Simulation and Optimising Returning to training Giulia Miles, Centre Manager Trent Simulation & Clinical Skills Centre Dr Caroline Brown, Assistant Director Postgraduate Education Nottingham University Hospitals NHS Trust

Safe Systems, Adaptable Teams, Capable Staff TSCSC 2004 ……Today Clinical and procedural skills Non- technical and professional capabilities Patient stories Faculty development High reliability teams Organisational Learning & Resilience TSCSC has evolved in terms of its work and how this can support the development of safe capable healthcare staff of all professions. This has increasingly addressed the needs to demonstrate high quality ‘non-technical’ skills, known more generically as ‘interprofessional and interpersonal skills’ (especially in the higher education sector) and ‘professional capabilities’ including team work and leadership (more so amongst qualified staff). The centre has also pursued patient-centred education and safety improvement themes using powerful narratives to promote candid and often illuminating facilitated discussions amongst students and staff. On a broader healthcare system and organisational level the centre actively leads and promotes development of educational faculty and trainers, whilst offering similar development opportunities for staff wanting to improve their awareness and capabilities in patient safety improvement. In more recent years we have built and strengthened relationships with academic, commercial and professional networks within and beyond healthcare. This has all benefited NUH and the wider local or regional health care system by our desire to engage with organisational leaders to promote a learning culture (both from avoidable harm and excellence), develop greater awareness of safety systems and how their design supports effective and safe care as well as helping address productivity and efficiency workstreams. However we feel that we are not in a position to support NUH and its place in the changing landscape of our healthcare systems anywhere near as much as we would wish. This has arisen by the centre being required by the Trust to pursue external commissioned activity, which we have undertaken successfully throughout our lifespan, whilst internal funding has been much less well developed. This will be considered in later slides. Networks & partnerships Patient Safety Human Factors Learning from Excellence Safe Systems, Adaptable Teams, Capable Staff Safe, formative, applied to practice

‘Simulation is a technique—not a technology—to replace or amplify real experiences with guided experiences that evoke or replicate substantial aspects of the real world in a fully interactive manner.’ 1.Gaba DM. The future vision of simulation in health care. Qual Saf Health Care 2004;13(Suppl 1):i2–10.doi:10.1136/qshc.2004.009878 Embedded in real world practice and supports transfer of learning to practice. Individuals working in teams

Sim Modalities Part task trainers VR Full immersion high fidelity simulation In situ sim Simulated patients

Effective teamwork and leadership Clinical and procedural skills Effective teamwork and leadership Non technical skills and professional capabilities System Issues

Simulation ‘journey’ Understanding learner needs Clear learning outcomes Pre-briefing and preparation Safe Environment Facilitated debrief Experiential learning Rehearsal for performance Develop confidence Learn and re-learn Demonstrate progress Transfer to Practice

Demonstration Simulated Patient

Regional Approach East Midlands Simulation Network Leicester Northampton Kettering Derby Nottingham IRiS – scenario sharing platform Collaboration to Supporting RTT

NUH Scoping and understanding what trainees and trainers require Design and deliver a pilot day (Sept ‘18) Developing local network Develop effective learning needs analysis tool

Situational Judgement Responses An enhanced Learning Needs Analysis approach for individual and team skills, behaviours and patient safety capabilities Situational Judgement Responses What each employee: UNDERSTANDS DOES NOT UNDERSTAND MISUNDERSTANDS What each employee’s: CONFIDENCE is in what they think they understand The second novel tool being introduced as part of the programme in its current year is an enhanced Learning Needs Analysis (LNA). This makes use of an assessment approach called ‘Situational Judgement Responses’ (SJRs) that has been used extensively in other industries for leadership and management development programmes. In healthcare it has been used primarily within the education sector for selection into Medical Schools as well as at a postgraduate level in progressing through different stages of specialty training. Validated tool (Cognisco) Widely used across many industries- civil service, banking, NHS, US healthcare Learning needs analysis Looks at understanding and confidence Individual/team /organisation Which employees are likely to: Apply the RIGHT knowledge with high confidence Which employees are likely to: Apply what is WRONG and potentially influence others Which employees will benefit from: Receiving focused COACHING and feedback in practice

RISK TRAIN NOVICE COACH TALENT +100 UNDERSTANDING -100 50 +100 CONFIDENCE & CAPABILITY TO EMBED IN PRACTICE ROLE MODELS & TALENT IDENTIFICATION ONGOING DEVELOPMENT OF SPECIFIC KNOWLEDGE WITH TRAINING DEDICATED ACCESSIBLE KNOWLEDGE & TRAINING PRIORITY DEVELOPMENT UNDERSTANDING -100 50 +100 CONFIDENCE Measures Understanding and Confidence Identifies areas for targeted development Provides an effective platform for Coaching Eliminates unnecessary, untargeted and ineffective training Supports talent management High understanding with high confidence = Above Standard High understanding with low confidence = Coaching Confidence Below benchmark understanding with varying confidence = Knowledge Focus Low understanding with low confidence = Significant Knowledge Focus Low understanding with high confidence = Priority Development Required RISK NOVICE TRAIN COACH TALENT

Follow us:@TrentSimulation Find out more: Caroline.Brown2@nuh.nhs.uk giulia.miles@nuh.nhs.uk www.trentsimulation.nuh.nhs.uk Follow us:@TrentSimulation