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NetworkZ: Simulation training to improve patient safety

09 March 2023
Simulation training that brings multidisciplinary teams together in real clinical settings can identify problems and break down barriers to save real lives.
Things weren鈥檛 going well in the operating room. The patient was having a reaction but the anaesthetist either hadn鈥檛 noticed or hadn鈥檛 figured out why.

A nurse noticed. Quietly, she suggested the cause of the reaction, but the anaesthetist didn鈥檛 hear. For a little while he continued along his path of care 鈥� the incorrect path 鈥� before the nurse gathered her courage and spoke up again. This time, the anaesthetist heard and changed what he was doing.

No harm came to the patient 鈥� not only because the nurse spoke up but because the 鈥榩atient鈥� was a hyperrealistic simulator. The anaesthetist and nurse were real, though, as were the rest of the team. They were participating in simulation training 鈥� and the lessons they learned that day might save real lives in the future.

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What makes NetworkZ unique

鈥淲e鈥檙e constantly learning, growing and improving as a result of the feedback we鈥檙e getting from the practitioners, patients and researchers. It鈥檚 an exemplar in the translation of research into practice.鈥�

Vanessa Ding

NetworkZ is a national programme run by the UniServices-managed (NIHI). It conducts team-based training for multidisciplinary healthcare teams with the goal of improving patient outcomes and healthcare equity.

Running since 2017 and originally focusing on operating rooms, NetworkZ has recently expanded its scope to cover more care settings and types of scenarios, including emergency wards, radiology, post-operative care and obstetrics. All scenarios are modelled on real-life situations.

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Vanessa Ding and Kaylene Henderson

NetworkZ is based on the research of Professor , an anaesthetist and the programme鈥檚 academic director. Her work has found that training health professionals to remove barriers to communication in clinical settings leads to better patient safety outcomes.

Historically, professional development has focused on single disciplines, so healthcare assistants and surgeons didn鈥檛 train together despite working together. NetworkZ was the first programme in New Zealand to bring multidisciplinary teams together for high-fidelity simulation training.

鈥淚n one debrief I conducted, a healthcare assistant talked about her role and the preparation she did, and the surgeon said, 鈥業 didn鈥檛 know you did all those things,鈥欌�� says Kaylene Henderson, the NetworkZ programme manager. 鈥淣ow she calls her by name every time she sees her. So NetworkZ is breaking down barriers and building relationships even within teams that work together all the time.鈥�

NetworkZ is also unique in that it鈥檚 part of an ongoing research programme, says NIHI General Manager Vanessa Ding.

鈥淚t鈥檚 not based on one-off research published back in the day. We鈥檙e constantly learning, growing and improving as a result of the feedback we鈥檙e getting from the practitioners, patients and researchers. It鈥檚 an exemplar in the translation of research into practice.鈥�

 

Learn about the courses NetworkZ offers to healthcare teams and the clinical settings in which it works
Learn about the courses NetworkZ offers to healthcare teams and the clinical settings in which it works

High realism

NetworkZ uses Laerdal SimMan 3G with realistic silicone overlays made by New Zealand company MedicFX, which started off making medical special effects for films and TV.

These sophisticated simulated 鈥榩atients鈥� are a key part of the programme鈥檚 success. The simulators represent patients of a range of ages, genders and ethnicities. They can be operated upon, intubated and even undergo amputations and births.

Not only do the simulators cover scenarios ranging from stabbings to sepsis, they blink, bleed and have pulses, pupils that dilate and chests that rise and fall. They can even grunt, speak or scream through mics operated by simulation assistants observing from another room.

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The realism of the simulations is crucial to the success of NetworkZ 鈥� not only the realism of the 鈥榩atients鈥� but also the fact that they take place in the real settings where multidisciplinary healthcare teams work.

鈥淭he scenarios we have are acute, rare scenarios so they push the limits of what鈥檚 possible in that setting, and that鈥檚 deliberate to ensure we鈥檙e uncovering latent safety threats,鈥� says Ding.

One team doing a simulation injected glucose instead of saline into a simulated patient鈥檚 artery 鈥� something which, if done in real life, could have led to permanent hand damage. This led the team to redesign their storage of fluids to minimise the possibility of mix-ups.

Another team discovered during a simulation that a defibrillator wasn鈥檛 working properly. As a result, the faulty equipment was replaced within a week.

鈥淭he scenarios we have are acute, rare scenarios so they push the limits of what鈥檚 possible in that setting, and that鈥檚 deliberate to ensure we鈥檙e uncovering latent safety threats.鈥�

Vanessa Ding

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The importance of communication

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The simulated scenarios are only part of NetworkZ training. Just as important is the debriefing process, when teams reflect on what happened in the simulation, why and identifying gaps in knowledge, systems or infrastructure.

After the simulation session where the anaesthetist initially didn鈥檛 hear the nurse, the discussion broke down barriers by allowing the nurse to talk about how hard it can be to speak up and the anaesthetist to express how much he values her contributions.

鈥淚t鈥檚 not us telling them what they did or didn鈥檛 do; it鈥檚 them reflecting on knowledge or communication gaps,鈥� says Henderson. 鈥淭hey鈥檙e the ones who come up with solutions, so that makes the training more powerful and effective.鈥�

An important aspect of NetworkZ is its focus on equity. Not only can it deliver the same quality of programme in tertiary hospitals as in small, remote ones, it is now working with M膩ori facilitators, clinicians and patients to understand how to better educate the workforce on equitable outcomes, says Ding.

The programme can also include discussions about withdrawing treatment when a patient has indicated they do not wish to continue beyond a certain point.

鈥淭hat鈥檚 a very emotive scenario that requires discussions about equity and how to manage end-of-life care for the patient and wh膩nau,鈥� says Henderson.

鈥淔undamentally, we鈥檙e trying to reduce patient harm, and our unique model of simulation training is a very tangible and effective way of doing that.鈥�

Vanessa Ding

The impact of NetworkZ

Henderson has been convinced of the importance of simulation training for a long time 鈥� decades ago, as an experienced anaesthetic technician, she participated in a simulation for research purposes.

鈥淒uring the simulation, they put in some faults and I didn鈥檛 find one. They were right in front of me and I missed them,鈥� says Henderson. 鈥淚t made me realise we can all make mistakes and ignited an interest in simulation training.鈥�

Henderson has been with NetworkZ since its inception in 2016. Since then, she and the team have trained more than 3,500 people nationally, plus some 600 instructors who can lead the programme independently in clinical settings across the country.

Not only has NetworkZ recently expanded the scenarios and settings it covers, it has also changed from a government-funded model to a sustainable, cost-recovery model that works in the public and private healthcare sectors. It has also begun to work internationally 鈥� so far just in Australia.

鈥淲e鈥檙e looking to scale the impact we鈥檝e already had,鈥� says Ding. 鈥淔undamentally, we鈥檙e trying to reduce patient harm, and our unique model of simulation training is a very tangible and effective way of doing that.鈥�

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