How Simulation is Transforming Patient Safety and Emergency Readiness

00:00:00:28 - 00:00:22:08
Tom Haederle
Welcome to Advancing Health. Practice makes perfect, the saying goes. And that's true in many things: sports, music and medicine too. In this podcast, we explore the shared commitment between Laerdal Medical and Advocate Health to advancing patient safety through the power of simulation.

00:00:22:10 - 00:00:52:13
Chandler Carter
Hello, and welcome to Advancing Health. I'm Chandler Carter, program manager at the American Hospital Association, and today I'm excited to be joined by Kelly Sabah, associate vice president of simulation at Advocate Health, as well as Brian Bjorn, patient safety manager at Laerdal Medical. We're so glad to have you both with us today. Your perspectives on simulation and patient safety, clinical quality and workforce readiness are incredibly valuable, and I know that our listeners will benefit from hearing your perspectives.

00:00:52:15 - 00:00:58:20
Chandler Carter
To start us off, I'd love to learn a bit more about your backgrounds in simulation. So, Kelly, why don't we start with you?

00:00:58:23 - 00:01:05:13
Kelley Sava
Sure, absolutely. So before we get started, I just want to say happy healthcare simulation week. I was during SIM week, so.

00:01:05:13 - 00:01:07:18
Chandler Carter
It's just very timely, I like that.

00:01:07:21 - 00:01:32:12
Kelley Sava
So I'm a nurse by background. I started in pediatric nursing, and became a nurse practitioner. I started working in hospitals and having played competitive team sports as a kid, I really had this desire and love for teamwork and communication. And that was really a passion of mine. And getting into hospital based nursing, I found that I was able to use a lot of those skills in a hospital based setting, which was really exciting.

00:01:32:12 - 00:01:56:20
Kelley Sava
And then fast forward a little bit and I became an educator, an advanced practice nurse educator within a pediatric realm. And shortly after I took that role, simulator, a Laerdal simulator showed up at my door and it got delivered to my doorstep. And so I was tagged, and said well, I got delivered it here so you're going to be the one that's going to figure out how we're going to utilize this amazing tool.

00:01:56:20 - 00:02:37:06
Kelley Sava
And so the rest was history. I started using it and fell in love with the opportunity to really, you know look at teamwork and communication within the health care setting. And from there, I was completely sold. You know, as a pediatric nurse, saw a lot of clinical situations and opportunities for improvements in how we provide safe care. Our organization then took a huge dive into patient safety, really launching high reliability and patient safety as a huge initiative within the organization. And part of their strategy and philosophy was launching a simulation program across the enterprise.

00:02:37:08 - 00:03:03:03
Kelley Sava
And at that time it was Illinois. It was our Illinois sites. And so I was fortunate enough to become the director of that program when it was just myself and our safety leaders that were fearlessly dedicated to this journey of high reliability. And from there, I my passion grew even more as to how we could utilize simulation to really make an impact for our patients.

00:03:03:05 - 00:03:21:26
Chandler Carter
That is incredible. Thank you so much for sharing, Kelly, and also bringing awareness to Patient Safety Simulation Week. Brian, as patient safety manager at Laerdal, can you tell us a bit about your background and some of the simulation work that you do with Laerdal, including the accelerate programing that Kelly just mentioned?

00:03:21:28 - 00:03:41:09
Brian Bjoern, M.D.
Absolutely. And let me just pause for a second, and thank you for having us on the podcast. We're excited to be part of this. My background is actually not so much in simulation. I'm a public health physician by training and have spent most of my career in safety and quality roles for working for hospitals and health systems, here in the US and in Scandinavia.

00:03:41:12 - 00:04:05:02
Brian Bjoern, M.D.
And at Laerdal I'm using that that background and quality and safety to really try to augment what we do already with our hospital customers. And we like to think of simulation and how it relates to patient safety as kind of  - there are three tiers to this. And the two first is I'm going to talk about what probably most hospitals that do simulation think of when they think patient safety and simulation, which is does you individual skills.

00:04:05:02 - 00:04:21:15
Brian Bjoern, M.D.
So that could be something like, you know, using a task trainer to learn how to insert an IV. That's important. And I think that does contribute to patient safety that we can practice that on a simulator where rather than on a patient. The second level is when we come together as a team. We all have our individual skills down.

00:04:21:15 - 00:04:40:00
Brian Bjoern, M.D.
Now, we need to figure out how to work together as a team. Most of us do not have that opportunity in school. So that really is on hospitals to figure out how can we do that. So training, practicing, high acuity, time critical scenarios as a team, I think is that is that second tier of simulation.

00:04:40:02 - 00:04:58:21
Brian Bjoern, M.D.
And then the third tier is kind of thinking a little bit more about how does the whole system work together. So using simulation really to drive quality projects forward and to use it as a tool to find the holes in the Swiss cheese, like we would say in patient safety, or figure out how to close the holes in the cheese.

00:04:58:24 - 00:05:18:08
Brian Bjoern, M.D.
The Laerdal accelerate program is an attempt to help hospitals with that approach by providing simulation in a box, really. It's a program that we developed now a handful of years ago that allow customers to have us run simulations on their behalf. So we really just need to know what's the clinical topic you want to practice?

00:05:18:08 - 00:05:46:15
Brian Bjoern, M.D.
How many people do we need to get through this, and when do you want to do it? And we come on site and run simulations for you. We bring in all the equipment an educator, Simtech, and we run the simulations. And when we're done, we you know, clean up, pack up, go home. And a couple of weeks later, we reconvene to talk about, what we call the progress report, which is how we translate all the thousands of data points we capture during those simulations into actionable insights so that we leave you with something that you, you know, get a snapshot of

00:05:46:15 - 00:05:53:05
Brian Bjoern, M.D.
what did you do well? Where is there some room for improvement? And how can, how could this data help you in that?

00:05:53:07 - 00:06:16:29
Chandler Carter
And for a lot of our members, I think one of the challenges is moving from concept into application. We know that Advocate Health represents a very diverse number of hospitals and care settings. Can you tell us what's worked well in securing buy in from different levels, from the executive team to frontline teams? And how have you really helped to make simulation a part of each institution's day to day practices for patient safety?

00:06:17:02 - 00:06:34:08
Kelley Sava
Yeah, absolutely. So I'm going to focus my answer on some of the work that has gone on in the Midwest, because we've just had a longer standing opportunity to build that culture in that space. And so we started out really with gaining buy in from our highest levels. And so we had, our patient safety leader.

00:06:34:08 - 00:06:55:25
Kelley Sava
And at that point in time, our system chief medical officer, who were very passionate about high reliability and safety and how simulation was going to impact, right? They helped us at the highest level get that word out. And our president at the time bought in 100%. We were able to gain that buy in at that level. The site level was very different.

00:06:55:25 - 00:07:25:09
Kelley Sava
And translating that desire from an enterprise or system level into the sites...it's a challenge because every hospital, as you know, has a different culture, different, right? We all have these cultures and behaviors that we follow together as a system. But when you really get into each of those sites, there's a different flavor to that. And so we really had to tailor our approach to each of those different cultures and flavors, if you will, at each of those sites.

00:07:25:09 - 00:07:42:29
Kelley Sava
And so our approach really varied. At some sites, our leaders, you know, we were able to meet with our leaders. And as long as we could get the leaders to understand the why and we could speak the language and find out what was important for them, we were able to get in the door and they were able to help us move forward.

00:07:43:01 - 00:07:59:03
Kelley Sava
I always use the question, what keeps you up at night? And that was the question that I would ask the leaders, and if we could get to something that was sort of on their plate or was causing them concern, we would be really successful. And we had other sites where the leaders, you know, they were like this is all great.

00:07:59:10 - 00:08:21:13
Kelley Sava
And that's where it kind of stopped. Right? Like these are sometimes, you know, hospitals that had different priorities or whatever. And in those situations we went more grassroots. So we changed our approach in those situations. And we would go into unit and we would work with the more local leaders, the managers and the supervisors and do simulations and get these great stories that they would then escalate up.

00:08:21:16 - 00:08:38:18
Kelley Sava
And so when they would escalate those stories up to those executives, then they would come back to us and say, we need a simulation here because our teams need it. Here's what happened in our unit. We would go, yes, we've worked very closely with your team. We're so grateful for their engagement. And let's spread this out, right?

00:08:38:21 - 00:09:08:10
Kelley Sava
What we had to do is be really flexible and fluid about how we engaged each of those sites to really get simulation embedded into their culture. We also worked really tightly with patient safety, right? So at a system level, we had really tight relationships. I still matrix report to our patient safety leader. And so having that relationship also helped us have an influencer within each of the sites already embedded, which was very helpful.

00:09:08:12 - 00:09:32:13
Chandler Carter
I love that idea. And I've heard that echoed across some of our member hospitals as well, having that champion of sorts, to help kind of progress the work in simulation. Which brings me to Brian. From your perspective, working with an organization that has done tremendous work in the world of simulation. What are your thoughts on how hospitals and health systems that can really build a culture that values and trust simulation as a strategic

00:09:32:13 - 00:09:33:00
Chandler Carter
tool to advance patient safety?

00:09:35:06 - 00:09:57:16
Brian Bjoern, M.D.
Buy-in at all levels is so important. But particular and this is true for any project, program, initiative in our organization, you need the executive team on board with this. They need to be present. They need to be supportive. That's the old saying that attention is the currency of leadership. And if you do not have the attention of leadership on this, you're not going to make that the kind of progress that Advocate has shown is possible.

00:09:57:18 - 00:10:17:25
Brian Bjoern, M.D.
And I think to some extent, really the biggest challenge is to get our senior leaders, our executives in health care, to understand that simulation is not just a great educational tool. It can do so much more. When I talk to hospital leaders, I often run into to people who think of simulation that's something that happens over in education.

00:10:17:28 - 00:10:44:08
Brian Bjoern, M.D.
They don't even, you know, connect the dots that they have this great tool and resource in-house that they can use to accelerate their safety and quality work. And I would argue that that simulation really can help build and maintain a culture of safety, because everything we do in simulation revolves around this idea of creating a safe space for learning and for failing, and without risking any harm to the organization or to our patients.

00:10:44:11 - 00:11:05:27
Chandler Carter
Thank you so much, Brian. Kelly, so we know at Advocate we know that simulation is very heavily embedded into how your systems improve care continuously. Can you share how you specifically use simulation to help uncover any communication breakdowns, any safety gaps, or any system level risks, before they begin to impact patient care or escalate?

00:11:06:03 - 00:11:28:25
Kelley Sava
Absolutely. I have a lot of stories about how we've utilized the tool in that way. So early on when we were getting our feet wet we were doing mockups, emergency resuscitation. The one thing everybody understood ubiquitously about simulation was a mock code doing CPR, emergency response. Everybody understood that. So we started there naturally. Just that's what people wanted.

00:11:29:01 - 00:11:59:26
Kelley Sava
And in doing so across our hospital system and doing it at different hospitals, we noticed very quickly that there was some trends in how care gaps were being identified within these events, and we identified that roles and responsibilities, while they're well laid out for the American Heart Association, how that translates into some of these hospitals that maybe have fewer resources than are identified in the guidelines or have way more resources than are identified in the guidelines, how does that translate?

00:11:59:29 - 00:12:33:22
Kelley Sava
And then other additional roles that right, maybe needed wayfinding and things like that. It just there wasn't very clear, delineation with what that we were seeing translate into care. We were seeing opportunities around our crash carts and how they were organized, what supplies were on the crash carts, what supplies weren't on the crash carts. Did teams know how to access the medications or access the supplies that they needed? And then also identifying that in some of our hospitals, we had up to four different types of defibrillators depending on the different units.

00:12:33:22 - 00:12:56:12
Kelley Sava
And one code team that was having to know how to use this equipment across multiple locations within their own building. And so we were able to escalate all of that to the system level. And we actually were able to, with the partnership of our patient safety team and our executive leaders to form a committee that really looked at practice within Code Blue.

00:12:56:12 - 00:13:15:16
Kelley Sava
And there was a new policy written. There was standardization defibrillators across the entire system, all of these things that then got put in place because of these findings. We were able to kind of tie it all together and then look to make sure post implementation that we weren't continuing to see those types of events.

00:13:15:18 - 00:13:36:23
Chandler Carter
I think that's an excellent example of how simulation can really reveal some of those hidden vulnerabilities that exist within complex health systems. So that's incredible. So as a follow up, Kelly, you've often described simulation as a space where people can learn, reflect and speak up. How have you used simulation to really foster psychological safety within your organization?

00:13:36:26 - 00:13:58:24
Kelley Sava
Yeah. So I think simulation has a natural ability to do this when we're bringing teams together and really having our front line teams in a safe spaces, as Brian spoke about, where they're able to talk through the care that they provide. Normally you provide the care in your unit and then you go on to the next thing you have to do, right?

00:13:58:24 - 00:14:26:00
Kelley Sava
Like we don't stop and really think about how in debrief every interaction, every process every single day. And so bringing our teams together and really providing that safe space for those opportunities is really important. And it allows for us to build trust. A recent example, and I just found out about this when we are in the midst of a huge safety project at one of our hospitals, they're opening a brand new tower.

00:14:26:03 - 00:14:55:18
Kelley Sava
In that process, they're having one unit that was not a tele unit is now going to be a telemetry unit. And so part of the testing that we did when we went in there was to combine this unit that was non telemetry and help combine training with them and our central tally center to do some training together so that they could better understand the process of central tele, that they could, you know, be able to learn those processes and workflows and escalations and things like that.

00:14:55:18 - 00:15:16:10
Chandler Carter
Incredibly important, incredibly important. And I think we're seeing now in the current health care landscape and the dynamic things are shifting rapidly. So I always like to look at things from a broader picture and implications for the future in the field in general. Brian, I can pitch this one to you. So as we look into the future, what role do you see simulation playing in hospitals?

00:15:16:13 - 00:15:22:08
Chandler Carter
In meeting the growing complexity of care, evolving technology and overall workforce readiness?

00:15:22:10 - 00:15:48:00
Brian Bjoern, M.D.
I think actually, that simulation might be, one of the things that that, you know, determine whether you're able to survive in the environment we are heading into. We recently were at AHA Leadership Summit, and the message we heard universally from the executives in attendance was that with the cuts to Medicaid that came with the OBBBA, there's just no way we can get away with incremental changes anymore.

00:15:48:04 - 00:16:16:29
Brian Bjoern, M.D.
We will need to fundamentally change how health care is delivered. And I think simulation can really be a crucial tool to get that right. Again, the whole premise of simulation is that it's a chance for us to practice and learn at very low, sometimes even no risk. So using simulation to test out different approaches, to use it to solicit feedback from patients, caregivers, providers and staff, I think will allow hospitals to adapt to this new environment much more quickly.

00:16:17:04 - 00:16:21:21
Brian Bjoern, M.D.
There's a lot of opportunity for using simulation in health care more than we already do.

00:16:21:24 - 00:16:34:14
Chandler Carter
Absolutely. I couldn't agree more, and I appreciate you both for taking the time to come and speak with us today on Advancing Health, not just for sharing your expertise today but for bringing such energy and insight into this conversation.

00:16:34:16 - 00:16:35:18
Brian Bjoern, M.D.
Thank you for having us.

00:16:35:21 - 00:16:37:18
Kelley Sava
Thank you so much.

00:16:37:20 - 00:16:46:01
Tom Haederle
Thanks for listening to Advancing Health. Please subscribe and rate us five stars on Apple Podcasts, Spotify or wherever you get your podcasts.