Fundamentally Human: Learning By Design

The core staff of the MHQA is an overlapping combination of Lean Six Sigma–certified belts; Certified Professionals in Patient Safety, therapists, nurses, statisticians, and others, bringing a wealth of perspectives to the table. While there are many simulation centers around the country, the MHQA has refined and polished its focus to use its unique group of partners, its breadth of simulated care settings, and its midlevel size. 

“The diversity of staff and shared vision of the partners of the Midwest Healthcare Quality Alliance allows us to be on the cutting edge of innovation in healthcare design and delivery, and will be the dynamic force for improved population health outcomes,” explains Todd Roberts, executive director of the MHQA.  

So when it comes to planning a patient safety and simulation symposium, the MHQA puts its skills to work to devise a comprehensive day that takes advantage of this incredible learning and working environment, combining traditional didactic presentations with hands-on simulation experiences that cement new learning in an event that is both educational and fun. 

Process/design 2015 

With the broad purpose of building capability in the regional workforce for improved patient care and outcomes, the team set out to design sessions focused on current patient safety topics that would also be enhanced by a simulation activity. In 2015, the topic of diagnostic safety continued to be one of the top patient safety issues nationally. Dr. Gordy Schiff, associate director of Brigham and Women’s Center for Patient Safety Research and associate professor of medicine at Harvard Medical School, was invited to present on preventing diagnostic errors in healthcare.  

Following his presentation, symposium attendees participated in a live simulation. Multi-disciplinary teams, which included nonclinical attendees, were assigned to different patient exam rooms; in each one, a 60-year-old male SP suffering from an acute onset of low back pain awaited diagnosis. There were subtle differences in each SP’s social history and contexts of onset. Each patient had different occupations and variations on alcohol use; some were taking opioids for an unrelated wrist injury; and some were on blood pressure medication. All of these factors were intended as potential biases. The objectives of the simulation were to:  

Appreciate the patient and caregiver factors that create the potential for bias 

Describe how bias increases the risk of diagnostic error and can influence the differential list 

Understand how the roles of clinical and nonclinical healthcare team members alike contribute to the differential diagnosis, and the importance of speaking up 

Teams were pre-briefed, and all members were strongly encouraged to participate and ask questions of the patient as needed. Attendees gathered around the patient, and the chosen leader (generally a physician) began a patient interview and completed a focused physical exam. Teams then discussed their findings with guidance from a facilitator, each team coming up with a list of five differential diagnoses. Attendees reconvened for a single large-scale debrief, where all the teams’ lists were displayed and discussed.  

The actual diagnosis—acute abdominal aortic aneurysm—was present on all 16 lists. “Interestingly, the diagnosis of ‘drug-seeking,’ or some variation of this behavior, was listed as a differential diagnosis on five of the lists—four of those lists were for patients with an opioid on their current medication list, and only one for a patient without an opioid on their current medication list. This type of observation and immediate feedback is really only possible in a setting with the capability of running several simulations concurrently,” observed Dr. Stacy Sattovia, medical director of the Office of Continuing Professional Development at SIU School of Medicine.