Improving the relational aspects of trauma care through translational simulation

Abstract

Background Major trauma care is complex and requires individuals and teams to perform together in time critical, high-stakes situations. Scenario-based simulation is well established as a strategy for trauma teamwork improvement, but its role in the relational and cultural aspects of trauma care is less well understood. Relational coordination theory offers a framework through which we aimed to understand the impact of an established trauma simulation programme. Methods We studied simulation activities using a narrative survey of trauma providers from anaesthesia, emergency medicine, medical imaging, surgery, trauma service, intensive care, and pre-hospital providers at Gold Coast University Hospital, in conjunction with data from an ethnography. Data analysis was performed using a recursive approach—a simultaneous deductive approach using the relational coordination framework and an inductive analysis. Results Ninety-five of 480 (19.8%) staff completed free-text survey questions on simulation. Deductive analysis of data from these narrative survey results using the RC framework domains identified examples of shared goals, shared knowledge, communication and mutual respect. Two major themes from the inductive analysis—“Behaviour, process and system change” and “Culture and relationships”—aligned closely with findings from the RC analysis, with additional themes of “Personal and team learning” and the “Impact of the simulation experience” identified. Conclusions Our findings suggest that an established trauma simulation programme can have a profound impact on the relational aspects of care and the development of a collaborative culture, with perceived tangible impacts on teamwork behaviours and institutional systems and processes. The RC framework—shared knowledge, shared goals and mutual respect in the context of communication that is timely, accurate, frequent and problem-solving based—can provide a common language for simulation educators to design and debrief simulation exercises that aim to have a translational impact.

Doing our work better, together: a relationship-based approach to defining the quality improvement agenda in trauma care

“…Although it is becoming a more popular tool in quality improvement, simulation’s ability to shape relationships and culture in work environments has not been well studied. These and other reflection on translational simulation by our participants strongly suggest that a thoughtfully designed programme can directly target each domain of RC, with particularly impressive implications for the development of mutual respect between groups 25. The potential for simulation to shape culture is in keeping with previous research in the medical school context 27.…”

“…*Previously published in our article “Improving the relational aspects of trauma care through translational simulation” published under the Creative Commons 4.0 Licence 25…”

Translational simulation for rapid transformation of health services, using the example of the COVID-19 pandemic preparation

“…Given our existing relationships with clinical services, our focus was on team and system challenges. We felt that our specific expertise in building relationships and shaping culture through simulation [7,8] was likely to be more important than ever as we undertook rapid and urgent high stakes change. Our strategy was aligned with the Queensland Health Pandemic Influenza Plan [9] and guided by the local Health Emergency Operations Centre (HEOC), to whom we provided biweekly reports.…”

Front‐line nurses' perceptions of intra‐hospital handover

“…At the micro‐level more frequent, timely, accurate and problem‐solving face‐to‐face communication between units may be required. For instance, translational simulation (Brazil, Purdy, Alexander, & Matulich, 2019) and nursing rounds (Tobiano et al, 2019) have been shown to enhance comradery across units (Rosenbaum, 2019). Promoting more opportunities for secondment in other units could also enhance relationships (Dryden & Rice, 2008).…”