Using simulation to achieve high reliability

Surgeons and other health care professionals seeking to improve the safety and quality of health care are turning to new methods to achieve highly reliable care that is free from defects. One such method is simulation, a topic that was presented at the 2012 Fifth International High Reliability Conference in May 2012, conducted by Strategic Reliability LLC and hosted by The Joint Commission. A technique rather than a technology, simulation provides an interactive, immersive method to amplify or re-create the experiences that occur in the health care environment. Simulation may include verbal exercises, role-playing, storytelling, and computer-aided simulations featuring virtual patients, patient actors, computerized mannequins, and so forth.

David M. Gaba, MD, has been a pioneer in health care simulation, beginning in the 1980s with his work in mannequin-based simulation and continuing today in his role as associate dean for immersive and simulation-based learning and director of the Center for Immersive and Simulation-based Learning at Stanford University School of Medicine, CA. During his presentation at the conference, Dr. Gaba stated that health care presents different challenges than other industries of intrinsic hazard, such as aviation or nuclear power. Noting that physicians and health care workers do not design or build patients, let alone receive an instruction manual, he acknowledged that the alternatives to providing medical care are often untenable, regardless of risk.

Dr. Gaba noted that the decentralized nature of health care in both daily operations and business structure—for example, an estimated 22 million surgical procedures with anesthesia occur annually at approximately 6,000 hospitals owned by more than 1,000 entities—is another factor that separates the health care industry from other high-risk professions.

According to Dr. Gaba, simulation provides a comprehensive, continuous, and integrated way for individuals, teams, and work units to strive for the perfection and mindfulness that characterizes high-reliability organizations. Recognizing that identifying and addressing system problems requires more than training, simulation scenarios are designed to elicit behaviors likely to occur in real cases. Thus simulation offers direct education and hands-on training, as well as a method for performance assessment and evidence regarding human factors and teamwork. Furthermore, Dr. Gaba said that shifting the focus to optimal communication and teamwork behaviors that are fundamental to health care simulation exercises may also prompt cultural change, thus improving quality and risk-management efforts.

For more information regarding high reliability and simulation, including the 2012 Fifth International High Reliability Conference and Dr. Gaba’s presentation and podcast related to simulation, go to

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