Crossing boundaries…..? or straddling the fence…..

….Uncomfortable journeys in healthcare simulation

Dr Victoria BrazilBond UniversityGold Coast Health Service

Tribes in healthcare

“Speaking up against a power gradient, or challenging a member of a different ‘tribe’ requires courage, and so poor decisions may go unchecked”

Jennifer Weller. Shedding new light on tribalism in healthcare. Medical Education 2012

As a DEM specialist [DEMC4] describes, this facilitates the emergence of ingroup solidarity:

“…and if we constantly feel in a state of siege of us against everyone we’re trying to refer to,…….I think everyone like to have a little team allegiance.. And having a common enemy is a really great bonding experience for a team..”

As a DEM specialist [DEMC4] describes, this facilitates the emergence of ingroup solidarity:

“…and if we constantly feel in a state of siege of us against everyone we’re trying to refer to,…….I think everyone like to have a little team allegiance.. And having a common enemy is a really great bonding experience for a team..”

Can we do more to help?

Have our aims and methods in simulation based learning sufficiently

recognised the social (tribal) and cultural context of health care?

Uncomfortable journey #1

- Give them a recipe and they’ll be fine

Communication skills training does not necessarily lead to skilled communication

Uncomfortable journey #2

– the dominance of exciting stuff

“Simulatoritis….”

Another dark side…….

Uncomfortable journey # 3

– negative training

QRMSA Rural Preparatory Workshops for JHOs

More negative training…..

Uncomfortable journey #4

– the delusion of evaluation!

“I feel more confident…..”

00.5

11.5

22.5

33.5

44.5

Uncomfortable journey #5

– failure to connect to patient outcomes or health service priorities

The doctor of the 21st century?

Healthcare simulation – pushing boundaries

Some more uncomfortable journeys…..

1. Aim small and more boring

1. Aim small and more boring

1. Aim small and more boring

2. Get some KPIs

2. Get some KPIs

“Count something”

3. Take a journey to the CEOs office

3. Take a journey to the CEOs office

The doctor of the 21st century?

The doctor of the 21st century

• Lead in complexity, and be expert in systems and team based care

• Train other providers to do many tasks we currently do

• Be stewards of healthcare resources• Improve care through practice audit and

skilled analysis of patient outcome data• ….? And more

4. Be a tribal translator

4. Be a tribal translator

…. For our patient sake…..

SummaryTribes and culture in healthcare are critical ingredients for effective simulation

Take uncomfortable journeys…..

Aim small and more boring

‘Count something’

Get to the CEOs office

Be ‘tribal translators’

vbrazil@bond.edu.au

@SocraticEM