Absolutely. It’s very clear that simulation and safety go together and in previous articles, we’ve discussed how quality improvement fits in as well. But how do simulation and safety go together? More research is being conducted in Medical and healthcare simulation and this is a good thing. Here’s some literature about simulation and why it’s needed in healthcare training and education.
The hallmark To Err is Human was released in 1999 and healthcare has made progress. In 2015, the National Patient Safety Foundation released a report entitled Free from Harm: Accelerating Patient Safety Improvement Fifteen Years after To Err is Human and outlined eight key recommendations:
- Ensure that leaders establish and sustain a safety culture
- Create centralized and coordinated oversight of patient safety
- Create a common set of safety metrics that reflect meaningful outcomes
- Increase funding for research in patient safety and implementation science
- Address safety across the entire care continuum
- Support the healthcare workforce
- Partner with patients and families for the safest care
- Ensure that technology is safe and optimized to improve patient safety
So, how are we doing? There’s room for improvement. Another alarming statistic that medical error is the third leading cause of death in the United States. Let that sink in for a moment. Third. In the United States. Further, Makary and Daniel (2016) suggest that there may be over 251,000 deaths annually as a medical error is not recorded on US death certificates.
There are many factors that can lead to a medical error including working conditions, patient load, distractions at work, resource shortages, personal stress, employee disengagement, unanticipated conditions such as natural or man-made disaster and the list goes on. Healthcare is a very complex system that has many moving parts at any given moment.
However, what if we had the opportunity to make a difference? What does that look like? Some might say “Yeah, but what can you do about it? The system is just too big to make a change”. Rather than give in, what if you reframed the conversation?
What if today, you observed a potential error and said something to someone about it (in a nice way, of course)? Maybe you noticed some unsupervised medications on a hospital unit. Perhaps, you noticed how an IV paralytic medication and a blood pressure medication have similar packaging. Maybe your simulation program relies on the good graces of expired medications that were donated and the school uses them for demonstration purposes.
What would it look like if you brought the potential of error forward to your supervisor or a senior management team? It takes courage to speak up, it really does. I implore you to say something if you see something that needs changing. The safety of people depends on your courage. We talk about patient safety a lot; but consider your personal safety, the safety of your colleagues, the safety of students. Critics may say “Sounds like too much work” or “That’s above my pay grade” and other complaints. Don’t be afraid to step up and speak up.
Safety is about doing what is right. At the end of the day, the most important thing is to go back home to our loved ones, our friends, our pets, our lives.
Be safe. Be awesome.
I want to help raise awareness for simulation-based education, patient safety, and quality improvement and I need your help. Please share the link with people that you feel would enjoy what we’re about. If you really enjoy the content, subscribe for free at the bottom of the page to get the good news delivered straight to your inbox.
About the Author: Matthew Jubelius is a subject matter expert in healthcare simulation. He is a consultant, educator and wants to change the future of people development, education, and training. He has championed the design, implementation, and evaluation of simulation-based education and training programs, including quality improvement measures for post-secondary institutions, private industry, and the federal government.
Matthew can be reached through www.amoveotraining.ca for simulation consulting, program development, employee training and speaking engagements.
Institute of Medicine (1999). To Err is Human: Building a Safer Health System. Courtesy of the National Academy of Sciences (2000). Accessed through www.nap.edu/catalog/…/to-err-is-human-building-a-safer-health-system
James, J. (2013). A New, Evidence-based Estimate of Patient Harms Associated with Hospital Care. Journal of Patient Safety, Vol 9(3). P122-128 Accessed through http://journals.lww.com/journalpatientsafety/Fulltext/2013/09000/A_New,_Evidence_based_Estimate_of_Patient_Harms.2.aspx
Makary, M.A., Daniel, M. (2016). Medical Error – The Third Leading Cause of Death in the US. BMJ 2016; 353 doi: https://doi.org/10.1136/bmj.i2139
National Patient Safety Foundation (2016). Free from Harm: Accelerating Patient Safety Improvement Fifteen Years after To Err is Human. Accessed through http://www.npsf.org/?page=freefromharm