Simulation Labs: Creating a Safe Space for Physicians to Practice

Physician burnout is increasingly prevalent in the medical community today. A contributing factor is that healthcare providers may feel their judgment and ability to provide quality care to their patients is constantly being challenged. A research report by the Rand Corporation, sponsored by the American Medical Association, reported, “When physicians perceived themselves as providing high-quality care or their practices as facilitating their delivery of such care, they reported better professional satisfaction.”¹

There are four key drivers for what physicians want and need when they show up to work: Quality, Efficiency, Input, and Appreciation.² Physicians want to know their patients are receiving excellent care, always. They want to practice in an efficient, effective work environment because they are constantly “on the go” and they have patients waiting to see them. Physicians want a seat at the table to provide input when decisions are being made, especially those that affect clinical outcomes and operations. Lastly, physicians, like all of us, want to know that they are appreciated. Too often, we take for granted the efforts and sacrifices made by physicians.

One tactic that can combat physician burnout and improve the work environment for physicians (and all medical practice staff) is to conduct Simulation Labs. Simulation labs provide a safe environment for key team members to practice tactics like Key Words at Key Times and AIDET^®. “In healthcare, when people see it in action, rather than just hearing it, they have a much better chance of doing it.” (Quint Studer, “Healing Physician Burnout”, Fire Starter Publishing, 2015). Additionally, these simulations identify areas in need of process improvement by walking through the process and identifying bottlenecks or operational waste. In addition to being a safe and cooperative learning environment for participants to practice key tactics and validate their skillsets around a desired behavior (i.e., AIDET^®), the Simulation Labs provide an excellent opportunity to connect back to the “WHY” in developing a deeper understanding for all participants involved.

How can we execute simulation labs? A simulation lab gathers everyone together who has direct patient involvement – including front-desk, clinical support staff and clinical providers. By utilizing “mock patients” (if possible, played by administration or a physician) and pre-planned scenarios, all participants work through each step of the patient encounter – from registration at the front desk through the rooming process to the clinical encounter with the provider. Allocate an hour and a half per session, ideally outside of scheduled patient time.

STEP ONE. Once the group has gathered, introduce and review the WHY behind AIDET^® and Key Words at Key Times. Emphasize with participants that we are looking for the way each individual actually does their role as opposed to “how they think it should be done”. Remember, the purpose of the exercise is for participants to practice and validate their skillset.

STEP TWO. Explain the simulation scenario. The scenarios that you use should be real-to-life scenarios that you deal with in your office. Remember that the point of the exercise is to work through the process and not to diagnose process improvement issues. Some examples could include a patient arriving late to their appointment, missing information, or attempting to collect a co-pay.

STEP THREE. Designate participant roles.

1. Reception / front desk staff – handle the “mock patients” on arrival, as would be typical in your office.
2. Medical Assistants / clinical support staff – room the “mock patients” and prep them, take vitals, and so on, before being seen by the clinical provider.
3. Clinical providers (advanced practice providers and physicians) – attend to the “mock patients.”
4. Visitors / family members / observers – for participants who are not assigned a role, designate them to accompany each “mock patient” through the process. Emphasize with this group that they will lead the discussion during the debrief session at the end of the exercise.

STEP FOUR. Begin the simulation lab by having the “mock patient” enter the practice. Register the “mock patients” in the system. Have the medical assistant / clinical support staff room the “mock patient”. Complete the rooming process as you would normally by having the patient sit in the reception area and the medical assistant / clinical support staff come out to the patient and bring them back to the exam room (and all the steps they would normally take in a patient encounter along the way). You do not have to weigh the “mock patient” or take vitals – these steps can be explained verbally. Complete the provider encounter as the advanced practice provider or physician normally would attend to their patient. Complete the encounter by having the reception / front desk staff check-out the patient (if applicable).

STEP FIVE. Debrief with the group. Encourage feedback; lead with the WINS / what worked well and then identify any opportunities for improvement.

It’s been my personal experience that physicians express their surprise at the amount of paperwork they were asking their front desk to collect from every patient. Simultaneously, the front desk staff had an eye-opening experience when they see the interactions and questions “patients” ask their provider in the exam room.

“In all, Simulation Labs impact all of the physician drivers. It gives physicians input into how they want to work with their patients. It improves efficiency and effectiveness of patient visits (and, thus improves quality)” (Quint Studer, “Healing Physician Burnout”, Fire Starter Publishing, 2015). Finally, it allows the entire team to appreciate the hurdles physicians have to navigate each day.

REFERENCES

1. Friedberg, M. et al., “Factors Affecting Physician Professional Satisfaction and Their Implications for Patient Care, Health Systems, and Health Policy,” Rand Corporation 2013.
2. Studer, Q., & Ford, M. (2015) Healing Physician Burnout, Diagnosing, Preventing, and Treating. Pensacola, FL: Firestarter Publishing.

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