The project, known as the Center of Excellence for Simulation Research, will use simulation infrastructure and methodologies developed in the aviation industry over the years to advance medical simulations so they can be an effective tool for health-care training, said Bill Hamman, Ph.D., who along with William Rutherford, Ph.D., is heading up the project.
Both Hamman and Rutherford are certified commercial pilots teaching at WMU’s College of Aviation. The college’s aviation program is one of the three largest in the nation, with more than 900 undergraduate students.
Simulation has blossomed drastically over the past five years in medicine with the powers of computers increasing and the ability through virtual reality to simulate the body, Hamman said. The dynamics of medical simulators, too, are much more like aviation simulators today.
“The simulators have become much more realistic. They bleed, they urinate, they blink their eyes, they talk and they have heart sounds, so the potential and power to simulate is much greater.”
The simulation itself is the “patient,” with the simulated “patient” mimicking the disease process.
As Hamman explained, it came to light in the mid-`70s and early-`80s that aircraft that were crashing most often were not having a major technical problem. They were perfectly good airplanes that were flying into the ground for no good reason except for the human factors — crew dynamics, communication, workload, rank gradients among the crew — that became an impediment to that crew performing their operation safely.
What has happened, he said, is that health care has come to the realization that a lot of the same issues are apparent in the health-care setting. The majority of the accidents and errors that are happening in health care are team based, human-factor based and systems based, according to Hamman.
The piece Hamman and Rutherford are bringing forward from the aviation industry is the concept of marrying both technical skills and human skills into an overall package of training.
While some general team skills probably could be gleaned from the work that’s been done in aviation, Hamman said, they feel there are enough differences between medical teams and aviation teams to warrant a study to identify the team skills most critical to health care. Once identified, they can be applied to the medical simulation already available.
Rutherford pointed to the 1999 Institute of Medicine report “To Err Is Human,” which identified the fact that most of health care operates as a series of independent practitioners or a series of cottage industries.
“There are elements of the culture of health care that are really incompatible with safe operations, much as we once had in aviation,” he said. “One of the things that the patient-safety movement speaks to frequently is the concept of a culture of safety.”
He said culture-of-safety disciplines work their way up the administrative chain to produce better-integrated systems on a hospital-wide or a health-care plan-wide basis. But it isn’t simply a case of trying to create a virtuoso medical team, he added. It’s a case of changing the dialogue within the health-care context and moving toward a culture of safety.
A culture of safety involves, substantially, the free exchange of information — a component of which is the ability to report incidents, near misses and things that went wrong but by luck or chance got interrupted, Rutherford explained.
“We want to know about those things, but health care — unlike aviation — doesn’t talk about those near misses. Unless they get caught, they don’t report an incident, and the reason is because of litigation.”
Human error can’t be prevented. People are going to make mistakes, Rutherford acknowledged. But he said systems and processes can be designed to intercept the error chain before people can cause serious damage.
“We are working on those processes to create a safety network that will mitigate mistakes, so the error doesn’t become an error chain that becomes an accident, which in this case would be the loss of a patient’s life.”
The study is supported by a $2.79 million grant from the Michigan Technology Tri-Corridor and a combined $1.4 million in matching funds from Battle Creek Unlimited and the Forest Park Foundation of Peoria, Ill. The Tri-Corridor award was the largest award approved among 24 announced on June 15.
The first order of the day is to establish simulation labs; matching funds are available for the required equipment purchases, Rutherford said. Michigan State University’s Kalamazoo Center for Medical Studies will help develop the labs, and there are other potential arrangements that could be made with other medical schools and hospitals around the country. He said the role of a hospital would be to provide potential subjects for the experiment.
Hamman noted that several departments of WMU’s College of Health and Human Services, as well as the university’s Center for Performance Evaluation, also will assist in the project. He referred to them as co-principal investigators on the project.
“I think what is really exciting and unique about this project is doing this detailed, scientifically rigorous analysis of team performance in health care,” Hamman said. “Nobody has really done that and nobody is really talking about it.”
In health care, teams form and disband a multitude of times during a procedure on a patient, he observed.
“You have the surgeon who holds a good part of knowledge, as is thought, and the next layer within the team is the nurse or allied health professional, and there is a day and night difference between the training and the cultures of those groups.
“To find out what is effective in the interface dynamic between those two groups, I think, is going to be critical for the health-care industry.”