International Journal of Healthcare Simulation

Background:

Equality, diversity, and inclusion (EDI) are high on the national agenda within healthcare. As an acute Trust based in London, we believe it is important to explore our simulation service provision through this lens, and make appropriate improvements. We have noted EDI interventions typically focused on single or isolated actions that often have minimal impact. The Safety Engineering Initiative for Patient Safety (SEIPS) [1] is a systems-based approach that considers the dual outcomes of system performance and human wellbeing. SEIPS is often described as the ‘Swiss army knife’ of human factors or systems-based models and can be used both retrospectively and prospectively to look at a defined work system, and its related processes. We utilise the SEIPS framework, to evaluate current barriers and enablers to EDI within our simulation service, and use the findings to design appropriate improvements.

Methods:

The SEIPS framework guided our thinking across all stages of the project and we considered the wider context of EDI within our simulation service. Interactions between different work system factors that produce both wanted and unwanted outcomes, and feedback loops were explored. Information gathered from a number of sources allowed for triangulation and a review of emergent themes. Data sources included: Optional online post-course survey, including quantitative and qualitative EDI questions relating to an experience on a recent simulation course. All participants and faculty that attended relevant simulation courses since November 2021 were included. Review of feedback from November 2021 of all relevant simulation courses. Qualitative data themes were mapped to the SEIPS framework. A patient representative shared common EDI experience themes that Trust patients had reported whilst interacting with our hospitals and healthcare services. Relevant scenario and course documentation was reviewed for EDI themes using CORE20PLUS5 [2] as guidance. Frequency of both implied and explicit references were measured.

Findings:

Stage one (evaluation) findings so far, suggest three key themes of accessibility, default gaze, and Work-As-Imagined versus Work-As-Done have emerged. Stage two (improvement) is to design system level improvements and assess them using the Inequality, Feasibility, Acceptability, Cost, Efficiency, and Sustainability (IFACES) criteria. Suitable improvement ideas will then be tested using a Plan/Do/Study/Act (PDSA) cycle.

Conclusion:

We reflect on the utility of SEIPS as a systems-based tool to support an EDI service evaluation and improvement project and share our journey so others may learn from this process.

References

1. Carayon PA, Hundt AS, Karsh BT, Gurses AP, Alvarado CJ, Smith M, Brennan PF. Work system design for patient safety: the SEIPS model. BMJ Quality & Safety. 2006;15(suppl 1):i50–58.

2. NHS England. CORE20PLUS5 – An approach to reducing health inequalities. 2021 Nov. https://www.england.nhs.uk/about/equality/equality-hub/national-healthcare-inequalities-improvement-programme/core20plus5/ [Accessed on 30/06/2022]