International Journal of Healthcare Simulation

Background:

Testing new healthcare systems, environments and processes using simulation-based methods is a rapidly growing topic in the literature. By testing systems in a safe and controlled environment, simulation for system integration allows operational and safety issues to be flagged up without risking patient care ^[1]. However, there remains a gap in the literature detailing how these approaches might impact staff experiences of change in healthcare. This research seeks to explore the experience of staff members in the midst of large organizational change, and the use of simulation (using a systems integration approach) to increase confidence and perceived preparedness.

Aim:

This study aims to explore the lived experience of change in nurses moving to a new hospital, and the impact of a simulation programme on their sense of preparedness.

Simulation activity outline:

The Patient Environment Simulation for Systems Integration (PESSI) programme was developed to test new processes and environments to identify latent safety threats and systems issues prior to staff, patient and community use. A major PESSI project was commissioned to aid the transition of paediatric care in Edinburgh to a new hospital site. Simulation scenarios were developed to mimic an average working morning for each department using staff feedback on processes or factors that might be affected by the change in environment. Staff were invited to participate in departmental simulation days which included orientation in the new environment, a simulation scenario, and a professional debriefing. Following each session, a report was produced detailing key findings.

Method:

The research team selected a constructivist phenomenological approach to the enquiry and using Bartunek’s et al.’s conceptual framework designed pre- and post-simulation semi-structured interviews (SSIs), and mid-intervention ‘headline reflections’ ^[2]. Nurses were chosen as key ward-based staff who could offer a breadth of experience on operational use of the new healthcare environment, and who are not regularly expected to rotate and adapt to new environments like their medical colleagues. Twelve participants were recruited from a range of departments. Data were analysed using a deductive thematic analysis based on Bartunek et al’s conceptual framework ^[2].

Results:

Results are currently being analysed following the hospital move in March this year. Early findings suggest ‘quality of communication’ and ‘opportunity for familiarization with the environment’ were key themes influencing participant’s feelings of preparedness prior to the move. While ‘recognition of voice’, ‘personal impact’ and ‘good leadership’ appear to be factors impacting participants’ feelings towards the change in working environment after the move. Early indications suggest that the inclusion of local staff groups as part of this simulation had a positive impact on the perception and preparedness of large-scale change.

Implications for practice:

As simulation for system integration becomes more common, it is important that we tailor simulation programmes to best prepare not only the new systems but also the people working there. This can only be done through listening and learning from staff experiences. The research team will seek to publish these findings to help inform future simulation for systems integration programmes.