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Simulation can take healthcare from hierarchy to teamwork

February 26th, 2014

by Lydia Forsythe

Social intricacies surround us. As we walk through our healthcare organizations they exist whether we acknowledge them. Recognizing these social nuances is important, but not easy to do, given the many societal layers and time constraints in our busy and complex health organizations.

In particular, both explicit and implicit activities socially shape healthcare teams. It's hard for new staff and leaders to acclimate to an organization and a team, which sometimes creates retention issues. We can identify and recognize a team's social structures by giving it a voice, and enhance its presence by using a qualitative simulation activity.

Planned team simulations can open doors to understanding how we connect in our care delivery hierarchies as socially constructed professionals.


We can slow down the environment and develop a space for interaction that normally does not exist. We can take real-time activities and bring a new dimension of increased discussion to allow time for additional interactions and improvements, while building positive relationships and increasing the efficiency and safety potential. Using this method, teams develop new ways to understand and welcome newcomers into the fold, thus helping with retention--enhancing team communication for increased patient safety and forging positive relationships.

Start by recreating a typical healthcare event that may lead to less than favorable team connections. For example, when recent medical school graduates and seasoned staff nurses switched roles in an emergency team code simulation, the participants realized how embedded they were in their own team hierarchy and professional existence. Even when play acting as physicians, the nurses found it difficult to challenge the newly graduated physicians. This reveals how important it is for us to develop connections as team members in our academic years.

Give participants the opportunity to change things in these simulated environments. This can be as simple as where they place an item in an operating room. Often, when events are actually transpiring, we are too busy to remember what needs to be changed. By slowing down the environment, teams can make actual changes to the setting, create a list of what needs to be adjusted or identify behaviors that do not encourage teamwork.

Be sure to simulate activities in an actual workspace, which will create a memory trigger that adds value to the experience. The essence of the event becomes more real because the memory is more vivid.

It's fascinating and encouraging to see what we can do in healthcare when individuals have time to actually explore their social worlds and environments. If this sounds interesting please add your comments!

Lydia L. Forsythe, Ph.D., MA, MSN, RN, CNOR, is an adjunct faculty member at Kaplan University School of Nursing. A nurse for 26 years and a retired major in the U.S. Army Nurse Corps Reserves, she also is president of Londes Strategic Healthcare Consulting in Oklahoma City.


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