In North America, approximately 1340 healthcare medical construction projects are currently in progress . A 2016 Hospital Construction Survey identified $97 billion was being invested into new hospitals, expansions, off-campus clinic, and medical offices . Along with aging infrastructure, many more hospital units are being redesigned and restructured to accommodate increased patient loads, innovative technologies, and new ways of caring for patients in healthcare [2, 3].
During the planning and construction phase of any new healthcare facility, there must be an integration of the perspectives of the architects, engineers, project management teams, and quality team members along with the operational requirements from leadership and the clinical requirements from clinicians who are at the front line of patient care . Relevant theoretical underpinning of research from human factors applied to healthcare, such as the Systems Engineering Initiative for Patient Safety (SEIPS) model, has provided a framework for recognizing core principles in system design . Further expansion of the SEIPS 2.0 model focuses on the work system, consisting of the organization, internal/external environment, tasks, tools, technology and person(s), the processes, and outcomes [5, 6]. These factors are ultimately critical in the construction or redesign of any new healthcare building.
Simulation-based education has historically focused on individual training for healthcare learners and team training for practicing professionals [7,8,9]. Process-orientated simulation is an emerging field in healthcare which uses simulation to examine the process of care, rather than the outcome of care . While process-oriented simulations can include system integration simulation, process simulations focus on gaining and providing information collected from simulation sessions for individual leadership to act upon when safety issues are identified. The concept of system integration is a much broader engineering term which relates to bringing together the component of subsystems into one system that functions together. Moreover, in healthcare, system integration is the ability to improve the quality of care and patient outcomes through re-engineering of care delivery processes .
For example, using simulation to re-create an emergency-based patient encounter within their intrinsic environment could reveal latent safety threats such as poor availability of patient equipment, inadequate emergency call buttons, or unsafe obstacles [11,12,13,14]. Latent safety threats are defined as unintentional harm that could affect actual patients once the facility opens, such as missing equipment, inefficient setup, or insufficient space for procedures. These process-orientated simulations which take place in an actual patient care setting and environments prior to occupancy can be used as a method for ensuring that the spaces created match the needs of the staff and administration while proactively identifying latent safety threats prior to first patient care [14, 15]. By only theorizing about the care delivery process, unintentional harm could affect actual patients once the facility opens. The application of simulation training within the actual patient care environment, referred to as in situ sessions, has become an exciting option, achieving the highest level of realism [15,16,17,18,19,20,21,22].
In the last decade, there has been emerging literature that looks at the use of process-oriented simulation training for the opening of new and renovated units, construction, and opening of new hospitals. Most examples have focused on openings of specific units within existing spaces and some within new satellites/wings in the hospital. Examples described in the literature include established teams and transference of established policies, protocols, and equipment to the new space from the legacy site [23,24,25,26,27,28,29,30,31,32,33,34,35,36,37].
In other regulated industries such as the construction industry, building commissioning is part of the quality assurance process provided for Facilities Maintenance and Engineering (FM&E) staff during and following construction. The process assures non-clinical FM&E staff and leadership that all systems and components of a building or industrial plant are designed, installed, tested, operated, and maintained according to the operational requirements of the owner or final client .
Unfortunately, in comparison with healthcare, such requirements are non-existent for handing over of new infrastructure for clinical staff who will be providing care to patients in these new areas, often leaving training and new systems/processes untested until the first patient arrives, which is a potential risk for patient safety.
Simulation for commissioning new environments, through the development of process-orientated simulations, is an innovative approach to test these processes and new systems to ensure safe facilities, safe patient care, and recognition of latent safety threats that may prevent delays in opening and decrease costs in reconstruction . In turn, these simulations could also be expanded for use as a part of the new site’s orientation and training plan. The following paper will explore a case study describing the use of process-orientated simulations to test the opening of a new 300-bed healthcare facility.