Deb & Ferooz Special - How to set up a Simulation Center

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Transcript

Disclaimer: 0:00

The views and opinions expressed in this program are those of the speakers and do not necessarily reflect the opinions or positions of anyone at Innovative Sim Solutions or our sponsors.

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Intro: 0:38

Welcome to The Sim Cafe, a podcast produced by the team at Innovative Sim Solutions, edited by Shelly Houser. Join our host, Deb Tauber, as she sits down with subject matter experts from across the globe to reimagine clinical education and the use of simulation. So pour yourself a cup of relaxation, sit back, tune in, and learn something new from The Sim Cafe.

Deb: 1:11

Welcome to another episode of The Sim Cafe. Today we're truly fortunate to have a colleague, Farooz Sakandapoor and this episode is not gonna be your traditional episode. We're gonna talk a little bit more today about how important designing simulation centers are and how, what are some of the questions, the key questions you need to be asking. And peruse and I are going to discuss simulation design. So for, why don't you go ahead and get started and share with our listeners your experience with simulation design, how many centers you've set up, and how many places you've actually consulted on the planet.

Farooz: 1:54

Thank you very much. Uh, Deb. Well, my experience, uh, I've been working with simulation for the last 18 years. My background is technology and information technology and, uh, I, my design experience has started in 2010. Previous to that, I was the IT manager of a simulation center that established in 2003 and one of the first centers that is accredited by American College of Surgeons and at University of British Columbia in Canada. So in, uh, 2010, we started to expand the world of simulation in our province. And so I was tasked to, as someone who ran the simulation, the spaces, So I was tasked to participate and provide some knowledge for this design team. So, uh, they asked me to provide a list of things that needs to be implemented in their design by the architect at the time. So automatically, when I start working into creating a checklist of what the simulation lab should look like, my vision at the time was a lab would look like that I didn't like about my own space. So before I know it, we start duplicating these spaces around the province. So each project that was finished, I, we did a listen learn. So I, a lot of listen, learn from these projects, it start getting into my list of checklists. And I immediately realized, Oh wow. Which we could have added things better here and there. And soon I started to create the first guidelines for our faculties. And that guidelines was to make sure that before starting of any other project, we needed to make sure that our designs or standards and, uh, our infrastructures are in place ahead of time, what the equipments will look like. So that's how it started. Basically. As of today, I'm very proud to say that I have designed and, and participated in the design of 26 simulations centers around the globe and my outside of my university, I've consulted with other universities and institutions as well. So yeah, that's, that's how I started and that's where I am and I'm very proud to see that. I also participated in and contributed to a book that was published with a help op STEM goes, uh, which is called Comprehensive Healthcare Simulation Operation Technology and Innovative Practice Book. And uh, chapter nine, which is about the infrastructure and simulation center design is written by me as well.

Deb: 4:25

Thank you. Now for, why don't you share your specific process if you have a new client, So say a new client comes in and they say, you know, we've got$2 million, what are you gonna say to the client?

Farooz: 4:40

Great. So we have a, I mean, during the process that I just described earlier, we also, uh, created a process of how to engage with the client and with a project team to learn. We do a need assessment, Toro need assessment. We wanted to know how many students they are going to serve, how many departments they are going to serve, who are their target audience and who are their main learners are and what they have existing, what their future plan. And often we, through our process, we help them to think out of the box and include those groups that are, that they're not included in their existing program. So because we wanted to make sure that the budget is set up in a way that it can expand and provide more opportunities and not only for the learners and also for sometimes money generation for the clients as well. Because often these spaces are very expensive to run. So if you program or do you design, include those sort of flexibilities, it allows you to generate income for the institutions as well.

Deb: 5:40

So what I think I'm hearing you say is you want to make sure that they're thinking into the future. So five years into the future, do you anticipate that you may be renting your center out to paramedic groups or different allied health organizations? I would imagine that you're going to consider at the C-suite level. Okay. Perhaps one person has a favorite stimulator brand that they like to include. So you would wanna make sure, because you don't sell simulators, you don't sell for Gaumar, any of those big places. So you would help your end user determine what are the best needs or best simulators and best products for their learners, as well as what k ind of AV solution and platform you would wanna determine a nd help them make those decisions prior to, but keeping them within their budget. But building for the future, like do you feel you might be able to get grants or donors for 2023? What about virtual reality? Do you have a space f or virtual reality built? What about telehealth? Do you have an area that's set up for telehealth, helping them expand the way that they're thinking? But then once again, making sure that you're working with the key stakeholders who are gonna be the decision makers.

Farooz: 7:01

I totally agree. And uh, so the way also that engagement is to meet with a client to get original, that initial plan and see what did their existing simulation program will look like, where they wanted to go and what it needs to go in order to. So again, um, we never consult on the actual brand of the equipments. Our design is often is hybrid. Now, in term of engagement, the, the rule of, or myself in most situation, uh, that I work with the client to get that vision and also to translate that into a design and work with everyone in the team around like architects, mechanical engineers, electrical engineers that would provide that sort of equipment to meet that vision or that<inaudible> so that the role would be that in the center would work with everyone else and talks the language and, and them. At the end of the day, it's important to make sure that what the vision and mission of that project is, that by the client is meet those standards while saving them time and money.

Deb: 8:08

Right. And if they have a standardized patient program, how would you build that in to make sure that you're helping them to think through some of those things that they might not have considered? There's a lot of these haptic products now that are coming out that are very usable. Exactly. I think one of the things that we would wanna ask a potential client is, do you wanna get accredited by the Society for simulation in healthcare or any accreditations? And we would wanna build that into the framework of the discussions so that when everything's said and done, you just turn the keys over and you're already prepared to become accredited. You've already got that investment.

Farooz: 8:49

Yeah, I think you brought a good point. For most of the institutions, sometimes it's very important for them to get accredited by S S I H and as well as American College of Surgeons in Canada it's, well, college of physician of Canada. So I think you need two years of data in order for you to apply for accreditation.

Deb: 9:09

Uh, well you need two years of data. If you wanna get full accreditation, if you wanna just apply for provisional, you don't need any of those metrics. You can open the door and say, we're provisionally accredited. Start counting now. Start your clock now with the data and then in a couple years, two years when you're ready to go for full accreditation, cuz you have two years of accreditation. Oh, I see. You would go back for full accreditation.

Farooz: 9:36

Yeah. Perfect. Thank you for describing that. So that two years, if you know already, and it designed in, in a way from day one. So basically you are not time losing any time and you're saving time and money and you will be, at the end of two years, you will be a full accredited institution. And I think that's something we make sure that that is considered or understood by the client and that's one of the roles that we play to make sure that they are fully aware and fully understand. And if it is important for them, we will make sure that we have all the tools available for them or as help them in that assessment and designing that vision for them.

Deb: 10:18

Thank you. Now first, can you elaborate on some particular lessons you've learned?

Farooz: 10:23

Thank you. I mean, with 26 simulation centers that are designed, I definitely learned a lot. So we, from very start of this, uh, getting involved in the design, listen, learned what embedded into the process. So each project, at the end of each project, we will, uh, listen, learn session with everyone involved. An example was, one of the sessions that I attended was that there was a building finished, a simulation center was finished. Uh, because they, from the start they said that this building does not have real patient, so it's only for education. At the end of the project, they realized all the elevators that they put in this building did not fit a stretcher because there was no patient needed. So what happens that they had to cut the walls of each floor to insert all of these equipments that needed to go inside. So very small things like that, but very important. And that's why we wanna make sure that those lesson learned from each project is embedded into the design that we have.

Deb: 11:28

What I think I'm hearing you say is that after you complete a project, you work with the team to debrief. What were things that totally went right. And then things that, let's make sure we've measured the elevators. I was actually, um, on site at a center when the only bed that would not fit in was the obstetric bed. So what they ended up doing was taking out a window. And you know, that's an ex very, very expensive cost that you don't wanna find out. You know, in the 11th hour, um, one center I was at, it was supposed to be a trauma area, but you really couldn't even get out the door. So you'd have to go all the way back through the center to get out a bigger door.

Farooz: 12:08

Totally. I think remember I was having a tour of a simulation center. I went into one of their operating room type simulation lab, and they used this simulator from, uh, c Healthcare called h p. And I just realized all the pipe in all the glasses and there's no, uh, sections for the C2 to go out. So basically then after this room that, you know, they never thought about that at the time. So I mentioned and immediately they realized that, uh, that is true and it is needed. So that's why all the little learned from other project, we make sure we create it sort of a checklist of what this can go wrong. We make sure those important things are check mark at every step of the way. So even, uh, I, I can describe how the process of engaging with the actual design team, after meeting with a client and knowing the design and doing the design process, working with architect, we make sure that these layout and meets does criterias are being submitted. So then architect has a guidelines to go through. And then with mechanical engineers, we have a standards checklist of things that they need to make sure that they are aware of to implement that. Whether it's infrastructure, whether it's a, you know, precaution, those are all being communicated with that. And then with the it make sure there's no conflict of wifi or any other technology with the medical equipment in the hospitals as well as the medical equip, the simulator equipments and they can conflict with your infrastructure. It's, you know, an example is we are using, um, in one of the hospitals here, we use a technology called viera. It's using a wifi, it's a basically a walkie-talkie, uh, a network to communicate. So basically I can print a button to locate that and then it will locate you into a corner of the hospital that I wanted to immediately communicate and it's hands free. And so what happens is with that, it was running at 2.4 gigahertz. And so every time we'd run a code blue, when the nurses rushed into the room, we lost connections between our simulator to the mankin and then we didn't know what's causing it. For a long time we realized that we are basically fighting over the same channel that our wifi technologies were using. So we were losing the connection. So that's why we make sure that the design that we communicate is considering all of these things. A lot of people, we never, maybe never heard of these things, but these are impacting huge simulation, uh, centers, capacity capabilities and the technology and infrastructure. So basically it's very important things a lot of people may

Deb: 14:47

Not know. No, I I think you're, you nailed it. And one of the things, things I think, um, you pronounced it, I think I've pronounced it Boer,

Farooz: 14:56

They call it visa, I think that's what it calls.

Deb: 14:59

Yeah. And it's that uh, communication device on your neck that tracks

Farooz: 15:02

You. Yeah, it's a white little microphone type and just you ping it to your clothes or Oh,

Deb: 15:08

You don't have to do any hand washing.

Farooz: 15:10

Exactly. Right That's Right.

Deb: 15:13

And you talk about like security and privacy and making sure the firewalls, you know, that they're set up and I think that's where the benefit of somebody like yourself would come into play because you are familiar with all of those different rules and regulations.

Farooz: 15:29

Yeah, and so too, normally, often what happens is for each of these roles, there's a different consultants and so each consultants know why the other consultants actually requires this technology. However, with our role that I play when most of the designs, it's good that I know all of these, the miscommunication is a lot less here as someone that works one person or one team works with everyone else, rather have a different consultants to talk, uh, on each of these topics to make sure. And so all the, the communications and the guidelines that goes to all of each of these team members or all unique and it's just considered the requirement of the simulation. Simulation. A lot of places it looks really glorious very night, but when you see half of the system doesn't work again, um, people often forget that a simulation lab is not just about the stretcher that goes into that room. You know, there's an athe machine goes in, there's a cutter, and even we have a simulation centers that we had DaVinci robot that we needed to bring that as a part of that training, we needed to bring a DaVinci robot. Uh, so we make sure that that design that we provide is allowing these sort of flexibilities and uh, for, for the clients

Deb: 16:46

And helped the clients understand storage is critical. You need to hear large storage areas for places so that you can, if you have simulations in a box, you can bring'em out to make, once again, ease of use promotes use. The easier that you can make it for the end user to use, the more they're going to use it and enjoy it.

Farooz: 17:08

Yeah. So we have a ratio of space when we design as well. So what a typical room icu. So we identified our design comes with sort of characterizing an ICU type room, what, how big that should be. And I or type should be what an award type simulation lab, how big should your control room and how centralized should be your storage is how big you, what sort of shelving you should put in the storage so that you can maximize your space and storage. Or people often forget about room for the simtech or stimulation operation specialist because those are the one needs to be there. Often people don't give them any spaces. So we make sure that that the case, that these are embedded into the design, those are the important things that we make sure that those, if you're

Deb: 17:59

Gonna have standardized patients, if they have a place to, you know, locker rooms for their clothes, if you're gonna have'em change into something else, all those need to be, you know, exactly before you

Farooz: 18:10

Start. Yeah. Most importantly is that people always forget again is the traffic flow because as someone who operated a simulation center for 10 years, I know how busy the simulation lab can get. So if you do that, when we design, we work with architect and all instructors and uh, users and everybody to even TB in a way with them ahead of time to reduce uh, the traffic flow into this space and make sure the traffic flow is optimized so that the student doesn't need to wonder from one side and to another side of the space just to go and find a debriefing room. And you're talking about a standardized patient space that is important as well where the standardized patient should come in through which door and where the students should come so there's no interaction between them and the doors that, or the students can come in once they're done, they needed to exit from a space so that they don't again interact with other students. So very important things considered like they've changed room, their washrooms and lockers. These are very important things that are making a design very successful.

Deb: 19:18

Right. Making sure you've got an area from your milage with a refrigerator and sinks so that you can get things cleaned up. All of these things become just crucially important and are sometimes after a center is completed, they're an off afterthought. Right, exactly. I think one of the other things are I had some experience, I was fortunate enough to have the opportunity to, to set up about 14 centers for one organization and the first time that we did it and there's planning meetings and all that beforehand, but the person that I was working with told me it's gonna take two and a half weeks. We're gonna be out here for two and a half weeks. And I had just gotten a puppy and so I thought I cannot be gone for two and a half weeks. So we work through how do you design a process so that we can do the actual setup of the simulation center in under five days. Now it took, it would be, you know, one person would come in on the first day, one to two people and be the scouts. We always had kind of a backup plan for who was gonna be the lead. So there was, someone was designated as the leader of the group, then we would have the equipment and supplies delivered. We would hire someone from the area to go ahead and help us cut open the boxes and get open the boxes. We would make sure that the vendors were gonna be there with us so that they could make sure that their products were gonna work. We had kind of all hands on deck to put everything where it needs to go and then at the very end you have a checklist to hand over to whoever it is to make sure so that you're not hearing back from the client later while you set this up. But a lot of things weren't working.

Farooz: 20:59

Yeah, I think you brought a good point. I think so people often very focused on the design and, and start of the project, but very important at the end of the project as again the commissioning part. The commissioning part as to a perspective one is that we go make sure that every technology that we put in that place is working the way we intend it to work. So that is where we can help. And so during this process, as you mentioned, we will work with also the client to bring some of their operational folks and educators along with us during this process of commissioning so they can not only see how these spaces are functional and because sometimes they never seen how these are supposed to be operated. So we, through this commissioning, we will also educate them as well to know how their space is being designed, how they're supposed to function and how their AV system works, how they can plug how other things like how auxiliary inputs that they have. Like you know, they can bring their ultrasound machine and be able to project it on the wall. They should be bring their ventilator or DRE Defor and they should be able to record that into their debriefing system. So those added stuff that are we design into that overall system is function and the client is also be aware of it and know and then that the handover would happens.

Deb: 22:25

Yes. Yes. I would say that if you go ahead and decide if you wanna get accredited, you need certain policies and procedures, but what you don't wanna do is have a policy and procedure cuz something went wrong. Whereas if you have the forethought and the mindfulness of going into it, did I consider are we gonna have sim operations texts run this? And the beauty of having somebody who does operations and someone clinical is, and the way I like to describe it is I worked many, many, many years in the emergency department over 25 and um, we had nurses and we had paramedics so the nurses would be responsible for you know, medications and other things. But the paramedics were always responsible for making sure that airway was in the intubation and how do we work together. Right. Yeah. But I think in a simulation center you would want somebody who's got a good solid understanding of it and your clinical person to work together to create a more seamless experience.

Farooz: 23:28

Yeah, I'm a little bit, uh, biased toward it, but you can, uh, when people ask me what sort of uh, skill set they should look when they are hiring at simulation technology, a specialist, I always say that a first check to see if they have it and a background because, uh, clinical you can teach them because they're not going to diagnose anything. But you can teach them anatomy and physiology and they should be able to operate. But the technology and uh, AVS portion is harder to teach someone because they need to kind of go to school and have that background and prior knowledge.

Deb: 24:01

And we also have, you know, if you're trying to get everybody on the same page, right, to create a shared mental model so that when I say red, yellow and green, right, red means stop, yellow means slow down, green means go a shared mental model so that everyone has the same ideas. We have some courses online simulation made easy, simulation made easy for clinical instructors, but there's some courses online to give people a shared mental model on what things are out there. So the courses go into history of simulation accreditation and standards of best practice equipment and technology, what equipment is in there, technology and realism. So how do you have mulla and what are other props to make the environment more real? The value of pre-briefing. So you know, having a pre-briefing checklist to make sure all the learners are prepared for the experience so they're not surprised simulation what it is and actually what is inside two or in SIT two. And then debriefing the different methods of debriefing. Are you doing, are you going to choose a standard debriefing model? What if you're debriefing it with two people? What about debriefing in an emergency department, Um, or a hospital? What is a hat debriefing? And then finally putting the course all together by operations, which is how do you set up, how do you select a hire, how do you evaluate your program for process improvement? And baked within those courses are many really amazing guests who have spoken on my podcasts that are involved in the training. So that would, that's what do say another way to get your, your stakeholders to have a more clear mindset of what is simulation. Simulation made easy.

Farooz: 25:50

Thank you for letting me know that. I, I think that is great because I think when institution expands from a small lab to a bigger simulation lab, often they don't have the resources and they're hiring. I think that the courses that you described, simulation made easy, I think that's going to be a great starter course for them. You know as onboarding I think they can use that as an onboarding course for them to know what they're getting into. And even for people that wanted to go into simulation and wanted to know more but they don't know where to start, I think that's another great place. So I definitely can, I would like to recommend some of your courses that you just mentioned to some of my contacts and networks as well that to see how they can start because I'm interested to see more cuz often people say we are going to hire what sort of courses first they need to take, where they should go get these courses. And so what you just described is, uh, this simulation made easy is a fantastic way to start for them. So where they can find that right now.

Deb: 26:49

So currently right now it's on my website, it's under healthy simulation, Lance has it and we're working on working with Beaker Health and we're gonna have the course available on that platform also.

Farooz: 26:59

Oh fantastic. Okay. And innovative sim solutions, your website. Okay fantastic. On

Deb: 27:04

The website. Yeah,

Farooz: 27:05

Right. I mean I'm sure some of our audience can hear, make a note of that. These three places that they can find that if you have a new staff, I think that's a great place to make sure that they can take a look at these courses and they can start. Or if you have a new hire, that's great place. That's the, which desk course is a, for me, when I started it in 2003, I had no idea what I'm doing. You know, in simulation say there was that lead some guidance overall. I mean these, what we have described so far is I think in the long term it's gonna save a lot of money. One things that I noticed is you walk into, I think it was one of the simulation centers in Middle East, I walked in their OR room was like, I think the 500 square feet of a space, just a massive space just, or why you never use that. You never put 200 people in the room or 50 people in the room. However I realized or you walking into a space, it's so small that people put a stretcher, they create that they never imagined that there will be at least four people in this room and there's medical equipments are gonna go around a bed. So either it's too small or too big. So what is the optimum? So I think, oh, uh, that is very important. So when I noticed that we actually placed everything in the room, so we put the number of FI three to five people in the room and we measured that also. They came up with an optimal number. So we don't waste this space. And also the layout of this space, the rooms were very important because not everyone has technologies to put cameras. When you don't see better view of the simulation lab from your control room, people use cameras, but that costs money. So this is how the design that I will incorporate so that they can save money and also save time.

Deb: 28:50

Thank you Peruse. Thank you very much. Thank you. Now if there's anything else that you'd like to leave our listeners with, go ahead.

Farooz: 28:58

So when you design a simulation space, make sure that you involve most of your department's IT people and AVS department even. They may not contribute on day one, but they will contribute at some point. Uh, their biomedical engineers departments are very important. I mean, it may just sound like in a way that self promoting, but I don't want to do it. But I, it's important I think if you know a simulation consultant like you or an organization, innovative SIM solutions and I think engaged these sort of organized consultants because I think they will save a lot of money and time and you don't have to worry the whole time that something may go wrong because the experience that these groups brings in is going to be termin tremendously helpful and they will be independent. So they will help you to make sure that what you have been vision has been achieved in the projects. Reach out to us if you have any questions. Thank you very much.

Deb: 29:52

Thank you. And in the meanwhile, happy simulating.

Farooz: 29:57

Happy simulating. Have a good day.

Deb: 29:59

You too.

Tag: 30:00

Thanks to Innovative Sim Solutions for sponsoring this week's episode.

Outro: 30:10

Thanks for joining us here at The Sim Cafe. We hope you enjoyed, connect with us at www.innovativesimsolutions.com and be sure to hit that like and subscribe button so you never miss an episode of The Sim Cafe.