Advancing Patient Care Through Translational Simulation: Insights and Strategies

What if you could transform patient care with the power of simulation? Join us for an enlightening conversation with Lisa Paganotti from George Washington University, an expert in simulation education, as she shares her inspiring journey from the emergency department to becoming a leader in the field. Lisa unpacks the concept of translational simulation, explaining how it bridges the gap between theoretical learning and practical patient outcomes. With her extensive experience, Lisa delves into the structured stages of integrating simulation into clinical practice, emphasizing the critical role of theories and conceptual models.<br><br>We also tackle the hurdles and triumphs of implementing effective translational simulation programs. This episode offers actionable insights into overcoming historical resistance and sustainability challenges, with practical advice from 18 seasoned experts. Discover how to develop a robust dissemination plan and maintain successful simulation-based education programs. Lisa Ann Buckley adds her perspective as a site reviewer, focusing on the significance of systems integration for accreditation. Whether you're just starting or looking to enhance existing programs, this conversation promises to equip you with valuable strategies for advancing simulation in healthcare.

Lisa Paganotti's email- Lisaannbuckley@gwu.edu

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Chapters

• 0:00 Exploring Translational Simulation in Healthcare
• 10:20 Barriers and Facilitators in Translational Simulation
• 19:04 Overcoming Barriers in Simulation Training

Transcript

Disclaimer/ Beaker Health 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 brought to you by Beaker Health. Beaker Health is a user-generated and peer-reviewed community educational platform designed for healthcare organizations. We let your community connect and engage with one another freely and efficiently. Beaker Health, where dissemination and measuring impact comes easily. 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: 1:16

Welcome to another episode of The Sim Cafe. Today, Jerrod and I are here with Lisa Paganotti from George Washington University. So So than yo 'lis fo joinin us a Thank you, Lisa, for joining us and thank you, Jared, for being here. Jared's in Mexico right now.

Jerrod Jeffries: 1:31

Yeah, w ell, thanks for being here with us, Lisa.

Lise Paganotti: 1:33

Yeah, thank you for having me, and would you want to?

Jerrod Jeffries: 1:36

vel e set set with all our listeners about telling us a little bit about yourself.

Lise Paganotti: 1:40

Yeah, sure.

Lise Paganotti: 1:42

So clinically, my background is a physician assistant and I practiced in the emergency department, and the emergency department always pairs well with simulation all the procedures and skills that we need.

Lise Paganotti: 1:55

So back in 2011, I started at a medical school as their simulation coordinator and then later their manager, and then I moved into the hospital-based simulation side, versus being on an academic campus, and at that point I really wanted to figure out how to tie my work in that simulation lab to patient outcomes and how are we actually improving patient outcomes. And at that point I was kind of looking around and saying I don't even know where to start. Honestly, I don't know the first thing about this, even though it was something that I think across the simulation industry, we all think, oh, we're out here for patient care and patient outcomes and patient safety, but I just didn't really see that more direct tie to the work that I was doing, and so that's kind of how I got interested in what I'll talk about today. But also I want to say yes, currently I'm assistant professor for the Doctor of Health Sciences program at George Washington University and there I focus more on the leadership and research aspects of simulation.

Deb Tauber: 3:05

Great, how long have you been there?

Lise Paganotti: 3:07

About two years now.

Deb Tauber: 3:09

And prior to that you were at Ross, correct? Yes?

Jerrod Jeffries: 3:11

Yeah exactly ctly. What made you get started in simulation? Was there a certain catalyst, or i it?

Lise Paganotti: 3:20

just more of an interest, internal interest. You know, I actually always wanted to get into education. My undergrad was education and then I did my master's in physician assistant. So there just became an opening that was available and I thought, oh, this might be a nice way to kind of segue into like an education role. And it happened to be within the simulation lab and as soon as I went in I was so fascinated and just so excited about the opportunity to really allow people to practice. I think for me personally that's a great way to learn. I learn a lot more by doing it myself and experimenting than by reading or hearing about it.

Jerrod Jeffries: 3:59

That's the beauty of simulation.

Deb Tauber: 4:01

Yep, that's what draws us into it. Now, Lisa, can you tell us a little bit about translational simulation?

Lise Paganotti: 4:09

Yeah, thanks for asking. I think it's really important to talk about the definition. So, as I was mentioning, this was kind of that area that I got interested in where I thought, okay, how do I know that what we're doing is actually tying into the patients and their experience and their outcomes? So I actually was getting my PhD at the time in translational health sciences and there's something called the translational continuum that comes from biomedical sciences and research and it's basically talking about, from the basic science, discovery of information. So, let's say, we discover something in the lab setting, there's a lot of steps and stages that it takes for that to get into clinical practice. So you need to move it from the lab to the clinical environment. So you got to think about you know, what we found in, potentially, mice or rats. Does that work in humans? Then you got to think about, okay, if it works in humans, like what kind of humans? How do we study how safe it is and who it works for? And that kind of gets you to that proven clinical application. And then from there you need to figure out well, how do we get clinicians then to adopt this, to start doing it, to implement this practice? How do we get that to be more widespread across, you know, all of the different providers, all the different clinics or hospitals all across the country. And then from there, how do we understand kind of that bigger public health impact? So that's like a little background on kind of where this comes from.

Lise Paganotti: 5:46

So for simulation, if we think about kind of applying that same idea to simulation, we need to have kind of these theories and conceptual models that support translational simulation, which I'll define in just a minute. There's a couple definitions out there, but right now, if you just kind of think of it as this big bucket of how do we tie simulation to patient care and patient outcomes, so you need these theories and conceptual models. And then from there you need to know within the simulation lab, are the people learning these knowledge, these skills, these attitudes, whatever it is we're trying to train them to in the simulation lab? You know, did they learn that thing? And then from there, if they did learn it, then are they using it when they go into the patient care areas? And then, even if they are using it in the patient care areas, then how do we know that it's actually impacting the patients? So again, you kind of see all these different stages in this process that you need to go through, and so I think that kind of gives an overview of you know where this comes from and what we're talking about.

Lise Paganotti: 6:58

But to be a little more concrete, I do have a couple of definitions that are out there from the literature. So the first one came out in 2017. This was from Dr Brazel out in Australia, and she defined translational simulation as a functional descriptor of healthcare stimulation with the purpose of directly improving patient care and healthcare systems through diagnosing, safety and performance issues and then delivering these simulation-based interventions to address those. And then in 2021, nixon and colleagues, they kind of defined it as activities that might be diagnostic, so determining the problems that exist and what are those characteristics of the problems, or interventional, so providing solutions to the problem, or potentially you do both you figure out what are the problems and then you kind of solve those problems. I think based on where we're at in simulation.

Lise Paganotti: 8:01

Now there's a couple different ways that this has evolved.

Lise Paganotti: 8:07

So something that the way that I've kind of been thinking about is there's kind of some different buckets, if you will, within translational simulation.

Lise Paganotti: 8:16

So there's kind of the systems integration piece, which is more about the simulation center program, integrating with the quality and the risk management department. So that's kind of one piece of it. There's systems testing, which is kind of focused on the testing for new equipment, or maybe you have a new ward that's opening and you want to test that system, maybe you have a new process that's in place so you're going to do some simulation around understanding how the humans in that event interact with that new process. That's kind of the systems testing. And then there's also like the skills translation, and I think the kind of classic example of that is all the work that Dr McGehee and colleagues have done on central line training, where again I think you could kind of see how I was talking about you they studied that in the sim lab and then could we move this from the sim lab to patient care and then to the outcomes, and they even also took that to like return on investment, which is a great example of kind of that skills translation piece.

Deb Tauber: 9:25

Yeah, Excellent, excellent. Now how did you decide on getting into that for your PhD? What drew you to that?

Lise Paganotti: 9:53

the hospital as a whole and I thought I really want to be able to know, to measure, to be able to say that we're having these impacts that I really felt that we were having. But I didn't have any data and I just really honestly didn't know where to start. I didn't even know the first step in doing it. I felt like it's like do I start with the hospital leadership doing it? I felt like it's like do I start with the hospital leadership? Do I start with my program? You know where do I go, and that's really where I came up with this. You know what ended up being my dissertation. Research is these questions to say where do I start? What do we know about this? What are the experts doing? I know people are doing this, so how can I learn from them and understand? You know what are the things doing. I know people are doing this, so how can I learn from them and understand? You know what are the things that are going to be barriers, what are the things that could facilitate me in this process?

Jerrod Jeffries: 10:41

And Lisa. If I can ask another question about the overall aspect in terms of transitional simulation from the clinical space, testing process, development and culture pieces, Do you find one to be a larger barrier than others for people trying to enter this?

Lise Paganotti: 11:05

That's a really good question. Honestly, I don't think that really came up in anyone's story and I guess I'll tell you why I think that happened Because basically everyone was working from kind of a similar place to what I described, which is like you're working in a place, you look around you and you're like okay, we have this problem, let me try to address that problem. So it really, I think, came more from the, I guess, just the setting that you were in the context to say, okay, let me try to address this problem. So it's kind of figuring out you know what's an important problem within your organization that you can address with simulation. So I think that's really how most people have kind of gotten into this.

Deb Tauber: 11:56

Can you describe the research study and what you found?

Lise Paganotti: 12:00

Yeah, thanks for asking. So I kind of mentioned some of the research questions that I had. So one of them was you know what are the barriers and the facilitators to running these translational simulation programs? And I wanted to know where to start. So I ended up asking 18 experts from our very wonderful simulation community so shout out to my anonymous wonderful participants who allowed me to interact with them. We had three different types of data collection, so I collected documents to understand some context behind them, and then I interviewed these individuals and then had a focus group as well so that I could triangulate the different data sources to make sure that I was really understanding what they were sharing with me.

Lise Paganotti: 12:45

So I'll start with kind of the barriers and facilitators and then I'll move into the kind of the recommendations that they have, which hopefully will be kind of some actionable takeaways for the audience too, if they're thinking like, oh, this sounds great, but again, I don't know where to start. So all right. So in terms of the barriers and facilitators, there actually were a lot of facilitators and that was kind of a surprising finding. I think we had about 10 different facilitators and we ended up having basically four barriers. So I'll talk through each of those. But there was kind of a discrepancy there, you know, with so many facilitators, and I don't know if that's because, again, I was talking to experts. I'm talking to people in our field who are doing this, who are very successful, who are out there talking about it or publishing about it in ways that I could know who they are and reach out to them. So we did have lots of facilitators, which I think is also encouraging for people who are interested in this or maybe just beginning in this area. So the facilitators I'll just list a couple of them because I don't want to go into too much detail.

Lise Paganotti: 13:52

But if you have a really strong simulation team as well as a research team, that's going to be helpful. Some of the characteristics of individuals they talked about, so people who have really good relationships with other people throughout their system, some of those informal leaders, you know, maybe they don't have the job title but you know that they have influence. Also, the human factors so having somebody who has some knowledge of human factors, which I think a lot of simulationists do. Now I don't think you need to be a degree or some kind of specific training in it, but just understanding you know what does that mean?

Lise Paganotti: 14:31

To kind of have that lens for looking at these different types of translational simulations. All right, so for the barriers, there were four main barriers. The first one I think everyone can relate to, which is I called it historical, but basically it's the historical context of healthcare and medicine and I think this just ties into behavior change. It's really pretty easy to share knowledge and to share information, but it's very difficult to get people to actually change and to do that change, to implement that change in their practice and then consistently do it.

Deb Tauber: 15:10

Do you think that's because people say, well, this is the way we always have done it?

Lise Paganotti: 15:14

Yes, exactly, you nailed it. That is like the absolute quote from this, this code of you know being historical. That's exactly right. We've done it this way. Maybe they don't feel there's a problem with the way we've always done it. You know, why do we have to change? Why do we have to improve? I mean, this is classic, I think, across all of simulation, not just translational simulation, but it is one of the biggest barriers that we face, for sure.

Deb Tauber: 15:42

I think it's especially pervasive in healthcare and in education. Yeah, yeah. Yeah, yep, a barrier, all right, so continue, continue. Thank you.

Lise Paganotti: 15:55

So the next one is or the next two actually kind of go together it's the dissemination and sustainability. So dissemination is really thinking about how do you get this work out there after you do it. And the reason that is a barrier is because we don't always have time built into our schedules, our days, our jobs, to actually share that information, to get it out there and share with other organizations or other individuals who are looking to do this same kind of thing. So throughout this study, the participants really talked about kind of having some sort of dissemination plan actually at the beginning of your project, where you can say, okay, this is how I'm going to share it with other people so that they know what's going on, so they can learn from what we've done.

Jerrod Jeffries: 16:44

Well, and to that part right, you spend 80, 90% of the overall scope of the project doing the work and if it's not shared, it's almost shooting yourself in the foot because it's like oh yeah, I presented once to this room of five people, for example, and it doesn't leave that those four walls is a little, yeah, last four sides. So I'm happy to see that there's in the beginning. It's how do you disseminate? What are some of those ways that different ones are disseminated?

Lise Paganotti: 17:10

If you know off the top of your head, yeah, well, I mean, this is one of them honestly doing podcasts, sharing on social media, sharing at the different simulation conferences, really any way that you can get this information out there. I mean, publishing is also one way, and this study has been published. But I'll tell you, out of my whole dissertation study, what I could publish was a very small part of this, and actually most of what I'm talking about today isn't even an article, because it's condensed down to such a short number of words that you can share. So I think the more ways that you can share and the more conferences and avenues that you can get to, the better, because you get a different audience at each one.

Jerrod Jeffries: 17:51

yeah, yeah, and you never know what's gonna. I don't want to say sticky what. What's going to be relevant to what audience? And some of them might be constrained on certain resources, or others might be solely on time or space. You just don't know what's going to be relevant or applicable towards each audience.

Deb Tauber: 18:10

Lisa, I'm curious about your 18 experts. Were they all in the United States or was it global? Did you have people from other countries?

Lise Paganotti: 18:18

Yeah, it was global. Yeah, intentionally, because there's a lot of this really good work happening in other countries. So because it was kind of the first overview study like this to say, okay, we don't really have a lot of information, let's try to pull all this together. I wanted to get just I went for the top experts in this area, so it was from anywhere in the world.

Deb Tauber: 18:40

Thank you. And how many questions were there? What did this look like?

Lise Paganotti: 18:44

Yeah, that's a good question. The interviews lasted about an hour for everyone. I forget the exact number of interview questions, but I would say it was probably around 12 questions because they were pretty open ended to really hear their stories and their experiences, to extract what they're doing.

Deb Tauber: 19:04

Now. Do you have an actionable takeaway for our listeners?

Lise Paganotti: 19:08

Yeah, I do. I actually have two more barriers, if you don't mind, oh of course.

Lise Paganotti: 19:14

Yeah, because I wanted to talk about the sustainability piece because that was another barrier. So this one kind of speaks to that idea that there's a lot of kind of excitement. Again, I think people can really relate to this. There's a lot of excitement around a new program, right. There's not as much excitement about maintaining a great program and I don't know why there just isn't, you know, and sometimes there's not even funding around maintaining the program. So I think that was really one of the struggles that I want to point out, because, again, you want to think about this if you're going to embark on this, you don't want to create a really great program that again doesn't continue because it's kind of a waste of time and energy and effort.

Jerrod Jeffries: 19:57

Lisa, I just see every single listener nodding their heads to that.

Jerrod Jeffries: 20:01

Yep yep, there is sustainability and maintenance it's. It's the shiny new toy right when you're, when you're building a new lab and it's just there's so much attention on it and I think the importance to your point of being a barrier it just kind of drops off a little bit and it's more important than ever to be like okay, let's make sure that they're getting the right education, let's make sure that we're facilitating all faculty instructor development, let's make sure that the right equipment's being used. And what metrics or data do we have to actually show that products that we've spent X dollars on is art being used? And so I think that one really resonates with a lot of our listeners.

Lise Paganotti: 20:40

And then you had a final one as well.

Lise Paganotti: 20:42

Yeah, I just had one final one which I think will also resonate, of course, is scheduling. I think scheduling is difficult for a lot of reasons, and this one actually reminds me of kind of the interprofessional education world and their scheduling issues. But a lot of these simulations might take place in situ versus in the sim lab, not always. It just depends on you know what the goal is, what you're trying to do, but thinking about you know that, in situ scheduling and how do you make sure that there's an adequate staff for the patient, the actual patient care needs and people for the simulation, and that it's a good time and a good day and all of these things to make sure that everybody is safe. So again, I think that's a common one, but again, good things to. I think the barriers are so important to know about because if you can go in anticipating these things, I just think you can really try to mitigate them from the beginning.

Deb Tauber: 21:36

And what about the actionable takeaway for our audience?

Lise Paganotti: 21:40

Yeah, thanks for asking that. One Depends on where you are in your program. But if you can kind of look around an inventory where your program is at and see how you can start to think about translational simulation for your program, whatever that looks like, try to kind of start to weave some of this into your work. It might mean having a conversation with your quality and patient safety department within your organization. It might be building some kind of intentional relationships with maybe some other leadership individuals within your organization or keeping your ear out for some kind of really important need that simulation could fill, some kind of really important need that simulation could fill. And then you can kind of start with that, you know, hopefully like small but successful project, and then grow and build from there. So I think it just depends a lot on where you are, I think if you are at an academic site. So I'll use myself as an example.

Lise Paganotti: 22:45

When I was just in the academic setting, I really didn't think that much about kind of the patient care side. I just felt like it was very disconnected from what I was doing and I would encourage people to try to think about it as connected. You may not be able to measure that because, as we know, there's a lot of confounders there that are going to happen between the training here and the patient care. But I think it's important to even just have that idea in your mind that I'm training them for this, and maybe there is one small thing that I could measure or find out. Maybe I can add a question to one of our surveys to find out, even if it's as simple as do my learners think they'll use this in patient care, and I know that's a very kind of low level outcome, but at least it's a starting point for trying to figure out okay, are we being successful in helping them really kind of move this forward into that patient care space?

Deb Tauber: 23:43

Yeah, this is a lot of systems integration with this. So, especially programs that are going for accreditation for systems integration, this would lend well to their work and to their application.

Lise Paganotti: 23:57

Yeah, definitely.

Deb Tauber: 23:58

Yeah. Now if our listeners wanted to get ahold of you and ask you about this, where would they go ahead and do that?

Lise Paganotti: 24:03

Yeah, sure, probably email is going to be the best way to get a hold of me, and that's going to be. It's lisaannbuckley at gwuedu. So that's l-i-s-a-a-n-n-b-u-c-k-l-e-y at gwu for George Washington University dot edu.

Deb Tauber: 24:24

And that'll be in the show notes. We can include that in the show notes. Yeah, now, lisa, you're also a site reviewer for the Society for Simulation in Healthcare, so why don't you want to share a little bit about what you do and if you've had a favorite review that you've done?

Lise Paganotti: 24:42

Yeah, sure yeah. I've been a site reviewer since about 2013. Since about 2013. And then, more recently, I've taken on a couple leadership roles within accreditation for the Society for Simulation Healthcare, so I'm excited to continue in that realm. Oh man, my favorite thing about the reviews is really just seeing a variety of programs, because people do things really differently and everyone has a little different context. I think there's so much good work going on out there. It's really fun to kind of have that eye into multiple different programs just to see you know how are people doing it and how are they doing it differently. Related to the topic today, my favorite is when I get to do a review that includes systems integration, because I get to see exactly what people are doing in this particular topic area. So that's always exciting.

Jerrod Jeffries: 25:37

Well, and seeing so many too, you see the good and the bad, of course, and then you say, okay, this is the best practices, so let's make sure we implement this in our own institution. So good spot to be.

Lise Paganotti: 25:47

Yeah, it's a real benefit in that way.

Deb Tauber: 25:50

Great. Any questions for Jared and I.

Lise Paganotti: 25:53

No, I don't think so, but thank you so much for interviewing me and allowing me to share this information. I'm excited about it. I welcome anyone to reach out to me if they have any questions or interest in this topic. I love to talk about it.

Jerrod Jeffries: 26:06

Yeah, I think it's very powerful what you're doing, and I love the application towards practice. I think that you've really hit something there, Lisa, and really look forward to hopefully making some connections with some of our listeners that are getting in touch with you.

Deb Tauber: 26:19

Yeah, all right. Well, thank you so much and happy simulating.

Disclaimer/ Beaker Health Ad/ Intro: 26:25

Thanks to Beaker Health for sponsoring this week's podcast. Beaker Health, where dissemination and measuring impact comes easy. Thanks for joining us here at the Sim Cafe. We hope you enjoyed it. Visit 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. Innovative Sim Solutions is your one-stop shop for your simulation needs, a turnkey solution.