Making the Most of Simulation

1. Making the Most of Simulation Summary of exploratory work to inform strategy development October 2014 Health Education East Midlands

2. Introduction This report presents the findings and recommendations from Frontline’s exploratory work to inform Health Education East Midland’s (HEEM) strategy to support increased engagement in simulation based education for NHS staff across the region. Context This exploratory work follows on from our previous review of simulation based education in the East Midlands in 2010. The whole health and social care landscape has changed dramatically since then, and this more recent work refreshes previous recommendations and positions them within the context of new organisational structures, pressures and imperatives. Over this summer we held discussions with 18 key stakeholders involved in the delivery of simulation activities across the region, seeking to gain their perspectives on the challenges involved in increasing the opportunities for simulation-based education as well as how HEEM might best be able to support this ambition. A workshop involving 12stakeholders was held in October exploring in more depth the issues and themes arising from our discussions and beginning a partnership approach to strategy development. In parallel to our work, ASPiH/HEA have undertaken a national simulation survey. Whilst the results of this survey are yet to be published, the main messages align very closely with our findings, namely for a focus on: • Standards and quality assurance • Common language – creating exemplars • Commissioning standards • Faculty preparation and development • National and local networks to be reinvigorated – communication and sharing • Increased emphasis on human factors

3. Discussion findings verified at workshop • Undergraduate simulation– delivered by universities and medical schools (with some linkage to simulation centres) • Key points: • a wealth of experience, expertise and facilities • delivery of learning and development in dedicated facilities • close links with local trusts to reflect service needs • not always aware of activity going on elsewhere • business model offers potential to open access to others and for other purposes e.g. CPD • ‘sharing’ of resources dependent on funding mechanisms • Simulation centres – activity focused on doctors in training and commissioned by the schools. Different funding models and allegiances with NHS trusts influence the amount and type of work outside of this main area • Key points: • the focus for experience and expertise across the region • interested in working in partnership on regional activities e.g. quality standards, facilitator development and CPD • some interest in working in partnership to more effectively ‘share’ delivery of commissioned demand • school commissioning processes do not always support business and service development and innovation – can also result in ‘silo’ working within centres • a network has been established • Service-led simulation – tends and often necessitates to be run in situ at the point of care. Might also be delivered or supported by staff from a trust-based simulation team • Key points: • often led by a medical ‘champion’ in a specific service area who ‘makes sure it happens’ • there is not always awareness of or co-ordination with other simulation activity being undertaken elsewhere in the trust • more likely to be aligned with trust strategy and objectives where dedicated simulation staff are involved who ‘fit’ into the trust’s organisational learning and development structure • more likely to involve multi-professional teams with an increasing emphasis on human factors • success hinges on the quality of facilitation and feedback • does not necessarily need equipment to get it up and running but rather, someone who is determined/supported to get it off the ground Discussions identified three main areas of simulation activity:

4. Issues and challenges highlighted and explored at workshop • Definitions & perceptions • Seen as for doctors only • Seen as performance management • Lack of general awareness of the scope • Just another educational tool • Operational issues • Time • Service pressures • Back fill • Money • Equipment • Demonstrate impact: patient safety and quality, link to results, insurance, mortality, CQC, Monitor, reputation, recruitment & retention • Need shared purpose, definition & language • Link to continuous learning - more than ‘a course’ • Link to emerging roles • Multi-professional • Human factors • Need to engage CEOs & commissioners • Seek alternative sources of funding • Research & evidence • Co-ordination & communication • Not integrated – ad hoc • Silo working • “Outsiders” • Funding/business model barriers • Wealth of experience & commitment • Quality of facilitation & feedback is key • “I love my job, I can’t believe I get paid to do it” • Not reinventing the wheel • Sharing and learning from each other • Quality standards • Support the champions • Not reinventing the wheel • Sharing and learning from each other

5. Workshop SWOT analysis to inform strategy development • Strengths • Champions • Infrastructure (HEEM) • VLE support (HEEM) • Enthusiasm • Expertise • Legitimacy of role (HEEM) • Credibility (HEEM) • Weaknesses • Limited clarity of purpose • Silo working • Financial ethos • Lack of resource • Lack of authority (HEEM) • Limited engagement • Limited sharing • Lack of evidence of impact • Threats • Retrenchment of goodwill – commercial, business, competition • Organisational upheaval • Insular working – local and national • Opportunities • Safety agenda • LDAs • Evidencing impact and outcomes • Selling the benefits not the features • Links to commissioners • Links to patient groups • HEE research policy • Research funding • HEEM’s enabler/convener role • Care homes • CQC

6. Recommendations for strategy development • An agreed purpose for increasing participation in simulation-based education needs to be clearly articulated focusing on the safety and quality agenda • There should be an emphasis on benefits, outcomes and impact working to identify and measure these where links are tenuous • A new focus should be placed on engagement with Trust CEOs and commissioner organisations to secure their buy-in, support and potential sponsorship • Simulation-based education needs to be defined in a way that clearly explains its scope to a variety of audiences. The development of a range of exemplars would support this • A stakeholder mapping exercise should be undertaken to identify new and different organisations and groups, including patient groups, whose engagement would support the strategy • Support should be provided to the East Midlands simulation network to expand its membership to include all stakeholders involved in simulation activity, clarify its purpose and its unique contribution to the regional strategy • Simulation centres and Heads of Schools should be supported to work together to identify opportunities for new/different ways of working to deliver post-graduate training to support innovation and multi-professional accessibility and cost effective delivery • There should be discussion with regional universities on how they might work in partnership with HEEM to support the development of an evidence base for simulation-based education • Different and new funding mechanisms should be explored, in particular research/improvement/patient safety related funding to further develop the evidence base for simulation-based education as a more mainstream learning and development methodology • The strategy should maximise and leverage opportunities afforded by national work in this area • The strategy should be future proofed as much as possible in terms of potential restructuring at national and regional levels