Simulation: what does scientific evidence show about its impact?

1. Reduces asymmetries between theoretical knowledge and care practice. ^4-6
2. Allows to control a sequence of tasks and prevents risk situations, allows students and professionals to fail in a controlled environment, and confronts each person with its limits. ⁶
3. Supports health organizations’ efforts to promote continuous medical education. ^7-9
4. Increases the professionals’ degree of confidence in critical moments when the time to make decisions is short and improves ongoing chronic disease management. ^7-9
5. Positively impacts patients' outcomes. ¹⁰

A step inside clinical pathways challenges

Focusing specifically on barriers that impede clinical engagement and uptake of care pathways, Evans-Lacko, S., Jarrett, M., McCrone, P. et al. gathered the clinician-related factors and distinguished three different levels: ¹¹

Simulation and clinical pathways implementation: a speck of light at the end of the tunnel

• Convincing people that there is a problem
  
  Authors explain that the literature is full of examples of interventions where clinicians insist that the service being provided is already good. Therefore, those designing and planning an intervention must be careful to target problems that are likely to be accepted as real and that the improvement activity will offer a relative advantage over the status quo.
  
  Solution: when using our clinical simulation software, you are able to give clinicians clear and customized insights on how their actions affect patients' outcomes and which changes would drive better results.
• Convincing people that the solution chosen is the right one
  
  According to this report, a second fundamental challenge is to convince people that the right approach to tackling the problem has been selected. Thereby, having a sound scientific evidence base for improvement interventions is likely to be important to the chances of success.
  
  Solution: in addition providing customized feedback on a particular healthcare professional performance, simulation allows each professional to check the scientific evidence supporting the performance assessment, working as a credibility stamp for the solution chosen, which, in this case, represents a clinical pathway designed to work as a roadmap to all teams treating patients with the same conditions.
  
• Getting data collection and monitoring systems right
  
  Data collection is an essential element of the process of improvement. Good quality data are the key both to demonstrating the problem and showing how it is being addressed. Additionally, the research found that some clinicians were reluctant to take part because they had not been consulted in the development of a care bundle.
  
  Solution: our clinical simulation software is useful to collect data at two different points in time: before designing a clinical pathway, in order to have a global perspective on how your staff approaches a particular disease; after designing a clinical pathway to evaluate the new behaviors and its compliance to best practices. Besides, it has an internal feedback system that gives each user the possibility to agree or disagree with a particular recommended action.
  
  Another topic evident from evaluation reports and the literature relates to the profound impact of organizational and institutional context on improvement efforts. This includes organizational cultures, organizational capacity, user involvement, etc.
  
• Organizational cultures, capacities, and contexts
  
  Not surprisingly, organizational cultures supportive of personal and professional development, and committed to improvement as an organizational priority, are more likely to provide an environment where improvement can flourish. However, it’s relevant to clarify the basis reasons of a quality improvement activity since it impacts staff engagement. Literature also reinforces complexity and lack of adequate structures to support improvement activities as a means to failure.
  
  Solution: besides giving quantitative and qualitative insights on your unit performance, more advanced simulation software provides you an intuitive and data-based means of evaluating clinical pathways applicability in the real world, making sure that you’re adding complexity to your staffs’ routine without a clear purpose. Furthermore, this software mimics an electronic health record (EHR), facilitating professionals’ onboarding processes.
  
• Tribalism and lack of staff engagement
  
  In contrast, “resistance to improvement based on ideals of professional autonomy, impermeable boundaries between professional groups, and resistance of professional cultures to change led from outside have all impeded efforts to improve quality”, stated the Health Foundation in a quality improvement challenges report published in 2012. Peer support was highlighted as an important feature in several projects.
  
  Solution: clinical simulation software work also as a training tool, in which health professionals can practice their approach to particular conditions in a safe and predictable environment. Also, it exceeds the personal dimension and ensures process standardization within a healthcare unit, regardless of the experience or expertise level of a particular professional.

Wrap up: in which dimensions can simulation be useful to create a successful clinical pathways strategy?

1. To understand the clinical processes in your hospital;
2. To test clinical pathways applicability in real world;
3. To train clinical pathways, making the teams aware of its recommendations;
4. To design future formative programs according to insights extracted;
5. To give clear and customized feedback on each performance.