Can you PACE yourself? The power of language to flatten hierarchy and empower multi-disciplinary healthcare teams in simulated critical scenarios

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Purpose/Problem

Potentially harmful mistakes in healthcare are often the consequence of poor communication among teams.1 Reasons for this communication breakdown are multi-factorial, but within healthcare a hierarchy, whether perceived or real can contribute to a reluctance to challenge decision making.2 In response to a serious untoward incident, a programme of in situ simulation training sessions was developed to replicate oncological emergencies. Sessions are delivered to multi-disciplinary groups, with a focus on non-technical skills and human factors. The hypothesis was that participants would have an increase in confidence to challenge decision making following the training.

Method

A multi-disciplinary group works together in a scripted high fidelity simulation, held in situ on an acute oncology ward. The simulation mimics a typical oncological emergency, for example neutropenic sepsis. The focus is on communication skills, clear handover and the challenging of decision making where necessary. Human factors challenges and interruptions are worked into the scenario to increase the realism. Participants are introduced to the PACE (Probe, Alert, Challenge, Emergency) acronym to aid them in communicating when faced with a steep hierarchical gradient. Participants take part in a structured debrief following the scenario.

Results

An attitudes questionnaire based on Kirkpatrick’s model was used to collect data.3Participants completed a questionnaire pre and post the simulation. The results demonstrate that 55% of participants felt more confident to challenge decision making. Participants also reported an increased knowledge of relevant trust protocols/algorithms.

Conclusion

In situ multi professional simulation training allows an opportunity for oncology team members to practice non-technical skills in a safe, realistic environment. The increased confidence levels represent a positive start to this research. This work is action research and a PDSA (plan, do, study, act) cycle is completed after each session. Sessions are quarterly, and are adapted to cover a wide range of oncology topics.

References

1. Green, B., Oeppen, R.S., Smith, D.W., Brennan, P.A. (2017) Challenging hierarchy in healthcare teams – ways to flatten gradients to improve teamwork and patient care. British Journal of Oral and Maxillofacial Surgery 55, pp 449 – 453.
2. Mc Culloch, P., Mishra, A., Handa, A, et al (2009) The effects of aviation-style non-technical skills training on technical performance and outcome in the operating theatre. Qual Saf Health Care 18, pp 109 – 115.
3. Kirkpatrick, D. L. and Kirkpatrick, J. D. (2006) Evaluating training programs. San Francisco, Berrett-Koehler.