Rapid cycle system improvement for COVID-19 readiness: integrating deliberate practice, psychological safety and vicarious learning

Albert Kam Ming Chan; Jenny W Rudolph; Vivian Nga Man Lau; Henry Man Kin Wong; Rosinni Si Ling Wong; Thomas S F Lo; Gordon Y S Choi; Gavin Matthew Joynt

doi:10.1136/bmjstel-2020-000635

Rapid cycle system improvement for COVID-19 readiness: integrating deliberate practice, psychological safety and vicarious learning

BMJ Simul Technol Enhanc Learn. 2020 Aug 21;7(4):199-206. doi: 10.1136/bmjstel-2020-000635. eCollection 2021.

Authors

Albert Kam Ming Chan¹, Jenny W Rudolph², Vivian Nga Man Lau¹, Henry Man Kin Wong¹, Rosinni Si Ling Wong¹, Thomas S F Lo³, Gordon Y S Choi¹, Gavin Matthew Joynt³

Affiliations

¹ Department of Anaesthesia and Intensive Care, Prince of Wales Hospital, New Territories, Hong Kong.
² Center for Medical Simulation, Cambridge, Massachusetts, USA.
³ Department of Anaesthesia and Intensive Care, Chinese University of Hong Kong, Faculty of Medicine, New Territories, Hong Kong.

Abstract

Introduction: In the face of a rapidly advancing pandemic with uncertain pathophysiology, pop-up healthcare units, ad hoc teams and unpredictable personal protective equipment supply, it is difficult for healthcare institutions and front-line teams to invent and test robust and safe clinical care pathways for patients and clinicians. Conventional simulation-based education was not designed for the time-pressured and emergent needs of readiness in a pandemic. We used 'rapid cycle system improvement' to create a psychologically safe learning oasis in the midst of a pandemic. This oasis provided a context to build staff technical and teamwork capacity and improve clinical workflows simultaneously.

Methods: At the Department of Anaesthesia and Intensive Care in Prince of Wales Hospital, a tertiary institution, in situ simulations were carried out in the operating theatres and intensive care unit (ICU). The translational simulation design leveraged principles of psychological safety, rapid cycle deliberate practice, direct and vicarious learning to ready over 200 staff with 51 sessions and achieve iterative system improvement all within 7 days. Staff evaluations and system improvements were documented postsimulation.

Results/findings: Staff in both operating theatres and ICU were significantly more comfortable and confident in managing patients with COVID-19 postsimulation. Teamwork, communication and collective ability to manage infectious cases were enhanced. Key system issues were also identified and improved.

Discussion: To develop readiness in the rapidly progressing COVID-19 pandemic, we demonstrated that 'rapid cycle system improvement' can efficiently help achieve three intertwined goals: (1) ready staff for new clinical processes, (2) build team competence and confidence and (3) improve workflows and procedures.

Keywords: Anaesthesia; Intensive Care; Quality Improvement; Simulation Based Education; Translational Outcomes.