Why is this important?

Most simulation research focuses on skills and knowledge (the easiest factors to measure), even though:

1. It is clinical outcomes that primarily matter, and;
2. Simulation is uniquely positioned to address improvements in the many domains of teamwork.

Brazil et al. applied a relational coordination (RC) framework to understand teamwork-aspects of simulation research, particularly as these impact wider institutional and healthcare system performance.

“The RC framework — shared knowledge, shared goals and mutual respect in the context of communication that is timely, accurate, frequent and problem-solving based — can provide a common language for simulation educators to design and debrief simulation exercises that aim to have a translational impact” (Brazil et al. 2019)

What did they do?

The researchers undertook a narrative survey of staff involved in early major trauma care at a university teaching hospital. Over half of the respondents had participated in the institution’s existing in situ trauma simulation program.

Survey responses were analysed using the RC framework, and found to be consistent with each RC domain. Most notably trauma simulation acted as an enabler of mutual respect and improved communication, along with enhancing the understanding of team roles and prioritising problem-solving focused communication.

The take-home

The impact of simulation needs to be understood in the context of the greater goal – healthcare system improvement – and that this occurs with pre-existing organisational cultures and relationships. Simulation outcomes goals are not exclusive to small teams or individual performance.

The various domains within the relational coordination framework provide an easy to use guide for understanding, communicating and deploying simulation benefits, drawing a path from the ‘here’ to the ‘there’ of improved outcomes.

“Simulation should be considered as a tool to build and strengthen relationships between practitioners across traditional boundaries.”

summary

• Victoria Brazil, Eve Purdy, Charlotte Alexander, and Jack Matulich.
• 1Faculty of Health Science and Medicine, Bond University, Robina, QLD Australia.
• Adv Simul (Lond). 2019 Jan 1; 4: 10.

BackgroundMajor trauma care is complex and requires individuals and teams to perform together in time critical, high-stakes situations. Scenario-based simulation is well established as a strategy for trauma teamwork improvement, but its role in the relational and cultural aspects of trauma care is less well understood. Relational coordination theory offers a framework through which we aimed to understand the impact of an established trauma simulation programme.MethodsWe studied simulation activities using a narrative survey of trauma providers from anaesthesia, emergency medicine, medical imaging, surgery, trauma service, intensive care, and pre-hospital providers at Gold Coast University Hospital, in conjunction with data from an ethnography. Data analysis was performed using a recursive approach-a simultaneous deductive approach using the relational coordination framework and an inductive analysis.ResultsNinety-five of 480 (19.8%) staff completed free-text survey questions on simulation. Deductive analysis of data from these narrative survey results using the RC framework domains identified examples of shared goals, shared knowledge, communication and mutual respect. Two major themes from the inductive analysis-"Behaviour, process and system change" and "Culture and relationships"-aligned closely with findings from the RC analysis, with additional themes of "Personal and team learning" and the "Impact of the simulation experience" identified.ConclusionsOur findings suggest that an established trauma simulation programme can have a profound impact on the relational aspects of care and the development of a collaborative culture, with perceived tangible impacts on teamwork behaviours and institutional systems and processes. The RC framework-shared knowledge, shared goals and mutual respect in the context of communication that is timely, accurate, frequent and problem-solving based-can provide a common language for simulation educators to design and debrief simulation exercises that aim to have a translational impact.

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