Tuesday, 16 December 2014

ASPiH 2014 annual conference: The plus and the delta (by M Moneypenny)

The 2014 Association for Simulated Practice in Healthcare (ASPiH) annual conference took place in Nottingham between the 11th-13th November. The following is not a definitive overview of the conference and if you feel strongly that something has been missed out, then please do comment at the bottom!

The plus

The keynote lecturers were very good, with lots of food for thought and a few lightbulb moments.

ASPiH Laerdal keynote lecture by Hege Ersdal (SAFER, Norway): Low-dose high-frequency simulation: saving lives of babies on a global scale

Hege gave a moving keynote looking at work carried out in Tanzania. A 1-day course was delivered which tried to teach the importance of the "golden minute" after birth. She showed promising results of a 50% decrease in neonatal deaths in the region, however when further analysed it showed that the 50% figure hid a significant disparity between centres, some had a much greater decrease, some had none. Hege and her team found that local implementation was hampered at some sites and that frequent onsite training was the major determinant of improvement (rather than having attended a 1-day course). The team therefore implemented mandatory low-dose high-frequency training in the labour ward, supported by local leaders and the hospital management. This led on to the argument that patient outcome depends on three factors:

  1. Science
  2. Educational Efficiency
  3. Local implementation

Hege also explained that their simulation was carried out using a technically low-fidelity mannequin (see Al May's great tweet) which makes the point that you don't need a SimNewB (or equivalent) for every labour ward.

In terms of "take home messages" for high-income countries, Hege felt that frequent in-situ simulation may be under-utilised.

Day 1 Closing keynote by Mark Gilman (Public Health England): Changing the bigger picture - the real driver to support new behaviours and lifestyles: lessons from addiction

Mark, a criminologist, talked about a smorgasbord of topics surrounding addiction. Unfortunately no amount of text can replace the experience of hearing Mark talk passionately about his work.  He discussed how PHE was managing to keep people with addictions alive, keep them out of prison, control blood-borne viruses and, at times, rehabilitate them. Mark discussed how the "big picture" has a tremendous effect on rehabilitation. If you have no friends, no job and no money then what is the incentive to stay sober or drug-free? He finished by telling us about the "5 ways to wellbeing" which applies to everybody.

Keynote lecture by Justin Moseley (National Air Traffic Services): Towing the Iceberg: Can education and training change the culture of professional practice?

Justin started his lecture with an impressive video showing the air traffic over Europe in a 24-hour period. He then told us about an equally impressive simulated training programme, with a mandatory annual component as well as on an ad-hoc basis for new equipment and procedures.

NATS has a dedicated team of expert investigators of "incidents", of which there are >2000/year in the UK. The team can release an immediate safety notice if necessary, as well interview all involved parties and creates a report (full or abbreviated) for every incident. Reporting incidents at NATS is now natural and commonplace, it used to be "I'm going to file a report on YOU!"

According to Justin, despite being a part of the "aviation" industry, TRM in air traffic control is relatively new but a TRM annual assessment will be a European Aviation Safety Agency requirement in the near future.

In terms of advice for others, Justin recommends sharing incidents, near misses and experience. He also encourages a "Safety II" approach, trying to do less "Don't do that!" and more "Do more of this!" Lastly he talked about how a "Just Culture" (which is not a "No Blame" culture) underpins Safety II and echoes Sidney Dekker by calling for "the line" (which must not be crossed) to be drawn by those who are actively involved in the job.

Day 2 Closing Keynote by Sebastian Yuen: Engaging your community: Being the change you wish to see

Sebastian talked about the rise (or arrival) of the #SocialEra with personalised healthcare and a fall in the power of big business. He talked about the power of communities and connections, and the need to engage with patients and people. He also talked about the effect of behaviour and showed a slide which  referred to a statement from Public Health England. It said:
"Our effectiveness depends on how we behave so we will:

  • consistently spend our time on what we say we care about
  • work together, not undermine each other
  • speak well of each other, in public and in private
  • behave well, especially when things go wrong
  • keep our promises, small and large
  • speak with candour and courage"
Which seems not a bad set of principles for simulation centres and hospitals.

The delta
Other than my lost suitcase there was very little I would change. One area of concern is the SimHeroes concept… With pre-conference heats, then semi-finals and finals it brings perhaps some excitement to the conference. However the notion of rating performance (in particular non-technical skills) makes one wonder about rater training, reliability, validity, etc. In addition, the focus on the performance in the simulation rather than the debrief perhaps emphasises the wrong aspect of simulation-based education. On the plus side, if the concept continues then we will quickly get a glimpse of what the future of gaming/beating the simulator will look like, as teams attempt to win first place.

See you next year

The next ASPiH annual conference is in Brighton, 3rd-5th November 2015. See you there?!