Developing a simulation safety policy for translational simulation programs in healthcare.

Healthcare simulation may present risks to safety, especially when delivered 'in situ'-in real clinical environments-when lines between simulated and real practice may be blurred. We felt compelled to develop a simulation safety policy (SSP) after reading reports of adverse events in the healthcare simulation literature, editorials highlighting these safety risks, and reflecting on our own experience as a busy translational simulation service in a large healthcare institution.The process for development of a comprehensive SSP for translational simulation programs is unclear. Personal correspondence with leaders of simulation programs like our own revealed a piecemeal approach in most institutions. In this article, we describe the process we used to develop the simulation safety policy at our health service, and crystalize principles that may provide guidance to simulation programs with similar challenges.

Improving the relational aspects of trauma care through translational simulation.

BACKGROUND: Major trauma care is complex and requires individuals and teams to perform together in time critical, high-stakes situations. Scenario-based simulation is well established as a strategy for trauma teamwork improvement, but its role in the relational and cultural aspects of trauma care is less well understood. Relational coordination theory offers a framework through which we aimed to understand the impact of an established trauma simulation programme. METHODS: We studied simulation activities using a narrative survey of trauma providers from anaesthesia, emergency medicine, medical imaging, surgery, trauma service, intensive care, and pre-hospital providers at Gold Coast University Hospital, in conjunction with data from an ethnography. Data analysis was performed using a recursive approach-a simultaneous deductive approach using the relational coordination framework and an inductive analysis. RESULTS: Ninety-five of 480 (19.8%) staff completed free-text survey questions on simulation. Deductive analysis of data from these narrative survey results using the RC framework domains identified examples of shared goals, shared knowledge, communication and mutual respect. Two major themes from the inductive analysis-"Behaviour, process and system change" and "Culture and relationships"-aligned closely with findings from the RC analysis, with additional themes of "Personal and team learning" and the "Impact of the simulation experience" identified. CONCLUSIONS: Our findings suggest that an established trauma simulation programme can have a profound impact on the relational aspects of care and the development of a collaborative culture, with perceived tangible impacts on teamwork behaviours and institutional systems and processes. The RC framework-shared knowledge, shared goals and mutual respect in the context of communication that is timely, accurate, frequent and problem-solving based-can provide a common language for simulation educators to design and debrief simulation exercises that aim to have a translational impact.