How Can Simulation Help Build Stronger Teams?

Sarah L. Beebe, PhD, APRN, CNM, WHNPr, CHSE

Graduate Medical Education Simulation Lab Program Manager 
PCOM Simulation Center at Bayhealth 
Bayhealth Medical Center

"Simulation can build better teams by giving them the opportunity to work on communication and to actually practice those team management and teamwork skills. 

It’s all well and good to talk about how to use different team dynamics like closed loop communication and shared mental models and stuff like that. But until you actually practice it in a clinical setting or in a setting similar to how you would do it, you just don’t get it. And so that’s the one thing in our program that we see the most often.

That’s where the “a-ha” moments come from is how important communication and practicing team management skills and teamwork – how important that is."

Jared M. Kutzin, DNP, MS, MPH, RN, FSSH

Associate Professor, Emergency Medicine & Medical Education 
Icahn School of Medicine at Mount Sinai 
Senior Director of Simulation, Emergency Medicine 
Mount Sinai Hospital

"Simulation makes better teams in a variety of different ways. I think just bringing together individuals who don’t always have the opportunity to work or train together really allows them to practice in a safe space and learn the fundamentals of teamwork and communication and those other Team STEPPS concepts like situational monitoring and mutual support, in addition to the clinical skills that are vitally important to treating our patients on a daily basis.

And then, also taking simulations not just in the simulation center, but out to our clinical teams: so in the in situ environment, in the pre-hospital care environment, in those areas in which our teams are functioning on a daily basis and allowing them to practice in those environments and for us to see the systems that they’re operating in, in an effort to improve those systems later on. So I think there’s a couple different ways that simulation helps improve teams and the foundational teamwork and communication skills all the way through putting those skills into practice in the clinical environment."

Connie M. Lopez, MSN, CNS, CPHRM, CHSEA, FSSH

Quality and Safety Improvement Consultant, Maternal Child Health Patient Safety 
Patient Safety (KFH/HP), Northern California Region 
Kaiser Permanente

"Simulation can help create better teams by providing them an opportunity to practice in a realistic environment. And not actually taking care of the real patient, [they] have an opportunity to stop and ask questions about skills, knowledge, information, have discussion amongst their teams, and then practice as the team: working on their teamwork and their communication. And especially around events that are rare – high-risk events may not have happened frequently for that individual, so it gives them an opportunity to practice for something that they haven’t experienced recently."

Roxane Gardner, MD, MSHPEd, DSc

Executive Director, Center for Medical Simulation 
Assistant Professor-Obstetrics, Gynecology at Harvard Medical School 
Department of OB/GYN at Brigham and Women’s Hospital 
Division of Adolescent Gynecology at Boston Children’s Hospital 
Department of Anesthesia, Critical Care and Pain Medicine at Massachusetts General Hospital 

"Simulation can help create better teams in a number of different ways. At the Center for Medical Simulation I, in my more novice days, observed how anesthesia residents and anesthesia faculty teams came together [in simulation] to manage critical events in the operating room or maybe in the intensive care unit or in the post-anesthesia care units (PACUs).
 
And they had an opportunity to figure out how to organize themselves, how to delegate roles, how to figure out what is the best maneuver or therapeutic endeavor that it would take to resolve the situation. And frequently you would see some interesting disorganizations or lack of organization, not taking the time to delegate roles. And no patient died. But I was able to see the faculty stop them and maybe talk about what’s going on, restart them, or just simply stop, debrief, and then take another case that’s not that dissimilar to what they had before and practice again.
 
You’re not limited to doing it there in a center or a lab. You can run situations in the unit, on the floor (as they call in-situ), and bring people together to manage a collapsed manikin or patient and talk to them afterwards about their teamwork skills. What went well? What can we do better? Having intermittent opportunities to practice like that helps the unit members have a little better muscle memory for how to organize themselves and work together better as a team."