real-world efficient and effective patient care, and for orientation and training of teams to their new environment [4–7]. Although the hospital had yet to open, testing the systems under immersive simulated conditions at the point of care delivery effectively replicated real-world workflows and systems [1, 6]. Within Australia, two new hospitals reported using medical simulation to test specific clinical scenarios and patient flow journeys prior to service delivery. Unfortunately in both instances, testing beyond the first round did not occur due to funding and human resource limitations. This led to considerable staff workarounds, rectification of process errors after commencement of patient care, and unfavourable media reports [8, 9]. This paper will provide an example of an approach to identify latent system issues using live medical simulation and the development of an associated documentation framework. The documentation framework aims to help structure medical simulation scenarios specifically designed for quality improvement activities, and to capture and report findings of system deficits identified in the simulations, to key decision-makers. Our metropolitan mixed public and private healthcare organisation built a satellite health service outside the capital city specialising in day oncology and day surgery, with 64 short stay surgical and medical inpatient beds. Two significant dilemmas were apparent: over half of the staff were new to the main organisation and no onsite critical care support was available. Additionally, the new facility was adapting existing processes from the main central facility, where services were not similar. A serious potential risk to patient safety was noted. Organisational priorities for opening included efficient and effective staff training and systems designed to ensure patient safety in concert with excellent patient experience. Testing of a whole healthcare facility is a large undertaking. It was decided that testing needed to occur over multiple iterations, allowing for system improvements to be made and retested. The final testing cycle was a 24-h live simulation activity. A critical part of the activity was data collection, which led to the development and utilisation of two new tools: the Simulation-based Quality Improvement Tool (SQIOT) and the Healthcare Failure Modes Effects Analysis (HFMEA) Summary Report. The first reporting tool, SQIOT, utilised the Plan-DoStudy-Act (PDSA) methodology [10–12] as the scenario template to capture data arising from each simulation activity. A second tool, ‘HFMEA Report Summary’ , was underpinned by the Healthcare Failure Modes Effect Analysis (HFMEA) framework [13, 14]. The HFMEA framework provided a way to collate the data and to target summary data to accountable leaders. The combination of the PDSA and HFMEA frameworks as developed and described in this article is a previously unidentified strategy in the literature. The overall design of the simulation * Correspondence: [email protected] Mater Education Ltd, Queenslane, Brisbane, Australia Full list of author information is available at the end of the article