Variation and adaptation: learning from success in patient safety-oriented simulation training

Peter Dieckmann; Mary Patterson; Saadi Lahlou; Jessica Mesman; Patrik Nyström; Ralf Krage

doi:10.1186/s41077-017-0054-1

Variation and adaptation: learning from success in patient safety-oriented simulation training

Adv Simul (Lond). 2017 Oct 31:2:21. doi: 10.1186/s41077-017-0054-1. eCollection 2017.

Authors

Peter Dieckmann¹, Mary Patterson², Saadi Lahlou³, Jessica Mesman⁴, Patrik Nyström⁵, Ralf Krage⁶

Affiliations

¹ 1Copenhagen Academy for Medical Education and Simulation (CAMES), Center for Human Resources, Capital Region of Denmark, Herlev Hospital, 25. Floor, Herlev Ringvej 75, DK-2730 Herlev, Denmark.
² 2Children's National Medical Center, 111 Michigan Ave NW, Washington, DC, 20010 USA.
³ 3London School of Economics and Political Science, Department of Psychological and Behavioural Science, Houghton Street, London, WC2A 2AE UK.
⁴ 4Maastricht University, Faculty of Arts and Social Sciences, Grote Gracht 90-92, Maastricht, The Netherlands.
⁵ 5Patient Safety and Learning Centre, ARCADA University of Applied Sciences, Jan-Magnus Janssons plats 1, Helsinki, Finland.
⁶ 6ADAM Simulation Center, VU University Medical Center, De Boelelaan, 1117 Amsterdam, The Netherlands.

Abstract

Simulation is traditionally used to reduce errors and their negative consequences. But according to modern safety theories, this focus overlooks the learning potential of the positive performance, which is much more common than errors. Therefore, a supplementary approach to simulation is needed to unfold its full potential. In our commentary, we describe the learning from success (LFS) approach to simulation and debriefing. Drawing on several theoretical frameworks, we suggest supplementing the widespread deficit-oriented, corrective approach to simulation with an approach that focusses on systematically understanding how good performance is produced in frequent (mundane) simulation scenarios. We advocate to investigate and optimize human activity based on the connected layers of any setting: the embodied competences of the healthcare professionals, the social and organizational rules that guide their actions, and the material aspects of the setting. We discuss implications of these theoretical perspectives for the design and conduct of simulation scenarios, post-simulation debriefings, and faculty development programs.

Keywords: Activity theory; Debriefings; Faculty development; Installation theory; Mundane practice; Patient safety; Safety II; Scenarios; Simulation; Video reflexivity.