Systems Integration

Abstract

Simulation applications within the “systems integration” construct are focused directly on patient outcomes. Simulation modalities can be used to improve the performance of health-care’s “complex adaptive system” toward Institute of Medicine-described (patient-centric) goals of safety, effectiveness, timeliness, efficiency, and equity.

To achieve systems integration, accreditation programs must demonstrate “consistent, planned, collaborative, integrated, and iterative application of simulation-based assessment and teaching activities with systems engineering and risk-management principles to achieve excellent bedside clinical care, enhanced patient safety, and improved metrics across the health-care system.” In this way, deficiencies in health-care delivery can be addressed via the systems and process engineering “tool” of simulation. Examples include simulating discrete adverse events and typical patient journeys to determine latent errors or inefficiencies and development of programmatic educational interventions based on organizationally identified risks or quality indicators. Utilizing system engineering principles, simulation modalities can be used to test and improve health-care systems and more profoundly affect patient outcomes and health-care processes.

“You’ve got to be very careful if you don’t know where you’re going because you might not get there.”—Yogi Berra

Appendix: Council for Accreditation of Healthcare Simulation Programs

Accreditation Standards and Measurement Criteria

Suggested Revisions as endorsed by Systems Integration Subcommittee of SSH Accreditation Council, amended and ­authorized by vote of SSH Accreditation Council January 29, 2012

Systems integration: facilitating patient safety outcomes

Application for accreditation in the area of Systems Integration: Facilitating Patient Safety Outcomes will be available to those Programs who demonstrate consistent, planned, collaborative, integrated, and iterative application of simulation-based assessment; quality& safety; and teaching activities with systems engineering and risk management principles to achieve excellent bedside clinical care, enhanced patient safety, and improved outcome metrics across a healthcare system.

Standards specific for accreditation in the area of systems integration & patient safety outcomes

BOLD: Required Criteria

1. MISSION AND SCOPE: The program functions as an integrated institutional safety, quality, and risk management resource that uses systems engineering principles and engages in bi-directional feedback to achieve enterprise-level goals and improve quality of care.

Provide a brief summary of how the Simulation Program addresses the Mission and Scope requirements described below (not more than 250 words)

(a) Systems integration and patient safety activities are clearly driven by the strategic needs of the complex healthcare system(s).

(i) There is a documented process in place to link the systems integration and patient safety activities to the strategic plan(s) of the healthcare system(s)

Provide a description of the process, including the roles of those responsible for executing the plan to impact systems integration

(ii) Provide a Copy of the Mission statement(s) with required elements including

Impacting integrated system improvement within a complex healthcare environment

Enhancement of the performance of individuals, teams, and organizations

Creating a safer patient environment and improving outcomes

(iii) Provide evidence from the past two (2) years documenting the simulation program being utilized as a resource by risk management and/or quality/patient safety with bi-directional feedback

(iv) Provide a letter (2 pages maximum) from organizational Risk Management, Safety and/or Quality-Improvement leadership supporting the Program’s role in achieving organizational risk, quality and/or safety goals

(b) There is clear demonstration of impact of the program in improving organizational integrated processes and/or systems, thereby positively (and measurably) impacting patient care environments and/or outcomes, utilizing principles of process engineering for sustained impact

(i) The program provides specific documentation of three (3) examples of Simulation used in an integrated fashion to facilitate Patient Safety, Risk Management and/or Quality Outcomes projects/activities. Supporting documentation for each project/activity will include:

Documentation of a systems engineering approach used to solve enterprise-defined patient safety concern(s), including design algorithm and bi-directional accountability structure(s) for the activity/project

Key project improvement document(s) (e.g. charter, A3, process improvement map, root cause analysis, cycles of improvement, etc.)

Documentation of simulation contributing to the achievement of enterprise-level goals and improved quality of care

Description of Interprofessional engagement and impact

Metric outcomes demonstrating system improvements

Report of findings to organizational leadership, including minutes demonstrating review and feedback

(ii) Provide evidence that demonstrates sustained (minimum 6 months), positive outcomes achieved by activities in which simulation was used, spanning multiple disciplines

(iii) Provide evidence that demonstrates organizational leadership’s ongoing assessment of outcome metrics

2. INTEGRATION WITH QUALITY & SAFETY ACTIVITIES: The Program has an established and committed role in institutional quality assessment and safety processes.

Provide a brief summary of how the Simulation Program addresses the Integration with quality and Safety Activities requirements described below (not more than 250 words)

(a) There is clear evidence of participation by simulation leadership in the design and process of transformational improvement activities at the organizational level

(i) Provide performance improvement committee rosters and minutes from at least two (2) meetings during the past 2 years to verify contributions of simulation personnel

(ii) Demonstration of accezss to appropriate qualified human factors, psychometric, and/or systems engineering support or resources