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Innovative SimSolutions.
Your turnkey solution provider for medical simulation programs, sim centers & faculty design.
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. This week's podcast is sponsored by Innovative Sim Solutions. Are you interested in the journey of simulation accreditation? Do you plan to design a new simulation center or expand your existing center? What about taking your program to the next level? Learn from Deb Tauber from Innovative Sim Solutions. A call to support you in all your simulation needs. With years of experience, deb can coach your team to make your simulation dreams become reality. Learn more at www. innovativesimsolutions. com or just reach out to Deb Contact today. Welcome to The Sim Cafe, a podcast produced by the team at Innovative Sim Solutions, edited by Shelly Houser. Join our host, deb Tauber, and co-host Jerrod Jeffries as they sit 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 Tauber:Welcome to another episode of The Sim Cafe. Today, Jerrod and I are here.
Disclaimer/ Innovative Sim Solutions Ad. Intro:Hey, Jerrod and we're here with Dr Robin Wootten.
Deb Tauber:So Dr Wooten has 35 years of experience, focusing primarily on perinatal care, healthcare education and patient safety through the use of simulation. So, Dr Wootten, would you like us to call you Dr Wootten or Robin? No, robin would be fantastic. Thanks, okay, thank you. Why don't you share with our listeners your story into simulation?
Robin Wootten:Okay, great. Well, thanks for having me. First of all, my journey goes way back to 2006. So I was a perinatal director in the middle of Missouri, jefferson City, the capital and there was, at the University of Missouri School of Medicine, there was a gift given that was a full body mannequin, and so they posted this very cryptic ad in the paper, for I don't even think they knew for sure what they wanted or what they needed, and so I thought well, that's interesting, I will go and talk to them. So I went and talked to them and in the course of my interview they took me down to this tiny little room in the corner of the library and they showed me this full body mannequin. They said we got this as a gift from an anesthesiologist. We don't know what to do with it. We need somebody that can make something with this. So I said you know, the minute I saw the mannequin and he showed me how it all worked. And of course I used simulation of sorts in nursing school all those years ago, but it just like was a bug that bit me and I said, oh, I have to do this. This is really interesting. So I became the inaugural director of simulation for the University of Missouri School of Medicine and over the course of a couple of years we built a 10,000 square foot center. I fully got to equip that and it was so much fun Hire all the staff, which two of the staff that I hired are still there today. So I'm very proud to say that.
Robin Wootten:From there that experience, I actually ran for the board of directors of the SSH in 2007 and was elected One of the very first nurses there was only there had only been a couple of nurses before me that were elected to the board. So I came on to the board in 2007. And then in 2008, Beverly Anderson was stepping down as executive director and through some various conversations with some of the board members, I actually was hired to be the executive director. So that was such a fun time early in the years of the SSH. In fact, accreditation and certification were both started under my watch by volunteer committees. We didn't even have personnel to handle those at the time. We they totally were done by volunteer and grown. I mean super smart volunteers, I will definitely who gave a lot of their personal time to create those certification or accreditation programs. But when I look back now I think, man, those are just shining times of the SSH. When we were starting stuff with volunteers, we really didn't have any staff. I had Judy Larson who was my meeting planner for IMSH, who's still there, and that was it. So I built the infrastructure, we created benefits, we hired employees. It was just such a great time of growth for the SSH. We did the first Asia Pacific conference so I was in Hong Kong a couple times during that year that we were trying to reach out and become a little bit more global. We said that we were an international society but we really had to put our money where our mouth was. So we moved out to that Asia Pacific area and did that conference. We started the corporate round table, which was the time was called the corporate council. Now I'm very proud to say that that corporate round table has a place on the board every year. So that has grown exponentially.
Robin Wootten:Following that experience, I was trying to work on my PhD and the travel. Everything was just crazy. So I stepped back and did some consulting while I finished my study. One of those businesses that I did consulting with was Limbs Things.
Robin Wootten:I went back to the clinical world another perinatal job at a large metropolitan Kansas City Center and they came to me as an expert to evaluate a product while I was at the hospital.
Robin Wootten:They said you know you consulted with us about this position because they're located in the UK and we really think that we want to hire that position. I said that's fantastic. You really should do that. That will help you grow into the US market and understand US healthcare. And they said well, we want you to do it. And I said, oh, no, I mean you should really interview I might not be the right person. They said, no, no, no, we want you to do it. And so it has given me the opportunity to literally see this business from every angle, from a director to being the executive director and knowing all the vendors and knowing all of the simulation centers around the world, and now to be on that vendor side. I literally know everything about all the angles and it's giving me a nice, well-rounded experience that I can share with others. And now I'm at the point I just really want to give back.
Jerrod Jeffries:You have seen and done it all, Robin.
Robin Wootten:Well, yeah, A lot yeah.
Jerrod Jeffries:So I mean, there's so many questions I have for you there. One is looking back, I don't want to say at Genesis, but in the very beginning, early times. Is there anything you would have done differently looking back now? Or is it just more like you guys were building and you're bringing all these resources together so you did the best you could? Or what would you have adjusted if you could have adjusted something?
Robin Wootten:The board was new at the time. They were new, there was a lot of physicians on the board, there wasn't a lot of nursing and they were moving toward getting that more diverse group of people. We eventually got there. I think had we tried to diversify a little bit earlier and got some other voices of simulation in there earlier on, it could have made the road a little less rocky. But anytime you're starting a brand new international society, you're going to have some bumps in the road. I mean, that's just the way it is.
Robin Wootten:I got a chance when I was at the chair of the corporate roundtable. I got to actually go back and sit on the board again. So this would have been 10 years apart from my 10 or 11 years apart from my original board service and I was absolutely 100% blown away at how far the board had come during that time. So it was very nice to see a board that was working so well together and they had a really, really capable staff that allowed. You know, our early board. They didn't have a staff, so they a lot was done by volunteers.
Robin Wootten:Then when we brought a staff on, it was really really hard for some of them to let go and let the staff do their jobs. And so I think if I could change anything, I would just say have built that staff to say, let's now, let's let go, let's let them do their jobs, and maybe they're going to make some mistakes, but it's going to be okay where nobody is going to die because of simulation. So let's you know we can go through this. But the overall picture is no, I wouldn't change a thing, because it's hard starting and growing a society and everybody at the time was giving a lot of time, a lot of energy in their spare time. Their physicians, nurses, their full-time jobs were taking their day times and we took a lot of their nights and weekends. So, but it was. It was a tremendous time in my career.
Jerrod Jeffries:And it's always incredible in those trying times I mean to your point of starting something, how everybody can just come together, and there's this magic that's almost undescribable and so many other professional aspects that you're just like how and why do we, who we accomplish what we accomplished in this?
Robin Wootten:short amount of time and if I look at certification and accreditation, and I think I was just reading an article that talked about the advancement of simulation is due in part, largely in part to the growing number of certified simulationists, and I was like, hey, in some small, tiny way I was a little bitty part of that, and now it's in the literature. Those are the light bulb moments where you say, hey, I did make a difference. You know, we are moving forward because of that very early work that we did in simulation.
Jerrod Jeffries:Yeah, so I mean this even leads to the perfect segue, because we usually ask about a favorite simulation story, but is there something in regards to what you've been doing with the society, limbs and things, or whatever you know from maybe a I don't think alternative, but a unique simulation side? What's your favorite or impactful story around simulation, which can include early days or even more recent?
Robin Wootten:You know, when I think about some of my best times in simulation, I think about those early days when I was trying to learn simulation at the University of Missouri and I went to the Harvard course and I did several different trainings. I went to Sarasota, I did several different trainings just to try to keep my head above water because I had no idea what I was doing. But I was at the University of Missouri, positioned between the nursing school, the med school and the hospital, so I was literally attached to all three of those. I was hired by the medical school, so the simulation center was owned by the medical school.
Robin Wootten:But the hospital came to us and said we are having terrible patient satisfaction problems and some of those are around our non-clinical people. And so I was very intrigued by that. And I thought you're non-clinical people, so explain to me what you mean by that. And they said like our housekeepers, the people that deliver the meals, the other people that are in and out of the room seem to really aggravate our patients and we get marked down on patient satisfaction and we're certain that that's. A lot of the comments point to that.
Robin Wootten:So my team and I created a simulation that was around how do you act when you go into a patient's room when you're not a clinical person and the things that you need to look for so our alarms going off, our bed alarms or monitor alarms are is the patient asking for something? Is there a call light on? So we just did a series of trainings around entering that room for whatever your task was and doing your task and how to scripting things to say to patients and things not to say to patients and those kind of things. And then when they completed our training, we had like a sort of a mega code at the end, you know like where the patient was, just all kinds of trouble and mad and messed up and we would make these people go in and kind of handle the situation and then go tell the nurse what they found or what they saw.
Robin Wootten:We created a little pin and a certificate that they had completed the training course and these people wore those pins like a badge of honor. They were so happy to be a part of this program and patient satisfaction had significant increases and so it was one of the very first time that I had a huge group of people. They were not clinical in nature but they could still affect the clinical environment and have fun while they were doing it and love the program and really feel like they had participated in something that was important. So those are the kinds of things that don't get written up in journals, those are the kind of things that nobody has time to write up or talk about, but those are the wins. Those are the wins when patients are happier and better cared for and employees are happy and they wear their little pins, which cost us 30 cents, but they made such a difference to those people. So probably one of my best simulation stories that didn't even involve nurses or doctors, but I love it.
Jerrod Jeffries:I mean, as we're all aware, there's a nursing shortage, but this retains nurses, this retains healthcare professionals. These things where you feel comforted and inclusive, feel like you belong. This is what we need to actually advocate more for. So I think it's a very powerful simulation story. It's different, but I love different, so that's wonderful.
Deb Tauber:Yeah, I agree, it's a great story and it is about empowering these people to be in that space and to communicate with the healthcare team and be a part of just because you have a different role, but you are a big part of the healthcare team.
Robin Wootten:Well, what we found that when we did debriefings with them because we did full-on simulations we did debriefings and everything what we found was that the monitors scared them, the alarms scared them. They didn't know what was happening, they were just understanding what's happening and all you need to do is just tell somebody that that alarm is going off, or what the patient said that you thought was pertinent, gave them a chance to communicate with the nurses or the people at the desk or the nurses desk or whatever. But it was just really fun and of all the stuff that we did, it still stands out in my mind and I think I wish we would have wrote it up, because it just shows that everybody makes a difference. It doesn't matter what your job title is.
Deb Tauber:Thank you, thank you so much. Where do you see the future of simulation going?
Robin Wootten:You know, early days we just worried about do people like it? Do they feel more confident? It was just warm and fuzzy. But now I think we're far enough into the science that we think it has to be about outcomes. There's beautiful research done on central lines and decreasing infection after simulation, training and all those kind of things. That's beautiful work out of Northwestern and other places have got onto that as well.
Robin Wootten:But those kind of outcome studies where they transfer to the clinical environment, especially procedure-based things, if those skills can transfer to the clinical environment, that's what we need to see more of. We need to see patient outcomes improving. It's not like a typical return on investment If you can't say, for every implant we placed we made X number of dollars. Or it is a much more gray area to try to find out what the return on that initial investment is. But we're going to have to figure out how patient outcomes are improving because of simulation. There's so many factors but we have to neutralize all those other factors and say it was simulation that caused the better, the improvement in patient outcomes. That's where I think the future is.
Jerrod Jeffries:Well said.
Deb Tauber:Yeah, I agree. We do have to have better patient outcomes and demonstrate that they were created by simulation.
Jerrod Jeffries:Is there something within that with patient outcomes or even with the institution story is has there been something that you've learned personally throughout your journey that has changed the way that you practice, or has it been any sort of like aha moments that you've felt?
Robin Wootten:You know, not only in simulation but also as a director, when I was a director of perinatal services, and the thing that over and over again comes to me when I'm in these situations is that the smartest person in the room might not be the most senior person in the room, and it always seemed like everybody defers to the most senior person and they're scared to speak up because if the most senior person has talked then that's probably the right answer. But in debriefing especially, you just find that there's so many things that there's so many smart people. I was always amazed at the medical students and how smart they were and how much they knew, and the nursing students, how much they know, but they just won't speak up because they're just afraid that they might be wrong or they're afraid. So I think my biggest takeaway always was why didn't you say that when we were in the room? Well, I mean because Dr So-and-So talked, or because the faculty member spoke and they covered it. So I didn't. It's like. No, you clearly were the smartest person in the room on this topic, on this procedure.
Robin Wootten:Don't hesitate to speak up, because the people that are not the smartest are sometimes just making decisions that they're not certain of. So if you know the right decision, you need to speak up and you need to feel empowered to do that. Even nurses calling doctors when I was a director they didn't want to call the doctor because they didn't want to get yelled at or they didn't want to. You know the doctor to be mad at them for calling at night or whatever, and I'm like be a patient advocate. We can't not lose the patient advocacy of what we do, because we are all here for patients and if you feel like there's something that needs to be said for this patient, you are obligated to say it. Don't worry about whatever backlash might come. You're still obligated to say it.
Jerrod Jeffries:Yeah, and it's that lack of confidence that so many have and it's like, well, you know, to your point of seniority and it's, you know, back to the student setting with med students or someone who's still in school.
Jerrod Jeffries:It's their enthusiasm and their passion that they just have all this insight and, of course, the every week and hour other I would say they're reading books, but now it's probably YouTube or some other video platform that they're learning from. But then it's like, okay, on the seniority side, it's okay, this is a, it's a habit loop, right, it's routine of I have to go on after exactly the same thing. I want to regurgitate exactly what I've said, but it's not a one size fits all model, and so, when it comes to these unique situations, you know there's always going to be someone who's, you know, a little nervous to say something because they didn't. It's the same thing as someone trying to say I'm not going to ask a question because it's a stupid question. It's like, well, probabilistically, there's probably 40% of other students thinking the exact same thing or asking the exact same question in their mind. So it's exactly.
Deb Tauber:Yeah, and I think simulations provided the area where, when people understand simulation, they understand that they want to make it safe for people to raise their voice and to share what's on their minds. So I think the more people that understand simulation, the more wide open communication channels will have in healthcare environments. When I worked in the emergency department, one of my favorite things was, you know, at the end of a code or of trauma, the physician would turn to us, that the team leader would turn to us and say is there anything else we need to do? Anything else we want to try? There's something I'm missing? And that would help provide an opportunity for those of us who may not be as sure of ourselves to speak up and to say what's. You know what we are thinking, and sometimes those are the things that need to be done and need to happen.
Robin Wootten:And one more thing I thought of that, when you're asking about light bulbs coming on, what we? You know, simulation always gets compared to aviation and all those things. So University of Missouri hired pilots to come and help with prep and simulation and those kind of things. And one of my jobs one day was to take a pilot under my wing and we were going to go to watch any codes that happened, because you know in the pilot's mind, you know it should just be structured and everybody should just be doing their job and it should be easy, right. So, sure enough, early in the morning a code got called and so we went. We sort of just stood behind the curtain so he could peek around the curtain. We were not in anyone's way, we were just observing. We didn't know anything about the patient or why they coded any of that stuff, but he sort of had a white face through it, never said a word.
Robin Wootten:And when we left we were walking back to the simulation center and I said so what's your first thoughts? What did you think? And he said it's so loud, and therein lies the issue. We are not in a cockpit, we are not two people, we are 20 people that don't always work together. We're coming and going, we're bringing carts, we're banging things around, we're yelling, we're giving meds, we're closing loops, we're doing all these things, but it is not a quiet environment like it is in the cockpit. And while you can say it's like aviation and to some degree I totally agree with that On the other hand, a person is not an airplane and no two people are alike and every code is going to be different depending on who's running it, what the patient history is and those kind of things. But I just remember him saying it's so loud, like welcome to healthcare.
Jerrod Jeffries:And it's really well said, Robin. And it's more like we always forget the situational or environmental aspects of any simulation, even in this multi-million dollar simulation center. So, oh yeah, we soundproof this room, we soundproof this, and it's like you usually have a curtain between you and things are going to happen and there's some liquid or some fluid that's spilled on the floor and it's hit your shoe and you just you really like it's great to train in the safe environment, or I don't want to say sterile, but more towards sterile than disinfecting. I really like that, the noise, because that's that's one huge element which obviously hits a major sense. But I think there's so many different variables that it's hard to overlap. But I think the aviation one is one that More people can recognize at least. So it's a starting point, but there's so many changes, you know, to your point of the loudness.
Robin Wootten:I think we changed his practice that day. I don't think he would ever approach it quite the same way again as after seeing the real thing take place, rather than seeing just a simulated code blue, which can still be pretty controlled it can be loud too, but it can be pretty controlled and I think seeing the real thing was probably a real eye-opener for him.
Deb Tauber:Right, right. And that almost gets back to your story about the people that were afraid because they heard the monitors, because, I mean, it's just the alarm goes off and the lights are flashing, and what is wrong, I don't know. So it's a point of helplessness too. Anything that you want to share, being from the industry side, centrally about product testing and things like that.
Jerrod Jeffries:Starting on the other side, moving into the industry side, that's really interesting yeah.
Robin Wootten:Yeah. So, starting on the other side, I did work with companies sometimes that had new products that they wanted us to try and certainly we were testing ground for that and we would provide feedback and what are, whatever format they wanted Fast forward. Little did I know that I would be doing the testing. We didn't used to do much testing before 2015 in the United States because, as I said before, the company's based in the UK. So, you know, medicine is medicine, right?
Robin Wootten:Well, what we found was that there are things that are done very differently in the United States and we have to account for those. So it can be as simple as is the patient laying down or sitting out for the procedure. That can always be laying down in the UK, but sometimes they sit up in the US for the same procedure. So it's those kind of things that we have to account for sometimes. So I now am responsible for all of the product testing in the United States. So I take another. I don't do it by myself. I usually have at least two of us and we go to different centers and I have lots of friends in the industry and they have been just beautiful to me to allow me to Bring stuff in and they gather up every all the specialists and the experts to try the procedure and give us feedback. We have lately started running into some folks wanting to charge for those services and everything from charging for the from the physician's time to the renting the room for a couple hours and those kind of things.
Robin Wootten:So charging for one for an evaluation right, like to like if I have a prototype of a product, they want to charge to use their room, use their staff Because it's a business. I get that. I understand I went through those days of having to be fiscally responsible and Charge departments for coming to use my simulation center and all those things. I totally understand that. But when it comes to products it's, and I can see it from every side. I get it because doctors are busy and the last thing they have time for is one more thing.
Robin Wootten:But they also are the people who do these procedures. So I can take a product to a Sim director or a sim tech or a Sim ops person and they can say, yeah, this is a great procedure, but they've never actually done that procedure on a patient. I can take it to a clinician, a nurse practitioner, a PA, a doctor, a nurse for whatever, and have them do it, and else they can tell me exactly what feels like it's being done on the patient and exactly what Is wrong, whether it's anatomy, the field, the pop, whatever. It is different. Those people that charge I end up not going to, because there are a lot of people in the world who will still do it without charging me for that, putting your thumbprint on the future of industry.
Robin Wootten:I love that. I love how you said that that is a very perfect way and I think, being in this for so long, I think we all want good products. I mean, we all want realistic training, and the people that make products are engineers, they are not clinicians. So they can look at an anatomy book all day long and they can draw the CAD drawing exactly like the anatomy looks, but when it comes to doing the procedure, they don't know if that actually compares to what it feels like when you do it on a patient. That's why we do prototype evaluations.
Robin Wootten:I remember, before we actually started this full scale, we would have people that would say to us this product is really good, but it would be even better if you would add XYZ. So we said why don't we get that feedback before we finish the product instead of after we finished the product? Because it'd be nice to be able to add the things in that they find essential not nice to have, but essential before we actually launch the product into the marketplace. And so that's sort of the birth of the prototype evaluation process that we have now.
Robin Wootten:We're certainly not the only company that does it. Every company wants to trial their new products, wants to make sure they're fit for purpose and those kind of things. So, you know, I guess it's my plea to just say let's work together to make the best products that we can. That trains the future of healthcare because, you know, if I have to have a chest tube down the road, I hope that the person that did it on a model it feels exactly like it is to do it on me, and so I guess that's my plea and something I would have totally never thought of when I was on the other side of simulation.
Deb Tauber:So I would say with that, those are probably some of the final words you'd like to leave our listeners with you can tell.
Robin Wootten:Simulation is a passion for me, so I mean I could talk all day, but you know, I appreciate it.
Jerrod Jeffries:I love it, Robin. I really love it.
Robin Wootten:Yeah, I appreciate your time so much.
Jerrod Jeffries:Likewise.
Deb Tauber:Well, thank you so much. This has been a wonderful interview. Are there any questions you have for Jerrod or I?
Robin Wootten:No, I love what you're doing. I love The Sim Cafe. I listen to them. I think it is a wonderful way to get it out there. Talk to the people who are making a difference. I love some of the people that you have on there. Some I know, some I don't, and so I love hearing people I don't know. I always love to hear great things going on in simulation, so good job to you guys.
Jerrod Jeffries:Thank you. It's a vast world and hopefully we're just pushing different ways of collaboration and sharing best practices and stuff. So thank, you, Robin.
Deb Tauber:Yeah, yeah, thank you for contributing and, with that, happy simulating.
Disclaimer/ Innovative Sim Solutions Ad. Intro:Thanks to Innovative Sim Solutions for sponsoring this week's podcast. Innovative Sim Solutions will make your plans for your next Sim Center a reality. Contact Deb Tauber and her team today. Thanks for joining us here at The Sim Cafe. We hope you enjoyed. Visit us at www. innovativesimsolutions. com and be sure to hit that like and subscribe button so you never miss an episode. Innovative Sim Solutions is your one stop shop for your simulation needs, a turnkey solution.