Augmenting Health Care Failure Modes and Effects Analysis With Simulation

Abstract

This study explores whether simulation plays a role in health care failure mode and effects analysis (HFMEA); it does this by evaluating whether additional data are found when a traditional HFMEA is augmented with simulation. Two multidisciplinary teams identified vulnerabilities in a process by brainstorming, followed by simulation. Two means of adding simulation were investigated as follows: just simulating the process and interrupting the simulation between substeps of the process. By adding simulation to a traditional HFMEA, both multidisciplinary teams identified additional data that were relevant for deeper analysis. The study indicates that simulation has a role in HFMEA. Both ways of using simulation seemed feasible, and our results are not conclusive in selecting one over the other.

The use of in situ simulation to detect latent safety threats in paediatrics: a cross-sectional survey

“…Carayon's Systems Engineering In Patient Safety framework is one method that is being explored as a method to codify events into domains including: tasks, providers, communication, tools, technology, organisation, environment and culture 18 19. The Healthcare Failure Modes Effects Analysis is an alternative method that can be used to triage LSTs based on their severity and probability 20. These approaches can help individuals determine the factors that are contributing to safety threats and to develop a timeline for improvement.…”

Documentation framework for healthcare simulation quality improvement activities

“…The first reporting tool, SQIOT, utilised the Plan-Do-Study-Act (PDSA) methodology [ 10 – 12 ] as the scenario template to capture data arising from each simulation activity. A second tool, ‘HFMEA Report Summary’, was underpinned by the Healthcare Failure Modes Effect Analysis (HFMEA) framework [ 13 , 14 ]. The HFMEA framework provided a way to collate the data and to target summary data to accountable leaders.…”

“…All documented data from each test and phase captured on the SQIOT was collated and presented in a format that highlighted the risks, identified potential system impacts, and allowed for decision-makers to prioritise future actions. HFMEA is normally used to identify causes and effects of failure modes in systems and processes before a significant event or near miss occurs [ 13 , 14 , 25 , 26 ]. In this study, the HFMEA was used for simulated patient care activities in the real hospital environment.…”

“…Health Failure Modes, Effects Analysis, and traditional Failure Mode Effects Analysis provide numerical ranking for the identified failures or risks based on severity and probability [ 13 , 23 , 25 , 26 ]. Numerical ranking scales vary, e.g.1–16 [ 13 , 14 , 26 ], 1–10 [ 25 ], 1–5 [ 27 ], or 1–4 [ 28 ] typically with 1 being ‘no’ or ‘minor impact’ through to the largest number meaning catastrophic harm (e.g. permanent patient harm) [ 25 , 26 ].…”

Failure mode and effects analysis: a comparison of two common risk prioritisation methods

“…Process maps and hazard tables can also be shared across specialties and institutions. Results of an FMEA are invaluable for developing risk-informed, reliable interventions to prevent or mitigate failures that are most likely to lead to patient harm 33 34. Healthcare organisations can also use the FMEA method to iteratively assess the effectiveness of implemented interventions 35 36…”