Leading change in practice: how “longitudinal prebriefing” nurtures and sustains in situ simulation programs

Abstract

In situ simulation (ISS) programs deliver patient safety benefits to healthcare systems, however, face many challenges in both implementation and sustainability. Prebriefing is conducted immediately prior to a simulation activity to enhance engagement with the learning activity, but is not sufficient to embed and sustain an ISS program. Longer-term and broader change leadership is required to engage colleagues, secure time and resources, and sustain an in situ simulation program. No framework currently exists to describe this process for ISS programs. This manuscript presents a framework derived from the analysis of three successful ISS program implementations across different hospital systems. We describe eight change leadership steps adapted from Kotter’s change management theory, used to sustainably implement the ISS programs analyzed. These steps include the following: (1) identifying goals of key stakeholders, (2) engaging a multi-professional team, (3) creating a shared vision, (4) communicating the vision effectively, (5) energizing participants and enabling program participation, (6) identifying and celebrating early success, (7) closing the loop on early program successes, and (8) embedding simulation in organizational culture and operations. We describe this process as a “longitudinal prebrief,” a framework which provides a step-by-step guide to engage colleagues and sustain successful implementation of ISS.

Recommendations for embedding simulation in health services

“…Finally, the fourth recommendation in this domain is ‘Identifying priority areas of work’. As noted in recent literature, buy-in from participating units is necessary for session objectives to be met [ 11 , 15 , 22 ]. Pathways to identifying priority areas of work may be found through (1) identifying the individuals and units who are enthusiastically willing to participate in simulation activities and (2) identifying challenges faced throughout the organisation that are amenable to change or improvement through the design and delivery of simulation activities.…”

Healthcare Simulations' Contributions to Improving Perinatal and Neonatal Practice

“…In addition, taking a patient room or operating room out of service and the participation of clinicians also have economic implications 23,25. Furthermore, those involved in planning and implementing simulations often require additional training to learn how to establish and maintain a safe learning environment, guide debriefing sessions, and help motivate participants to move from a precontemplative state (“there are no problems”) to a contemplative state (“change is needed”) 23,24,26. Another crucial motivational factor is recording, addressing, and communicating system changes to participants.…”

“…23,25 Furthermore, those involved in planning and implementing simulations often require additional training to learn how to establish and maintain a safe learning environment, guide debriefing sessions, and help motivate participants to move from a precontemplative state ("there are no problems") to a contemplative state ("change is needed"). 23,24,26 Another crucial motivational factor is recording, addressing, and communicating system changes to participants. A lack of follow-through or failure to communicate could lead to waning interest in participation.…”

Faculty development for translational simulation: a qualitative study of current practice

“…The simulation community has embraced translational simulation (also described as ‘ systems focused’/”QI” ), and attendant novel approaches to simulation design [ 1 , 2 ], delivery [ 1 , 3 – 6 ], debriefing [ 7 – 9 ], and institutional engagement [ 2 , 10 ]. However, the adoption of these simulation strategies has not been matched by clear guidance for training the practitioners who deliver translational simulations.…”

“…Translational simulation practice may require a different strategic [11,34] and operational [1] approach to educationally focused simulations. With limited published guidance to draw upon, we find diverse methods and tools-from quality improvement [35][36][37], safety science [9,38], human factors/ ergonomics [39,40], design thinking [17], change management [2,10], implementation science [41] and systems engineering [42]-have been used in translational simulation activities [1,40]. These are often unfamiliar perspectives and skillsets for simulation practitioners.…”