How can simulation help identify and mitigate latent safety threats that could compromise patient safety? 

Jennifer: When we explore the uses of simulation for latent safety risk, it’s important to identify what we mean by that term. And we can pull information from Professor James Reason’s Swiss Cheese Model, where systems are aligned to allow errors to pass through and occur.  

Currently, we spend a lot of time looking at processes after an error. … The use of simulation [allows us] to explore proactively where these latent risks are living so that we can eradicate them before near-sentinel or sentinel events.

What are some examples of latent safety threats that simulation can help uncover? 

Jennifer: I’ve observed firsthand how the simulations have shown data about where to store equipment so that we can change practice and have better outcomes. An example of that would be falls in the emergency department. 

The other thing that I’ve observed firsthand is a change in practice, where we’re going to reduce the time from EMS acknowledgment in neurology cases to actual CAT scan diagnostic time. And practicing that before we go live so that the systems and safety measures are all in place, so that every clinician is safe – but mostly, our patients are safe. 

A famous quality maxim says that a bad system can beat a good person any time. Do you think that past simulation efforts in healthcare quality improvement have focused too much on individuals and too little on improving systems of care? 

Jennifer: There’s an important opportunity for us as a profession and working collaboratively with healthcare organization leadership to take the misnomer that we have bad people in healthcare delivery and that’s the cause of our patient safety issue.  

We actually have excellent people who are caught in bad systems. This has been shown not only in the evidence for the last 25+years, but the 1999 report ‘To Err Is Human’ underscores this important point. And it’s important that we collectively embrace that for our clinicians and to achieve no harm.

It’s exciting right now in healthcare simulation to think about where we’ve been in the last 25 years and where we want to go, and then have the purposeful pursuit to make sure we travel where we want to be.  

And one of the things that I’m curious about with latent risk assessment is, is there an opportunity to have bidirectional use – both from health systems to academic pre-licensure programs, where we’re working collaboratively to share information and address patient safety on a more collaborative level? 

How are you successfully collecting and using data in the context of your simulations that you can identify and prioritize areas for intervention? 

Jennifer: The adage that data drives the story and drives the outcomes can never be more true than when we’re looking at simulation and latent risk assessment. This data is not just qualitative with numbers and outcomes and reductions, but it is also the anecdotal storytelling of how these simulations were modifying the practices and raising the confidence of the clinicians to achieve better patient safety outcomes. And then of course, the storytelling from the perspective of the patient and what an amazing outcome they were able to achieve by the collective work that we’re all completing.