Episode 18: Simulation Transformation

Healthcare simulation has had a powerful impact on medical education, giving students and providers the opportunity to gain hands-on experience with complex procedures within a safe, controlled environment. But what is the potential for simulation to also help address the persistent problems of patient safety? Join host Karen Wolk Feinstein and guests Lance Baily of Healthysimulation.com and Dr. Paul Phrampus of the Peter M. Winter Institute for Simulation, Education and Research, for glimpse into the future of healthcare simulation and how it can transform safety for both patients and providers.

Listen to this episode on: Apple Podcasts | Spotify

Featured Speakers

Referenced Resources (in order of appearance)

Episode Transcript

[00:00:00] Paul Phrampus: The simulation is part of the future, and it’s not separate from the future. It’s ingrained into quality. It’s ingrained in the safety.

[00:00:12] Lance Baily: You’ve got to put these headsets on people, but once we do, wow, they really understand the power and the potential. And again, this is just the beginning of where it’s all going to go.

[00:00:21] Paul Phrampus: But like many things with safety and quality efforts, it’s not just a single thread. It’s a multi-pronged approach. It takes a commitment from the system. It takes a commitment from the community.

[00:00:34] Karen Wolk Feinstein: Welcome to the second season of Up Next for Patient Safety. We’re thrilled to continue to share conversations with the most interesting people doing the most important work toward our common goal of making healthcare safer.

I’m your host, Karen Feinstein, president and CEO of the Jewish Healthcare Foundation and the Pittsburgh Regional Health Initiative, which is a multi-stakeholder quality collaborative here in my hometown. We’ve been working to reduce medical error for over 25 years, and I will say at the start, we never believed the progress would be so slow. However, I do know that revolutions come from hope and not despair. We hope these conversations will inspire all of us with hope, as we hear from safety leaders of distinction.

Healthcare simulation has made incredible contributions to medical education, giving students and providers the opportunity to gain hands-on experience with complex procedures within a safe, controlled learning setting.

We’ve talked about the need to transform medical education previously on this podcast. And our guests today are both leading the way in promoting advanced technology within simulation as a tool both to enhance the skills of current and future practitioners and also ultimately to improve patient safety.

I’m thrilled to be joined by Lance Baily and Dr. Paul Phrampus, who will share their insights into the value of simulation within health care. I’m going to give you a good background on both of our speakers, since they bring unique perspectives to the field of simulation.

Lance Baily is the founder and CEO of HealthySimulation.com, the world’s leading healthcare simulation resource website, with daily news, continuing education webinars and courses, and job listings. Lance started the website while serving as the director of the Nevada System of Higher Education’s Clinical Simulation Center in Las Vegas back in 2010. He’s also the founder and acting advisor to the board of SimGhosts.org, the world’s only nonprofit organization dedicated to supporting professionals who are operating simulation technologies. He recently co-edited a book called Comprehensive Healthcare Simulation Operations, Technology and Innovative Practice. He currently serves on the advisory board to the Patient Safety Technology Challenge. His background also includes serving as a simulation technology specialist for the L.A. Community College District, firefighting, Hollywood movie production, rescue diving, and global travel.

In another direction, Dr. Paul Phrampus is the Medical Director of Patient Safety for the UPMC Health System and Director of the Winter Institute for Simulation Education and Research. He is a professor in the Departments of Emergency Medicine and Anesthesiology of the University of Pittsburgh School of Medicine and a member of the School of Medicine Master Educators and a Certified Physician Executive. Paul is past president of the Society for Simulation in Healthcare and serves on the editorial board of the journal Simulation in Healthcare. He is a seven-year veteran of the U. S. Navy, and he serves as co-chair of a regional effort in Pittsburgh to advance autonomous patient safety solutions.

Welcome, Lance and Paul. Let’s get started. So, Lance, as I mentioned, you’ve taken an unconventional route into the field of healthcare simulation, having been educated in film and digital media production, also working on the set with Tom Hanks’ production company, Playtone. You’ve served as a volunteer firefighter and trained to become a certified rescue diver. What motivated you to enter the simulation space, and how does your background in creative arts serve you in your current role?

[00:04:44] Lance Baily: Well, thank you, Karen. I really appreciate the question and the opportunity to be here with you all. Certainly, you know, one of the things I learned from film business was from Steven Spielberg, and he said, “surround yourself with people who are much smarter than you, and you will find great success.” And clearly, I have done that today with yourself and Paul and from the team here from the JHF. So, thank you for the opportunity. You know, like many of us in healthcare simulation, I sidestepped into the industry and the community. And so my background was audio video, digital technology, as you kindly shared, and then I went back to school and became an EMT and a firefighter. And while I was going through that process, my mom was actually the director of nursing at El Camino College and their nursing program there. And she said, Hey, come on into this new ward we have. I want to show you something. I think that you’ll really like it. And lo and behold, what we had there surrounded by camera and audio video technology was a Laerdal SimManClassic, and it was like an aura around this thing because all of a sudden, all my strange worlds that I didn’t understand how they connected came brilliantly together.

And so we were using audio video systems to record this mannequin, do experiential learning right then and there. And we used a lot of technology, which obviously in film production these days, contemporarily, we do. So it was just a wonderful way to kind of blend those things together and really experience the chance to kind of share those skill sets in a unique way. I’ll tell you just a quick example. I was in one of the nursing schools that I was working for at the L.A. Community College District, and there were 12 nurses in a new simulation space and they couldn’t get the audio video projection system to work. So literally, they called in Lance, the Sim Tech. I plugged in one AV cord, the projector work, and I got a standing ovations from the nurses, and I was like, this is the job for me, because, you know, previously in Hollywood, I did not have as much appreciation for my unique skillset, let’s just say. So, you know, and this has really stuck with me, though, is that there is really no professional educational degree pathway for those in simulation, especially not in the technical space, right?

There are a few now, many years later, degree programs for masters or PhDs in clinical education and debriefing, and kind of more of the clinician side of things and very few avenues for the technical specialist. And so, um, you know, I just understood from going to a couple of conferences back then in 2008, 2009, that there was a strong need to be able to support those technical folks or those who are operating simulation programs to be able to connect with other peers who come from unique backgrounds, right? Because there just is no bachelor’s degree in every community college with regards to simulation technology operations. And so, you know, next to me could be somebody with 20 years of IT experience. Next to us could be someone who has, she’s got 20 years of military experience. And so if we could all find ways to come together and share about our experiences from our unique backgrounds, We’ll all walk away with so much more. And this was really the impetus for things like HealthySimulation.Com and for SimGhosts.org, to be able to create spaces for groups to come together and share their backgrounds and their experiences to be able to help one another learn, grow, and develop from there.

[00:07:59] Karen Wolk Feinstein: Well, thank you. And I’m guessing that whatever attracted you to firefighting and rescue diving also led you to saving patients. So, thank you.

Paul, you’re part of the anesthesiology faculty at the University of Pittsburgh, even though you’re not an anesthesiologist yourself, although you know what a big fan I am of the specialty for how it’s embraced technology and safety and all the research that’s been done to make incredible strides in making the specialty safe.

So we even did an entire episode on this topic. What role has simulation played in transforming the specialty’s approach to mitigating error?

[00:08:46] Paul Phrampus: Well, first of all, let me say thanks for having me on here with you and look forward to this time to discuss things. I think that the transformation of the safety in anesthesiology began in the nineties, when that closed claims analysis came out that looked at a lot of the data behind mishaps in the operating room. And that led to a multi-pronged approach to patient safety. And at the same time, kind of serendipitously, there were people making efforts early in the days of simulation to have mannequins that could respond to clinical care, and that was eventually woven into one of the prongs of how the operating room was made so much safer.

But like many things with safety and quality efforts, it’s not just a single thread, it’s a multi-pronged approach. It takes a commitment from the system. It takes a commitment from the community, and I think it was fortunate that the technology was evolving in a way that made it more affordable, made it scalable, and made it customizable to be able to be programmed for various scenarios to line up with what they were finding in the closed claims analysis and then convert over to training retraining, continuing education training that allowed lots of policies, procedures, and practices in the operating room bring forward a much more safer environment than existed previous to that time.

[00:10:21] Karen Wolk Feinstein: And you have the data to prove the value. So, Paul and then Lance, why is anesthesiology among all the specialties the only one to have a patient safety foundation, which, by the way, goes back to 1985, and to welcome the input of many other disciplines in making anesthesiology safe.

[00:10:46] Paul Phrampus: I think that’s a really fundamentally good question, and I think that we need to pose that to the current community of health care. But I think that as I mentioned earlier, there was a previous commitment in terms of operating room safety that represented that was represented by data analysis of risk management data, primarily back in the nineties, as well as a few high-profile cases that made it into the media.

And I think that it became a succinct kind of hallway or pathway to go down to address safety efforts. I think that there’s been a big expansion of simulation over the last two decades to make a lot of specialties safer in terms of, I think, of emergency medicine practices, I think of pre-hospital care practices in the field, as well as critical care medicine.

But I think there’s also a long way to go. With regard to a safety foundation, I think that that multi-pronged approach that I talked about earlier led some of the early thinkers in the modern era of patient safety to realize and recognize that it takes more than just the people in their specialty to kind of recognize some of the warts of practice policies and procedures, and having a multidisciplinary group that involves engineers, administrators, people from the public, all coming together around the water cooler for the problem of safety in a particular discipline lent itself well to the birth of the Anesthesia Patient Safety Foundation. I personally wish more specialties would move in that direction, but I think We’re going to talk about that in a little while.

[00:12:24] Karen Wolk Feinstein: You and me both. So Lance, in the work that you do, the programs you run, do you have other specialties clamoring to be engaged, and which ones?

[00:12:38] Lance Baily: Yeah, so we’ve definitely found that the majority of our audience, maybe 50 percent is nursing. And I do feel that, you know, as simulation has continued to expand across multiple disciplines and the opportunity to see simulation successfully operating, you know, if you build it, they will come, right? And so, in a sense, I think there’s not so much of a, within the healthcare space, a lot of room for what we do in Hollywood all the time, which is imagine, you know, what we want to build and create, and then we make these worlds. And so we have to kind of show simulation for it to be kind of understood as a potential tool to the clinical education space, into the clinical training space. And so I think, you know, you’ve seen those initial launches out of anesthesiology where you, you had the Gabas of the world who were engineers and a very technical place where again, you didn’t have a lot of patient movement. You know, the mannequins could remain still. And then as you saw that kind of success, other groups started to say, Oh, wow, how could we use this for also education and training within our own domains?

But, you know, I think it’s expanding into every aspect of clinical practice, any particular group. You know, we wondered for quite some time, you know, where mental health would be in terms of simulated experiences. But, you know, the opportunity to work with a simulated patient or an actor who is representing a case of mental health, even that provides a great opportunity for learners to experience those patient cases in a safe and controlled environment way, right? So every aspect of health care is expanding, but of course, you know, I think I’ve seen a ratio of 12 nurses for every doctor on a floor, and so, you’re going to see this kind of expanding out as we get to different tiers of the healthcare system, more, you know, EMTs than emergency department physicians, right? And so there’s going to just end up being more people that are going to be integrating into the clinical simulation experience from throughout the entire hierarchy.

[00:14:49] Karen Wolk Feinstein: It’s hard for me to imagine what we don’t do without simulators. So, I’ve delivered a baby, and I’ve learned how to do chest compressions, and we do regular Red Cross safety training for our staff. I haven’t had a chance to use either. I hope I don’t. No one wants me delivering their baby. But what would we do without simulators?

The other thing I’ve loved is the kind of equity that you’ve brought. We now have Down syndrome simulators, simulators representing other anomalies and different racial backgrounds. I do think that the emphasis on having people train for a variety of different body types and different human structures is very important. So that’s another reason for me to heap on my enthusiasm for simulation.

So I’m going to direct to Paul one of the trickiest because we have worked together for many years. One of the common themes that often comes up when we discuss why progress has been so slow in patient safety are the many challenges of taking solutions to scale and getting buy-in from the medical profession.

So, Paul, you’ve been instrumental in deploying WISER throughout the UPMC Health System and beyond, well beyond. I’m always surprised by how far you wander, from Singapore and Europe and every other direction. Share a little bit about how you’ve been able to overcome some of these challenges.

[00:16:32] Paul Phrampus: Yeah, I think that with regard to the expansion of WISER and the support at UPMC, it has been a multi-decade journey, sort of combination of top-down buy-in for simulation, patient safety, and quality, along with a healthy amount of grassroots participation to create our programs. At WISER, we have a somewhat unique programmatic build insofar as WISER kind of houses the expertise of simulation, project management, curriculum development, and so on. And we partner with the clinical operations and the clinical departments from the nursing school, the medical school, from the hospitals. to jointly create these programs, and that allows us to kind of move things forward in a more scalable solution than if WISER was hiring each and every educator that taught each and every program.

I think that the important aspect, though, that I talk about when I travel around the world, about UPMC, is there is a large commitment to believe that simulation is part of the future, and it’s not separate from the future. It’s ingrained into quality. It’s ingrained in the safety, and they’ve entrusted us that run WISER to be good stewards of the investment in WISER and to tactically move forward when simulation is the most effective, is the most efficient tool. I always like to say we shouldn’t be simulating because we can. We need to simulate because we need to. And this is particularly true in the hospital operations side of WISER. We want to be able to bring to bear solutions that require simulation when simulation is the right tool and take a pass on things if simulation is, let’s say, excessive, for the particular goal or can’t quite simulate it enough, or simulate it appropriately to invoke a learning response that becomes so powerful with simulation, but it has to be when it’s applied, that simulation is the best tool for the job to get things done. Many simulation programs just offer solutions for the things that they were founded for as opposed to being integrated into the quality and safety infrastructure of the hospital side of operations to truly understand what the unique problems are.

As you know, Karen, patient safety is, you know, we can list the top three problems at most hospitals, but then the next three down from that are local to the hospital or to the institution. So it’s important that there’s a continuous analysis and refining of the data that are floating around in the quality and safety ethos of the healthcare system to be able to inform where the simulation center can bring the biggest bang for the buck.

And I think that’s been part of our, that trusting relationship that we’ve built up with senior leadership, and then my, sort of, movement in my career to grow in the safety and quality side of things, and sort of enjoy this unique position where I’ve kind of got one foot in simulation and one foot in quality and safety has allowed me to usher in solutions where WISER brings determinant returns on investment for the money that’s invested in us from both the university and the health system.

[00:20:02] Karen Wolk Feinstein: I have watched the many ways in which WISER, this is Karen’s opinion, of course, kind of gently introduces human factors engineering without calling it that. You know, simulation is now highly regarded. It’s now an accepted part of how we approach solving safety problems. But in some ways, I also look at it as something that brings some human factors thinking into our problem solving. So let’s go to the frontiers now. There’s been so much accomplished, but I know that knowing both of you, you haven’t stopped here.

So let’s think of some of the frontiers now for simulation and where it might go at both the education level, but the practice level. And let me introduce in this the fact that the simulation is often the patient, right? The simulators are often patients. But when I look at some of the things that the Department of Defense and DARPA pays for, the simulators could be the provider. So, talk to me a little bit. I’ve now seen pods and vests, and other things that can go onto the battlefield and actually diagnose and treat the wounded. So talk to me a little bit, what do you see as the frontiers of simulation?

[00:21:28] Lance Baily: You know, we try to really focus a lot on some of the forward-thinking technologies that are going to be influencing the space of clinical simulation. And for us, you know, the question of chicken and egg, oh, well, you know, do we put the methodology first, the technology first? And to me, we couldn’t do what we’re doing with clinical simulation 500 years ago, right? We just didn’t have the computerized technology to do so. So the technology is the egg, and it does come first. However, just as Dr. Phrampus said, we have to identify the learning objectives first and then apply the technology that would be appropriate for getting to those outcomes, right? And so there is this back and forth that we need to be kind of really cognizant of. It’s not just about using the shiny new toy to be able to get to those outcomes; if there can be something that is more cost effective and more useful in terms of the outcomes that we can garner because running simulation, there’s a lot to it. And so we have to be really efficient with our kind of considerations and then, you know, putting the right technologies to work. That all being said, it’s our belief that XR technology is going to revolutionize, to a great degree, the clinical education and training space.

And the reason is, because, while we need to increase physical simulation, there is going to be a kind of a whole new layer to the learning pyramid or to the training pyramid with regards to digital-based technologies. We did a survey to our global audience and found that post-COVID, a lot of institutions had made technology investments and in remote distance-based learning technologies, including XR, and had found great success with them, you know, including, tele-simulation, and as well digital patients that weren’t necessarily connected to a headset, but that you could interact with for either things like prioritization or patient care or learning about procedures and process through virtual patients on a desktop computer.

And so much so that they found the success that they were going to continue to look at remote distance-based learning technologies, even though COVID was wrapping up. And so what we’ve seen is kind of a ripping off of this Band-Aid and the demonstration of these technologies to, let’s be quite frank, laggards within the clinical faculty who, if they had any other way to do, you know, escape the challenges of COVID, they probably would have gone for it.

But then now that the technologies are in the space, they’ve actually been finding, again, great success with it, right? So the reality is, is that with the virtual reality headset, you can put that on, and you can be anywhere with anyone doing anything, at any time, right? And so that is an affordability. That is a flexibility that you can deploy headsets and be doing CPR training in the back of an ambulance. One minute, flip a switch, and now you’re on the face of Mars doing a surgical prep for some futuristic mission, right? And so, I think you get to this kind of democratization of technology that becomes, especially if we look at smartphones, much more affordable over time, wherein we have even better graphics and ability to display, and ability to perhaps add haptics, right, long term or the ability to touch and feel things as well in these clinical spaces.

So we’re on the beginnings of what XR is going to be doing to the space, and it’s because of groups like Sony and Facebook and Microsoft developing these big hardware technologies and then allowing specialists out there with clinical practice knowledge to build the curriculums that are needed in the clinical spaces, right? Or in other verticals like construction or mining or aerospace or space and so, and military as well. Finally, to this point, I’ll just mention that, you know, we did an amazing webinar with Dr. Ben Goldberg out of the U.S. Army recently, and he showcased and shared about the amazing ways that the U.S. Army is taking participants with biometrics with real-time AI interlaced with multiple video sets and being able to really challenge traditional ways of assessing teams and modernizing them In a way that we’ve prepared to do it at scale, right, for all across the U.S. military and through the U.S. Army and all of their personnel. So, really exciting to see how these technologies are finding ways of coming together and maximizing outcomes with regards to the investments that are being made in a really serious, serious way. So, really excited about what this is going to do for our space in the near future, because I think the more that we can get the technology in the hands of people where they have a chance to see what’s possible, the more they’ll understand, just as I kind of alluded to earlier about that, you know, there’s not so much imagination, so we’ve got to put these headsets on people, but once we do, wow, they’re really understand the power and the potential. And again, this is just the beginning of where it’s all going to go.

[00:26:06] Karen Wolk Feinstein: Well, it’s very interesting. I have a sense, you know, and this is from a distance, that the military is much more open to introducing various technologies, particularly when it comes to saving lives, than maybe the civilian market. So I’m going to turn this to Paul now.

Yesterday we had a Patient Safety Technology Challenge here for young entrepreneurs from a variety of disciplines, and they had all kinds of ideas. They’re full of ideas. We’ve been doing this around the country. And we find young people from business schools, you know, engineering schools, not necessarily the health professions. They’re full of ideas and actually viable technology solutions to some of our major safety problems. Here’s where there’s an obstacle, and that is, is there a market? We have talked to organizations here that do safety products and services and analytics for other industries. And we say, can you bring those to health care?

They say, We could, if there were a market, if there was an investment in these technologies. So here’s the big question: Paul, how are we gonna develop a market? We know that technologies are out there. We know that simulation could keep moving forward doing more and more dramatic things, but the commercial interests are only going to work on this if people will buy it.

[00:27:41] Paul Phrampus: Yeah, I think there’s a simple answer to this, and then there’s a longer, complicated answer. And I think the simple answer is, once we get people caring about a planeload of patients dying every day because of medical error, and equivocate that to the crashing of a jumbo jet in everyone’s mind, then we will move the healthcare industry in a direction that, you know, truly has to embrace patient safety and, and quality of care. That’s my simple answer.

[00:28:12] Karen Wolk Feinstein: What have I said? I’ve been trying to do that, as you know well, for over 25 years, and I haven’t been successful. So let me try this out on you. What if the big health systems who are connected to a strong research and innovation entrepreneur enterprise, they were themselves entrepreneurial, and they also were doing the research that could be transferred, what if those big systems actually tested their own discoveries themselves and then commercialized them?

Do we have a chance to build a new kind of mindset, which is quite okay based on the good old American way of capitalism, to say, look, as a system, you may have more and more challenges balancing your books with traditional health care, but you could be commercializing the products that make it more efficient, safer, and actually take the burden off your front line, but you should develop them and sell them yourselves.

[00:29:16] Paul Phrampus: I think that’s a great way forward. I mean, I think that, you know, entrepreneurialism and capitalism has certainly been a driver of this country since its founding. And that is kind of the push that health care needs at the moment, because we need to be able to create a better plan of incentivization or disincentivization to make sure that quality is the business case of the future. You know, and one of the things I noticed last night when we were judging all of those young entrepreneurs’ projects over time was the enthusiasm and innovation that comes from being unshackled with resistance at all turns really was an exciting thing to see.

And I think that you’re onto something by thinking about the health system with the entrepreneurial efforts and either partnerships with academics or inbred academics that can develop solutions for the future. And I think that piloting them on their own data and piloting them on their own, in their own systems and on their own patients, is going to, you know, figure out which of these (A) solves real problems in patient safety and/or the delivery of quality health care and (B) then identify the scalability of such foundations, and these could be things that are in training, kind of what we were talking about earlier, they could be things in actual healthcare operations to make the day go smoother for the healthcare providers, which will allow them to pay more attention, take more time with their patients, or be preventative in the future when We’re, let’s say, flying into an area of bad weather, you know, to make an analogy with the airline pilot, and have automated systems kind of guide the clinical care in the right direction as far as an error avoidance strategy. And I think that those kinds of innovative solutions can only come from lots of large scale testing of things that may or may not make it to market and be scalable.

[00:31:25] Karen Wolk Feinstein: You can imagine my ecstasy. So a couple of days ago, I opened your medical school magazine, Pitt Med. And I saw the senior vice chancellor saying just that: that he really did see the future of taking this enormous research enterprise, transferring the discoveries and commercializing them for better patient care.

And then today I opened the Business Times, and there was the new chancellor of the university saying the same thing. So, I think it’s the American way. I’m willing to live with it, you know, the excitement of taking the research enterprise, transferring discovery into experimentation, making that into a commercial product, I’m all for that. That’s the American way. Maybe that will be our answer because we certainly have a lot of potential with technology.

[00:32:21] Lance Baily: Yeah, Karen, so I‘m just going to just quickly add to that, that, you know, I think for a lot of what we’ve been doing in patient safety and clinical simulation has been from the ground up, right? It’s been very grassroots trying to find people, connect them, and then make the case to leadership across health care in the United States and around the world. And I think we also need to think, you know, when we’re talking about a technology adoption curve and that bell curve, we also need to think about those laggards who are not going to do anything until they are told that they have to because it’s regulated, right? And so to me, we also have to start looking at the conversation from the other side. And so if we can find ways to get C-suite execs from hospitals to call us and try to figure out better ways to bring in patient safety and clinical simulation to improve outcomes, then We’ll be able to faster meet somewhere in the middle, right? And get a technology diffusion that we are all seeking. And I think what that means is that we’ve got to find a way to get C-suite execs to call us. Well, what’s gonna do that, right? And I think what’s gonna do that is demand from patients, right? If their first thing that a patient asks when they come into any clinical space, if we could change it to the very first question is, What’s your patient safety score?

Just like we have restaurants, like I’ve seen in California where they have the letter rating right on the front door as you come in. You’re not eating at a C restaurant. That’s gross, right? You’re going to leave and go find someplace else to eat. And so I think the same thing can be applied. And so you see things like The Leapfrog Group where you have ratings for hospitals that are going to be displayed and available. And then you, of course, have outlier contributors like UPMC or MedStar. Many of them are showcased at the Patient Safety Movement Foundation annual meeting, where these are institutions that want to go out there and try to push forward for these types of improvements into the space. But you don’t see the mass demand, right? And I don’t think we get there until the populace is educated about the realities of medical error in practice, right? And so I know we’ve all been doing this for so long, but I do think that the marketing background and the production background that I come from helps me to see that there is a campaign that needs to happen at some point in the future here, where we can educate the populace to then demand legislation, demand hospitals to have better outcomes. And all of a sudden that puts pressure on the C-suite to say, Oh, we really now need to focus on this because our competitors are, because the government’s telling us that we have to, right? And we switch the model on that. And at some point, that’s where We’re going to get, because if you look at aviation, it’s mandated and regulated down to the level of the simulator. Because it’s so realistic that you can actually learn how to fly a plane on that, right? And so we need to be in that place. We need to look at our industry from that contextualization of being 50 years, a hundred years in the future and looking back and saying, Oh, these were the steps that were necessary to get us there. And that includes educating the population, the lay population, about the realities and the dangers that exist within the medical system as it is today.

[00:35:26] Karen Wolk Feinstein: Well, I like your belief in regulation, but in health care, it’s really a thorny issue. Mining has been regulated left and right. Most mines have inspectors there. They have state inspectors, they have federal inspectors. It’s kind of hard to fudge. And mining has had dramatic results. I will agree—I’m not going to do aviation because we always do aviation—mining’s had dramatic results from heavy regulation. It is the most inspected industry in the country. The most dangerous, the most inspected. I don’t know how well that works in health care. The other is patient demand. I love the different rating systems, but they’re not consistent. I find them confusing. Even people in health care don’t use them. Even in our wonderful state, the Pennsylvania Health Care Cost Containment Council data, I know people who are in health care who don’t consult it when they’re having major surgery. The other issue we have is the numbers aren’t always accurate. I’m afraid we have companies that come in and they decode, recode, play around with the data. So even though I like those two, I’m going to still put my money on commercialization. Because I think if it relieves the burden on the workforce, and that’s important, if we can find technology to make health care safer and take a burden off the front line, and there’s a financial argument for doing so, the opportunity to actually make money by doing this, I’m going to tell you, I think it may trump or beat both patient demand and regulation. But I’m going to turn this over now, Paul, for any last words that you have or Lance has on whether creating a National Patient Safety Board, one of our passions, could help accelerate this, not only progress within simulation, but progress in every way toward patient safety.

[00:37:36] Paul Phrampus: Yeah, and we’ve talked about this many, many times before, recently, and I commend you on spearheading this effort because I think that there’s a lot of opportunity that could come from the creation of a National Patient Safety Foundation, and it could come in forms of advocacy, like Lance was just talking about with the community. It could come with advocacy from the healthcare workforce that you just mentioned. And I think that is the crux of the challenges that We’re going to face in the next 5–10 years. The mass exodus that has occurred over the last four to five years and then accelerated by COVID is really crippling our ability to take normal care of patients as opposed to high-quality, safest possible care, you know, and thinking about how we can make the environment better to attract, recruit, and retain the workforces is a critical phenomenon that We’re just now getting ready to explore. It’s interesting, I just read earlier today, a quote from the CEO of Penn Medicine that, in a shocking kind of announcement, came out and supported the idea of fixed nursing to patient ratios in a legislative kind of format.

And everybody was aghast at somebody that’s running a hospital system supporting this. And part of his explanation for his position had to do with truly improving the quality of the environment that We’re asking people to work in when they’re challenged with taking care of patients. And I think that that is a key portion of things that could be investigated by such a federal board that We’re proposing, looking at different levers of opportunity, levers that can nudge, cajole, you know, incentivize, disincentivize, along with helping to usher in this commercialization of patient safety. I think it would be best done by this independent board that would have multidisciplinary representation and be able to touch many aspects of things that bring awareness to quality and safety issues that need to be thought about.

And moving forward, the other thing is I think that it could keep a tight focus on safety, you know, we talk a lot about education. We talk a lot about quality efforts. But under the big umbrella of quality and the way I think about it is safety. And a lot of times when the words quality and safety are juxtaposed to each other, they’re just kind of tossed together ,and one doesn’t really mean quality or really mean safety. And what I think ends up happening is the foci of safety kind of softens up in there. And I think a National Patient Safety Board would be an environmental think tank that would keep the focus on safety and make sure, of course we need quality. Of course we need to make sure people are happy with their experience, and so on. But I always like to say, if we harm them during the course, there is no chance that there is a quality patient experience. So, you know, we have to really get our legs underneath us. We have to put our money where our mouth is and walk the walk of safety to be able to make sure that we can take care of the people, whether it’s in the urgent care environment or acute phase of hospitalization, as well as the safety efforts that are being realized now from diagnostic errors in the community and in the outpatient setting, there’s so many avenues to go down. And I think bringing it together with the National Board some more accurate standardization of data collection that would allow us to attack different corridors of the safety problem with the resources available, along with planning for what resources do we need for the next decade to ensure success.

[00:41:42] Karen Wolk Feinstein: It’s so interesting. I haven’t heard about the recommendation coming from Penn, but we do have this problem. You could be running a lot more water in a leaky pitcher and it’s still leaking. So I often wish there were as many solutions to the nurse resignation problem as there are surveys. So I read the surveys, find the surveys. Why are the nurses bailing out? And we feel it here. We get so many applicants for every job position from nursing. And I actually don’t want to take people out of the front line, but one thing they all cite in their surveys is their patient safety and their own safety over and over again. And, and there are tactics, solutions, some autonomous that I think could be helpful and some, of course, just related to creating a safe environment. And I do think that that workforce issue, I mean, we would love to have a higher nurse:patient ratio everywhere, but we’ve got to have the nurses and they’ve got to stay, is not helping right now, but it’s so leaky.

[00:42:51] Paul Phrampus: And I think that transcends the nursing occupation. There is study after study after study in the physician literature of burnout causes and so on. It’s not because we use an electronic health record. That’s an easy answer, that’s kind of silly, quite frankly, because it’s trite, but the fact of the matter is what if you distill down a lot of the burnout issues, a lot of the people who have intention of leaving the profession or are leaving their profession, their respective profession, be it a pharmacist, be it a respiratory therapist, be it a nurse, be it a physician, has to do with because the work environment at the front line has become untenable, and it is a tough, it’s a big pill to swallow, and it’s one that a lot of people don’t like to talk about, but we have to address it. I agree with you that there are technical solutions that if we bring them in to scale can help reduce some of that pressure. But I think we are going to have to join with our human factors colleagues and others to really study, you know, at what points have we brought the care expectations of individual human beings to the brink of performance. And we just can’t get any better unless we relieve that environment and make it more palatable to work in and give the people some breathing room when they are taking care of patients.

[00:44:20] Lance Baily: Yeah, it’s not just about the patient, you know, this is all also about the provider and the level of stress that they have with regards to the demands that are put on them. Again, you know, and, and people saying, Oh, stop talking about aviation. We’ve talked about it. No, we’re not going to, we’re going to keep talking about aviation until we are like aviation and can mimic it more realistically in terms of the training outcomes. But when you have a 747 take off in Los Angeles and land in Hong Kong, you have four pilots, two to take off the plane who fly for four hours, two who fly for eight, and then the original two come back because we need to have no more than eight hours of effort put in, or we get a loss on the performance and the outcomes of the pilots, and pilots are making two errors an hour anyway. So the systems of redundancies that are there, like, you know, acknowledging that there’s a certain amount of time where a professional is going to get exhausted and they’re going to start making even more mistakes, well, we don’t have any of that in health care. And so I think this is all not just about the patient and patient safety, which is obviously super important and crucial, but also about provider safety and provider well-being, as well.

[00:45:24] Karen Wolk Feinstein: Well, I would say that both of you are at the frontier, that you are comfortable and you have brought technology into play in healthcare settings where others have feared to tread or been shown the door. So the one thing that’s wonderful to all of us, simulation has stuck. Our systems are really proud of their simulation centers. And I keep thinking the field has just begun. So, and you know, we can fold lots of things, robotics, right, a lot of hot AI, robotics, all of these things are going to fit comfortably within simulation.

So thank you so much for the work that you do. Thank you for joining me here today and shedding some light on where We’re going to go in the future. But most importantly, I do think that both of you are on the border of the future. And I thank you for that.

[00:46:26] Paul Phrampus: Thanks for having us, Karen. Appreciate it.

[00:46:29] Lance Baily: Yeah, so it’s been an amazing opportunity and we look forward to supporting you on all the work of the Advocacy Group for the National Patient Safety Board and the JHF as much as we can. You know, we applaud what you’re doing and We’re here to help and support.

[00:46:42] Karen Wolk Feinstein: Up Next for Patient Safety is a production of the National Patient Safety Board Coalition in partnership with the Pittsburgh Regional Health Initiative and the Jewish Healthcare Foundation. It’s produced and hosted by me with enormous support from Scotland Huber and Lisa George.

This episode was edited and engineered by Jonathan Kersting and the Pittsburgh Technology Council. Special thanks to Lisa Boyd, Carolyn Byrnes, and Robert Ferguson from our staff. Thank you for listening, and please take action, whatever that is, to advance patient safety.