International Journal of Healthcare Simulation

Background and aim:

Traditionally the focus of simulation has been centred on clinical management. More recently there has been a drive to enhance training on ‘human factors’ [1]. In simulation, human factors can be challenging to replicate, particularly with regards to how individuals interact within a system.

At GSTT we introduced a concept known as ‘social GRACES’ into simulation training. Social GRACES, first described by John Burnham in 1992 [2], outline a framework to understand an individual’s personal and social identity.

An abundance of research into the development of human factors skills exists in the literature. Our aim was to integrate social GRACES into our simulation programme as a novel approach to engage trainees with human factors.

Methods:

Between October 2022- April 2023, there were 23 full-day simulation training days. The course started with an introduction on human factors and the social GRACES. This was followed by a ‘lost at sea’ activity where trainees worked individually and in teams to prioritize the items they would take if lost at sea. This was followed by 4 clinical scenarios with debriefs related to clinical management, human factors and social GRACES. Pre and post course questionnaires were disseminated, and delegates were consented for data being used for quality improvement. Unique identifiers allowed for paired data analysis.

Results:

101 pre-course and 138 post-course feedback forms were received. To allow for paired analysis, only completion of both questionnaires was included, leaving 83 responses. There was a statistically significant increase in the percentage of responders who strongly agreed they felt confident in recognizing (7.2%-35.2%), assessing (15.7%-43.4%), managing (3.6%-20.5%) and escalating care (15.7%-35%), in acutely unwell patients. Additionally, confidence improved in understanding the impact of human factors in delivering care (9.6%-35%) and the performance of healthcare professionals (9.6%-39.8%). We explored confidence with regards to the practical implementation of human factors in healthcare (Table 1-A40).

Table 1-A40:

10 questions were devised to assess confidence relating to practical aspects of human factors in healthcare with regards to teamwork, communication, and leadership. Following paired data analysis, we found a statistically significant improvement in confidence in all areas investigated.

Question – On a scale of 1-10 rate your confidence in: -	Pre course	Post course	p value
Constructively managing others’ negative emotions at work	6.1	7.8	<0.001
Requesting help from colleagues in other professions	8.0	8.6	<0.001
Communicating effectively with a colleague with whom you disagree	5.9	7.6	<0.001
Prioritizing when many things are happening at once	6.2	7.9	<0.001
Speaking up as part of a team to convey what you think is going on	6.2	8.2	<0.001
Involving colleagues in your decision-making process	7.4	8.3	<0.001
Dealing with uncertainty in your decision-making process	6.0	7.5	<0.001
Asking other team members for the information I need during a busy ward environment	6.8	8.0	<0.001
Recognizing when you should take on a leadership role	6.0	7.9	<0.001
Monitoring the ‘big picture’ during a complex clinical situation	5.8	7.7	<0.001
Anticipating what will happen next in clinical situations	5.7	7.6	<0.001
Working effectively with a new team in clinical situations	6.6	8.1	<0.001

Conclusion:

The results demonstrate that the interplay between managing acute clinical scenarios & human factors can effectively be taught through simulation and enhanced with an understanding of social GRACES.

An increased understanding of human factors and simulation training was useful in improving 3 crucial skills; teamwork, communication and leadership, which are instrumental in improving clinician confidence and patient outcomes.

Future direction should look to include awareness and implementation of human factors within mainstream simulation to effectively replicate real time clinical scenarios & pressures.

Ethics statement:

Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable.