Table 3 General tips for the interaction with your organisation

Offer your simulation services to workplace leadership teams to help them meet the (impending) crisis.

• If your team is not recruited or charged to assist the organisation, offer the organisation your services to help prepare staff and the organisation for the crisis.

• Keep in mind the urgency of the situation and how this affects staff, processes, decision-making, and priorities.

• Understand the value your service can provide, the limits, and how to proceed.

• If accepted, establish a clear mandate to operate including scope of activities, possibilities, limits, degree of self-determination, leadership, and reporting lines (two-way). Establish mutual agreement on how to proceed.

 o Once active, your team will be approached for help: anticipate which requests you can handle yourself and where you draw on the help of others.

 o Ensure other support functions (such as infectious disease, health and safety, quality, and others listed below) receive information on the simulation/education team’s function with intent to collaborate.

• Establish an over-arching coordination lead; find mutually agreeable communication between teams to avoid straining personnel/equipment; determine time-slots for training and how to share those (i.e. intranet calendar, internal social media groups, whatever works best).

• Synchronous communication via telephone and face-to-face meetings (respecting necessary pandemic transmission guidelines and keeping social distance) [35] can increase the speed in which agreements are made and misunderstandings are clarified.

• Keep registers of participants, ideally in appropriate existing hospital databases.

• Help individual departments to build their own competence and take over responsibility for their training.

• Find existing teaching material within and outside your organisation. Your organisation or other organisations have probably created material that can be useful for you. Coordinate the search to avoid wasting colleagues’ time looking for the same material. Scale other peoples’ resources to fit your needs rather than designing new systems. Also, the resources provided in this article might be helpful in this regard.

• Adjust your approach to the concrete problems and resources at hand. Use different tools, think outside of the box, but keep the problems at hand in mind.

• Use existing plans and protocols relevant for the situation (e.g. pandemic plans). Try them in simulation to help identify important aspects to consider, such as bottlenecks, inconsistencies, and dependencies. Inform relevant others in and beyond your organisation about your findings.

Perform a pragmatic (training) needs analysis

• Focus on the organisation’s current (and rapidly updating) overarching crisis plans, pathways, and protocols to find training needs and situations [36, 37]. Establish ways to be notified about these updates and feedback loops that you can use to report insights from putting updates into practice.

• Differentiate situations where training is required from situations which might require other approaches (e.g. equipment or resource needs, work organisation)

• The greater the clinical pressures and urgency, the more important it is to analyse situations swiftly but adequately. A lot of time can be lost when working correctly but in the wrong direction.

• Follow agreed reporting lines for prioritising, reporting, and feeding back findings:

 o Identify stakeholders and feedback pathways to them with observations and suggestions for rapid improvement based on in situ simulation [38].

 o Who needs to be involved, to approve, to be informed?

 o Also, consider “feedback of negative decisions”: why should an initiative not be implemented?

Maintain and rapidly build alliances across the organisation

• Clinical leads:

 o They are the gatekeepers and must manage the rapidly developing crisis and all it entails. Be aware of their workload.

 o Identify and communicate how simulation sessions can help them meet their needs with the crisis.

 o Be an active collaborator. Bring your system-oriented/human-factors/education perspectives, and help to constructively address the challenges. Together establish the potential effect simulation should have and the best way to get there.

 o Focus on needs of the unit/pathway where simulation will occur.

• Other support initiatives and departments:

 o Infectious disease teams: They are in high demand, and everyone wants their input simultaneously. Be considerate and rapidly find a way to collaborate professionally: maintain/establish good relations, expectations, and find a way to work together to support staff, bringing together the best knowledge and education methods to provide efficient education.

 o Other profession-based education staff: How they can help in the different approaches? Consider, for example, educators from midwifery, nursing, ambulance services, educators.

 o Health and safety: They are important as support and resources for staff well-being and the mental and physical health of staff. These aspects will be stressed in a crisis; it is useful to remind participants of this in debriefs.

 o Quality improvement: Collaborate with quality improvement experts for their methods that complement repeated in situ team training for continuous improvement, for example, protocol adjustments (i.e. stroke team simulations become “patient with stroke and COVID-19”). Probe the system [5], and in collaboration with clinical senior decision makers, revise the protocol for infectious disease situations.

 o Administrative staff: get help in booking (educational) rooms; assist in maintaining log of attendance; registration of education/preparation activities in staff competency plans; coordination of multiple simulation activities to avoid over-load on certain departments and double-booking of simulation. Create accessible e-calendar for overview and procedures to keep them updated.

 o Logistical staff: procuring adequate storage for in situ equipment, organising the laundry of simulation clothing.

 o Media and communications department: help to promote or advertise simulation activity, both for staff and the public: “We train for your safety.”