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      Translational simulation for rapid transformation of health services, using the example of the COVID-19 pandemic preparation

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          Abstract

          Healthcare simulation has significant potential for helping health services to deal with the COVID-19 pandemic. Rapid changes to care pathways and processes needed for protection of staff and patients may be facilitated by a translational simulation approach—diagnosing changes needed, developing and testing new processes and then embedding new systems and teamwork through training. However, there are also practical constraints on running in situ simulations during a pandemic—the need for physical distancing, rigorous infection control for manikins and training equipment and awareness of heightened anxiety among simulation participants. We describe our institution’s simulation strategy for COVID-19 preparation and reflect on the lessons learned—for simulation programs and for health services seeking to utilise translational simulation during and beyond the COVID-19 pandemic. We offer practical suggestions for a translational simulation strategy and simulation delivery within pandemic constraints. We also suggest simulation programs develop robust strategies, governance and relationships for managing change within institutions—balancing clinician engagement, systems engineering expertise and the power of translational simulation for diagnosing, testing and embedding changes.

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          Translational simulation: not ‘where?’ but ‘why?’ A functional view of in situ simulation

          Healthcare simulation has been widely adopted for health professional education at all stages of training and practice and across cognitive, procedural, communication and teamwork domains. Recent enthusiasm for in situ simulation—delivered in the real clinical environment—cites improved transfer of knowledge and skills into real-world practice, as well as opportunities to identify latent safety threats and other workplace-specific issues. However, describing simulation type according to place may not be helpful. Instead, I propose the term translational simulation as a functional term for how simulation may be connected directly with health service priorities and patient outcomes, through interventional and diagnostic functions, independent of the location of the simulation activity. Electronic supplementary material The online version of this article (10.1186/s41077-017-0052-3) contains supplementary material, which is available to authorized users.
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            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.
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              Doing our work better, together: a relationship-based approach to defining the quality improvement agenda in trauma care

              Background Trauma care represents a complex patient journey, requiring multidisciplinary coordinated care. Team members are human, and as such, how they feel about their colleagues and their work affects performance. The challenge for health service leaders is enabling culture that supports high levels of collaboration, co-operation and coordination across diverse groups. We aimed to define and improve relational aspects of trauma care at Gold Coast University Hospital. Methods We conducted a mixed-methods collaborative ethnography using the relational coordination survey—an established tool to analyse the relational dimensions of multidisciplinary teamwork—participant observation, interviews and narrative surveys. Findings were presented to clinicians in working groups for further interpretation and to facilitate co-creation of targeted interventions designed to improve team relationships and performance. Findings We engaged a complex multidisciplinary network of ~500 care providers dispersed across seven core interdependent clinical disciplines. Initial findings highlighted the importance of relationships in trauma care and opportunities to improve. Narrative survey and ethnographic findings further highlighted the centrality of a translational simulation programme in contributing positively to team culture and relational ties. A range of 16 interventions—focusing on structural, process and relational dimensions—were co-created with participants and are now being implemented and evaluated by various trauma care providers. Conclusions Through engagement of clinicians spanning organisational boundaries, relational aspects of care can be measured and directly targeted in a collaborative quality improvement process. We encourage healthcare leaders to consider relationship-based quality improvement strategies, including translational simulation and relational coordination processes, in their efforts to improve care for patients with complex, interdependent journeys.
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                Author and article information

                Contributors
                vbrazil@bond.edu.au
                belinda.j.lowe@gmail.com
                Leanne.Ryan@health.qld.gov.au
                rachel.bourke@health.qld.gov.au
                Clare.Scott@health.qld.gov.au
                Simone.Myers@health.qld.gov.au
                Hellen.Kaneko@health.qld.gov.au
                Jane.Schweitzer@health.qld.gov.au
                Brenton.Shanhan@health.qld.gov.au
                Journal
                Adv Simul (Lond)
                Adv Simul (Lond)
                Advances in Simulation
                BioMed Central (London )
                2059-0628
                3 June 2020
                3 June 2020
                2020
                : 5
                : 9
                Affiliations
                [1 ]GRID grid.1033.1, ISNI 0000 0004 0405 3820, Faculty of Health Sciences and Medicine, , Bond University, ; Gold Coast, Australia
                [2 ]GRID grid.413154.6, ISNI 0000 0004 0625 9072, Department of Anaesthesia, , Gold Coast Hospital and Health Service, ; Southport, Australia
                [3 ]GRID grid.413154.6, ISNI 0000 0004 0625 9072, Simulation Service, , Gold Coast Hospital and Health Service, ; Southport, Australia
                Author information
                http://orcid.org/0000-0001-9103-2507
                Article
                127
                10.1186/s41077-020-00127-z
                7267758
                32514386
                eefe3d5c-486b-4ded-a4c4-6e103d9e1bb0
                © The Author(s) 2020

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

                History
                : 21 April 2020
                : 19 May 2020
                Categories
                Innovation
                Custom metadata
                © The Author(s) 2020

                translational simulation,covid-19,pandemic,healthcare
                translational simulation, covid-19, pandemic, healthcare

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