The Influence of Best Practice Standards on Patient Care with Dayna Downing sponsored by Innovative SimSolutions

Ready for an enlightening journey through the exciting world of simulation in clinical education? Prepare to be riveted by Dayna Downing and her tales of her transformation from a US Air Force medic to her current role as the director of program operations for the Immersive Design Systems program at Boston Children's Hospital. Get ready to be moved by her compelling account of the profound impact of simulation on patient care, and her urgent plea for adherence to best practice standards. As an enthralling bonus, Dayna will share a poignant simulation story that underscores the potential trauma nursing students can experience when simulations go awry.

Wondering about the dynamics of your workplace and how they might be affecting your success? Listen closely as we transition into discussing the invaluable importance of nurturing strong relationships at work. Dayna brings her unique insights into workplace politics, shares her personal "aha" moments, and reflects on the privilege of working with a dedicated and driven team. And guess what? We'll be delving into the thrilling future of simulation in healthcare - think virtual reality! Dayna also emphasizes the importance of upskilling with soft skills, such as communication, in the fast-paced healthcare industry. This is one conversation you won't want to miss!

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Transcript

Disclaimer/ Innovative Sim Solutions Ad/ intro: 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. 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, as she 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: 1:31

Welcome to another episode of The Sim Cafe Today. Unfortunately, Jerrod is not with me, but we have the esteemed guest today, Dayna Downing. Dayna is the Director of the Program Operations for the Immersive Design Systems program at Boston Children's Hospital. And, Dayna, why don't you go ahead and tell our listeners a little bit more about yourself and we'll talk about simulation?

Dayna Downing: 1:57

Okay, so, as Deb mentioned, I am the director of Program Operations at Boston Children's Immersive Design Systems and we have, as a program, been around for about 20 to 23 years. I think. I have been there since January of this past year. Prior to that I started a restarted the simulation program for Roxbury Community College and prior to that, when I got my start in simulation, I was at Children's Health in Dallas, Texas. So that's where I got into sim, fell in love with it and decided I wanted to keep a career. So there's that in a nutshell, thanks.

Deb Tauber: 2:40

So how did you actually find simulation? Tell me about your clinical career and how you actually got into simulation, because it's always really interesting to see how someone ends up here.

Dayna Downing: 2:53

So, yeah, so I did. The very first time and I didn't realize this until much later that I had been involved in simulation was in 1992. I was in the US Air Force and I was trained as a medic, and so, while we didn't have the simulators that we have today, we did a lot of field trainings where we were basically simulated participants, and so we did the field trainings. We did mass casualty trainings and unfortunately we didn't have task trainers, so we were drawing blood and stuff like that on each other. But that was my first experience with si m. If you then skip forward, I got involved in anesthesia technician for a couple of hospital surgical programs, working with anesthesia and critical care, and every now and then they would do simulations, and this was particularly at Hopkins in the OR, and so I had a little bit of exposure there. And then my academic background is in organizational studies, and then my graduate degrees are an MBA and an MHA.

Dayna Downing: 4:06

I had been trying to figure out how I could stay involved in healthcare and make some kind of difference with those particular credentials and ended up moving to Texas from Maryland in 2012 and needed to find a job. I had two options. One of them was to be a consultant for a company that would go into hospitals and kind of look at, you know, operations, bottom lines, all that stuff. That isn't that exciting. And the other job was a simulation position.

Dayna Downing: 4:38

And while I realized that the simulation position at that time because I hadn't finished my master's would pay much less, it seemed much more interesting and so I took that position and I started out actually as an operations specialist, which is how I got involved in helping design and write the CHSOS and then also evolved into education and then finally administration, and so I was with that program for 10, 11 years I think it was, and it was great. It was a really, really great time. It was where I was able to see the difference in, you know, having that impact on the patient at the bedside, like in the OR, and particularly because I was in pediatrics, of helping soothe the patient as they're going to sleep and waking up to understanding that I would now have a much broader impact on the patients and being able to have something that helps the providers both deliver better care but also have the families experience just have better experiences.

Deb Tauber: 5:46

Thank you. Thank you for your service as well, and I do want to congratulate you becoming a 2024 SSA Academy Fellow inductee. That's a big accomplishment, a wonderful achievement, and you should be very proud of yourself. Thank you very much. I appreciate that. You're very welcome, so you're in with children and I can see that as being very rewarding because the family's all scared and they're going. That's a parent's worst fear putting their child under for some type of a procedure. It's yeah.

Dayna Downing: 6:23

Yeah, and I think, like one of the things for me, having worked in that environment was that that is the type of environment I really wanted to stay in, was pediatrics, and I really, I really, truly feel that people who work in pediatrics really do feel called to be in that area because of, like you're saying, this is one of the most vulnerable populations that we serve, and then you've got the families and having to help them get through it as well. So, yeah, I just I really love the organizations that serve those children.

Deb Tauber: 6:55

Yeah, no. Do you have favorite or most impactful simulation story that you'd like to share with our listeners?

Dayna Downing: 7:02

Yeah, so you know what's interesting is this. Has this had recently come up? I saw this on LinkedIn a little while back. Susie Kardong-Edgren had posted about what is happening with nursing students in terms of how simulations are being executed and what is basically the trauma that the students face when the simulations aren't being run to best practice standards. Right, and I actually had experienced that when I started at Children's.

Dayna Downing: 7:35

We had a new nurse residency program, and when I first came in, one of the things that I noticed was that the nurse residents would get really upset in simulations, regardless of how well they did right.

Dayna Downing: 7:48

And so these are new grad nurses and finally, after a little while, I stopped one of them who had started crying at the end of the simulation and just asked her you know what's going on, do you want to sit down and talk?

Dayna Downing: 8:03

And what I found was the trauma from nursing school was being carried over into the hospital-based simulation environment, and so I talked to this particular nurse, as well as some other ones who clearly seem to be struggling, and decided that what needed to happen was to have a conversation to kind of reframe simulation for them when they came in, and so after that, one of the things that we did was at the beginning of every new cohort, was we had a day that was set aside specifically to talk about their experiences in simulation, what it was like and what their expectations could be of us in terms of how we practice, in terms of creating that psychological safety and safe learning environment, as well as to let them know that if there was any breach of that by any of our, say, clinical educators or faculty, that we wanted to address that, and there were a couple of times where we did and so I think that was something that really stood out to me was just somewhere in the pipeline of nursing education, there are these things that are going on where the end result is this fear of SEM, and that we really need to take the time, particularly with these groups, and just check in on them when they first come in and see what was your experience like.

Dayna Downing: 9:29

Here's what you can expect from us, and I really, I really actually did pride myself on the fact that we created a very safe environment where we were able to reframe simulation for them and make it something that they saw as being helpful for them in their careers and not something to be afraid of.

Deb Tauber: 9:49

No, exactly, I mean coming out of nursing school with PTSD and then getting into the clinical environment where you know that transition to practice, that big leap. And my daughter's a nurse as well and I remember the first night that she was off orientation by herself and she was working in critical care and I remember her calling me just going. I am so scared.

Deb Tauber: 10:12

And you know, it's just that real feeling and I think that fear is real and these nursing students that are coming out need to be reassured that everything will be, you know, okay in the simulation. So thank you for doing that. Yeah, absolutely. Now, Dana, where do you see the future of simulation going? Everyone's got, you know, different thoughts and I think for many of us, the pandemic did provide a really good window to move things forward very quickly. So where do you see the future?

Dayna Downing: 10:48

So it's interesting and moving to a much bigger program where we have what we call right now pillars, and so we have a teaching and performance pillar, which is simulation as we generally think about it. We have a human factors, that systems design pillar, where we get involved in the beginning of, like big architectural projects and we help test things, we do the tabletops and we move on through to the final clinical rehearsals and testings at the end, and then we have an applied engineering team, and so that is the customized devices, the 3D printing and anatomical modeling, as well as our XR team, and so for me, I see simulation eventually evolving into bringing all of these things together, where right now we've still got kind of the mannequin based over here. We've got some XR VR over here and there are I do know that there are vendors who are bringing these things together. I know that Gammard has they've got their virtual reality goggles or augmented reality goggles that they're using with one of the pregnancy simulators. But I think that it will come to a point where we're using all of these things not just in training performance, but also in that realm of human factors and systems design, and so, particularly with, like our engineering group, there will be ways, I think, down the future, to be able to incorporate the work that they're doing just across an entire program like that. So some things I think will stay the same. I don't think we'll ever give up the mannequins, but I do think that our thought of what simulation is, in terms of being much more immersive, will become much more widespread.

Dayna Downing: 12:36

I think part of the inhibiting factor right now is cost with regard to having the larger 3D printers. So this was when I came to children's. It was the first time I had seen one that was about the size of a car, and we have two of those, and so that's where a lot of our anatomical modeling 3D printing has come out of stuff like that. But also being able to integrate the XR more widely spread as well Wow, how do you like 3D printers? Oh, my gosh, they're massive, like. I just think they're like really cool. We've had our 3D printing program, has been going for about 10 years now, and so they're really expert in that area. We do have in our applied engineering side like everybody is an engineer of some sort which I think has been helpful as well, but I also don't think that it's necessarily a requirement, obviously.

Deb Tauber: 13:39

So, yeah, Now tell us a little bit more about your current role. You've been in the role for coming up on a year, Is it?

Dayna Downing: 13:47

Yeah, so oh, did you have a specific question related to it?

Deb Tauber: 13:51

No, I'm just curious about how you're liking it. What's your favorite thing there? A Boston Children's Hospital, what you know.

Dayna Downing: 13:58

Yeah, so it's interesting because I had an interviewee ask me that question about what do I like best about being there. So I did come in almost a year ago it was January 9th when I started and I've been good friends with Jennifer Arnold for years and so she had taken over as the program director for IDS and we've been trying to work together. The last third times a charm organization that she's been at, and so you know we finally were able to get that worked out and so I am over all the operations of our program, and so everything that has to do with, say, processes or budget or has any kind of impact on the program operations will likely come through me. My actual team consists of a team of project managers, administrative assistants and the operations specialists, so I've got a team of direct about nine and you know they're fabulous.

Dayna Downing: 15:00

But I think that my favorite thing about working there really and truly is the entire team. They're just so driven, they believe in the work and they're, I would say probably most of them are considerably younger than me. I feel like anybody who talks about Gen Z has not met these folks. I mean, they are so driven, they care so much about the work they do and putting out quality work that they're just amazing, and I really do feel that it is a privilege to work with them every day because of the things that they accomplish.

Deb Tauber: 15:39

Right, I'm working with Dr Arnold. That's gotta be.

Dayna Downing: 15:41

Oh yeah.

Deb Tauber: 15:42

She's a blast. I love her. Yeah, she is just such and such an inspiration.

Dayna Downing: 15:48

Yes and truly like one of the nicest people in the world.

Deb Tauber: 15:52

Agree, yeah, we agree. Yeah, Deirdre and I had the honor of interviewing her a while back and she, like you said, she's just. She's a special, special person. She is yeah. Now can you share with our listeners the biggest thing that you'd like them to know, something that when you learned it, it really changed the way you practice. So, essentially, a personal aha moment.

Dayna Downing: 16:16

This one might be a little. I'm not sure how people will take this one. So for me it has to do with workplace politics and the fact that you have to engage in them, but it's a matter of how you do it that counts. I think Workplace politics or, as you know, we like to call it myself and some of my colleagues at work like to call it workplace dynamics are really instrumental in when you go and where your program goes, and it's kind of like that saying of if you're not at the table, you're on the menu, kind of thing where you need to be engaging, you need to be building relationships, and this isn't to say at all about not being authentic, but to understand that there are relationships that you need to form, engage in and cultivate to be able to both Accomplish your goals as well as the goals of your program. Like, you have to know who is it important that you are advocating to for your team and how that is best received, and also paying attention to the water cooler talk kind of things, which we don't have as much now with everybody working hybrid, but it still happens and those conversations count, and so I think you know I know a lot of people who say, well, I don't want to get involved in politics, right, I don't want to do any of that.

Dayna Downing: 17:33

But I feel like it's because it has such a dirty connotation to it and so negative. But I think that if we flip it around and just look at what are the dynamics here, what will help our program, I think can give you kind of a different frame to work from. So that was a big thing for me was Understanding that one. I'm actually I'm an introvert and I'm like if I'm at a party I am socially awkward, but I understand that there are people that I need to meet, I need to get to know to really and truly be able to help my program. So that was a big thing for me.

Deb Tauber: 18:07

That is a big thing and it's something that people don't really talk about. I remember when I was at one of my jobs in the emergency department and the secretary used to tell me Deb, you have to play the game PGW, you have to play the game and and I struggled with it. But you know, it's very true and I like the way that you communicated that very important lesson.

Dayna Downing: 18:30

Thank you.

Deb Tauber: 18:31

Now, are there any final words that you'd like our listeners to remember this conversation by? Anything else that you want to talk about, or anything you want to ask me?

Dayna Downing: 18:40

I think, regarding final words, it probably goes back to what I was just talking about and for people to remember the necessity of building relationships and advocating both for yourself and your team. I know a lot of people will say I just want my work to speak for me, but I remember reading in an article once that your work doesn't actually talk, so you need to be able to do the talking that demonstrates what the work is and how it provides value, and so I think that's whether it's in simulation or any other industry I think that's something very important to keep in mind. But I would actually kind of like to ask I don't know in terms of time, what do you see in terms of where simulation is going?

Deb Tauber: 19:23

Oh, that's a great question. Thanks for asking. I do see a lot more of the virtual reality thing and first I was just dead set against it wouldn't. But I think that some of the companies are really doing a great job integrating and working with the right people, like if you look at some of the work that Michelle Abersol e is doing with new graduate nursing in virtual reality, and I think that they're moving the field forward.

Deb Tauber: 19:51

I can really see a place for virtual reality in the hospital setting, where you don't have as much time and you want to discern from your high risk, low frequency events. So the caregivers are actually familiar with some of these emergencies. But how do you train form rapidly? And, yeah, what is postpartum hemorrhage, what is preeclampsia, some of those things to differentiate, and how do you get through these emergencies, similar to some of the things that you see in pediatrics. Right, you only have the only amount of seconds to minutes emergencies that you have to be able to respond to. So I can see virtual reality in the future as being something that is here to stay.

Deb Tauber: 20:38

I would say that I agree with you as far as the simulators are. The simulators will probably be around for a pretty long time and I think that a lot of communication is really where we need to focus with our younger generations, because they have grown up on the technology and so some of those soft skills like communication, leaning in and knowing when it's inappropriate to use some of the therapeutic touch or anything like those, those are more difficult for the younger generation. They're much more comfortable to just text. We're putting a foley in. So I think that's some of the things that I see is where simulation is going. I'm looking forward to IMSH in January. I think it's always just fascinating to see all the new things that are in the exhibit hall.

Dayna Downing: 21:37

Yeah, and it's gotten so big Right, yeah, amazing.

Deb Tauber: 21:43

Well, is there anything else you want to share with our listeners?

Dayna Downing: 21:46

I don't think so. I just hope to see everybody at IMSH.

Deb Tauber: 21:49

What are you looking most forward to at IMSH?

Dayna Downing: 21:51

Probably presenting with my new staff. This will be the first time that I've done anything with them.

Deb Tauber: 21:58

Yeah, and you sound very fond of them, so that's awesome, great, great. You're probably also looking forward to receiving that yellow lanyard.

Dayna Downing: 22:08

Yeah, so I'm not the only one in my workshop that doesn't have one, right?

Deb Tauber: 22:13

So congratulations again and thank you so much. It's just been a true honor and pleasure to have you on today, and thank you. Happy simulating.

Disclaimer/ Innovative Sim Solutions Ad/ intro: 22:24

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.