使用模拟构建高性能团队

If you look at healthcare organizations who are leaders in delivering safe, patient-centered care, there’s a common thread. They place a premium on creating great teams.¹Across healthcare, these teams represent thousands of doctors, nurses, anesthesiologists, and others who, despite vastly different skill sets and training, come together every day, assume their roles at the patient’s bedside, and perform nothing short of miracles in giving back patients their lives.

莱德拉尔荣幸能够在今天训练的时候支持许多这些球队，明天跑得更擅长。使用仿真，这些团队可以推动，测试，并以在遇到真正的患者之前给他们一个深刻的优势的方式来了解自己。

美国医院可预防的医疗错误占估计有25万人的患者死亡人数，每年有超过100万次伤害。²The majority of these cases can be attributed to a breakdown in teamwork and communications.^3.Great teams know this, and so teamwork is where they focus—not just on refining individual skills but on instilling the skills necessary to excel within teams.^4.

We thank those institutions that place a premium on creating high performance teams in healthcare. Below we share some trends and findings based on our clients’ experiences in the hopes of supporting your organization’s patient safety initiatives,

Teamwork and communication are latecomers to medical education. Many institutions, however, have resolved to change in light of recent patient harm statistics. Leading medical schools are beginning to re-tool their programs to teach doctors the importance of teamwork and communications.^5.And, many nursing schools are beginning to overlay Quality and Safety Education for Nurses (QSEN) across their curricula, which has a large teamwork and collaboration component.^6.

Historically medical education has served a singular purpose: to produce experts licensed in their clinical field. Only recently have major institutions challenged whether that licensure qualifies experts to work effectively within a team.^7.Findings show that multidisciplinary team training leads to better teamwork and communications, especially in emergency or time-critical situations. It’s a paradox in healthcare that the many disciplines that must come together daily to treat patients all train separately during school and during continuing education. The following takes a deeper look at why this is a problem.

The realities of hospital operations are that rigidly assigned teams are a rarity.^8.Teams are often based on who’s on schedule, the nature of the case at hand, and so on. Consider this real world example: a patient suffers an obstetrics emergency. The hospital has 208 staff members that make up the 6 disciplines necessary to form the critical event team that will respond.^9.How many team combinations are possible?

答案是381,000,000。这就是这家医院的团队组合可以聚集在一起，以应对一个妇产权的紧急情况。81 x 50 x 16 x 12 x 14 x 35 = 381,000,000。请参阅下表。

Position	Number in Unit
Obstetricians	8.1
Labor and Delivery Nurses	50.
Anesthesiologists	16.
Neonatal Nurse Practitioners	12.
磨砂技术人员	14.
认证注册护士麻醉师	35
总参谋部	20.8.
团队的总组合可能！	381,000,000.

How many team combinations could come together in your organization to respond to a patient emergency?The numbers can be staggering.

医疗保健中的传统团队培训假设团队必须一起培训以实现高性能。^10.The math above shows that this is impractical. And, patient harm data show us thata team of experts does not automatically make an expert team.^11.

Organizations that build great teams approach the problem by focusing on the cognitive and interpersonal competencies that create great teams regardless of what combination of people is assigned to a case.^12.These organizations train their staff in team “systems” like TeamSTEPPS®, Crew Resource Management (CRM), or ones they've developed on their own. And, they reinforce that system through process design and carefully communicated expectations. Everyone is trained to conduct teamwork and communications to the same standard. This becomes especially critical in emergency situations where inconsistencies in approach and expectations can manifest themselves in the form of confusion, delay in action, and even a complete breakdown in team performance. The result for the patient can be disastrous.

Medicine has traditionally relied on a “see one, do one” approach to learning and experience.^13.Didactic learning in this context focuses on imparting knowledge. Simulation-based learning makes that knowledge come alive in a setting created to mimic real clinical encounters and lifelike experiences where teamwork counts.^14.

作为一个高赌注/高风险行业，医疗保健仍然是使用模拟来改善团队表现的相对新人。航空和军队是使用模拟作为构建有效团队的先决条件的先驱者。并且，在这些部门的情况下，证据明确了，仿真导致提高团队有效性，更好的使命结果和降低风险。在医疗保健中应用相同技术的情况下，结果非常相同。

According to a study published in BMJ Quality & Safety, simulation-based team-training can improve team communications, coordination and cooperation. And, such training has led to improved patient safety outcomes. Thirteen studies published between 2011 and 2012 reported statistically significant changes in teamwork behaviors, processes, and/or the team's ability to respond to emergencies. Ten studies reported significant improvement in clinical care processes or patient outcomes, including mortality and morbidity—all as a result of implementing a team training program.^15.

在这种情况下，模拟提供了教学学习无法提供的团队的好处. One is the opportunity for deliberate practice, i.e., quality practice, not just quantity. Another is the chance to debrief and truly understand the strengths and weaknesses in a team’s behavior. Furnished with all this, providers leave the simulation better equipped for future patient care.^16.

That may come as surprising advice from one of the world’s leading providers of patient simulators. But, it’s been validated time and time again that focusing first on your training and education objectives and not on which simulator to choose is the best path to success.

想象一下，您正在尝试在应用Teamstepps®，CRM）或可能是QSEN竞争力的基础上培训多学科团队的情况。如果您的培训和教育目标是确保学习者都舒适地应用合理通信和团队合作工具，则先进的模拟器可能不会增加体验。事实上，它可能会贬低它。我们看到了使用基本的Manikin甚至任务培训师进行伟大的团队培训。

但是，如果您想向同样的多学科团队提供相同的多学科团队，在一个真实世界环境中应用他们的新发现通信和团队合作技能的经验，在患者对患者对紧急干预措施的反应来衡量的情况下，一个高保真模拟器至关重要。因此，这将是一个适当的书面场景和用于汇报的视频捕获系统。

允许您尝试解决的问题，并且您所需的结果决定了您选择的模拟器，而不是另外的方式。

In situ simulation means conducting simulation on location in your team’s own care setting using the same staff, protocol, processes and equipment that your team uses every day. In situ simulation allows teams to review and reinforce their skills and problem-solve, all the while identifying hazards and deficiencies in their systems and environment.^17.

One of the fundamental obstacles that our clients often say they face is the lack of infrastructure to house and support a large simulation program.In situ simulation proves that a large infrastructure is not essential – and a large infrastructure is never a substitute for simulation best practices.

In situ simulation promotes training efficiency since it occurs during the actual workday, utilizing staff while they are on duty without the need to backfill or schedule training days. And, it can be conducted with minimal resources and investment beyond what’s essential to get the job done. The most important resource needed? A local champion.

Consider looking at your team training objective in the context of what your teams experience at the patient’s bedside. Identify the teamwork and communications deficiencies that occur routinely then and there. Looking at problems this way from an in situ perspective and then creating an in situ simulation in response can be an effective means for gaining the results you want to achieve – in the very place where you want the learning applied.

Perhaps you are a Department Head, or an Educator, or a Risk Manager. Whatever your role, we want to help you be a simulation champion. Simulation, especially in situ simulation, can yield significant results.18 Studies show that in situ simulation has yielded marked results in areas like obstetrics^19,20, pediatrics^21., trauma care^22., neonatal resuscitation,^23.and even new clinician orientation.^24.

莱德尔的使命是帮助拯救生命。我们这样做的方式是通过装备提供者进行最佳方法来进行模拟，其中常常发生提高患者安全的挑战：在团队和现实世界环境中。如果您需要帮助，请联系我们。