Simulation (Front and) Center
The simulation concept has long been used in many industries; aviation, military, and nuclear power facilities. These have used simulation to recreate complex scenarios that are either physically or financially impossible to otherwise accurately duplicate.
Now that list includes healthcare, as many fields, such as anesthesia and laparoscopic surgery, have started to require simulated training, and as a result, the technology has evolved at an accelerated pace.
An increasing number of medical schools and academic medical centers around the country have joined the simulation trend in recent years, but few have interdisciplinary centers like the UW Health Clinical Simulation Center, located within the University of Wisconsin Clinical Sciences Center.
The 6,500-square-foot center, designed by Flad Architects, brings state-of-the-art simulation techniques to the hospital and university, allowing medical students, faculty and staff to hone their skills in a truly realistic way, 24 hours a day.
“UW Hospital and Clinics is a large academic medical center hospital serving the clinical, research, and teaching needs of the State of Wisconsin,” explains UWHC President and CEO, Donna Katen-Bahensky. “The Clinical Simulation Center allows us to fulfill all of our missions. As an organization, we had identified the need from an educational standpoint and were aware that other hospitals had used simulation to improve clinical quality and to enhance the efficiency of clinical operations. It started as an interest on the part of leadership and became a full-fledged commitment when we recruited our new Chair of Surgery, Dr. Craig Kent— who had the vision and we had the interest. After Dr. Kent’s successful recruitment, we identified the space, the budget, and the administrative and physician leadership to make the strategic interest and vision a reality.”
UW Health leadership—and surely the leadership of manyother facilities and systems that have undertaken simulation programs of late—understood that perhaps more than any part of the organization, asimulation programhad the opportunity to bring performance improvement to clinical, research,and teaching activities in one integrated program and physical facility.
Especially in teaching hospitals like this one, the simulation center is the one safe place where people can learn from mistakes without doing harm to patients, while working together to develop the valuable individual and interdisciplinary team skills that lead to positive outcomes. The Simulation Program may be physically focused on the Simulation Center, but its reach extends to every corner of the facility.
“Through simulation,we can set up scenarios so staff can see how they would handle a potential safety issue or a rapidly declining patient,and how they would communicate and work together in a real situation,” says Katen-Bahensky. “In the case of healthcare, practice does make perfect.”
Location, location, location!
While many simulation centers are located in out-of-the-way areas of facilities, the decision was made at UW Health to place its Simulation Center in a prime location. The simulation experience begins before visitors even enter the Simulation Center proper.
“Because we are an educational facility, we felt it was important to educate the public,” says UW Health Clinical Simulation Program Administrative Director, George R. Keeler, MA, MBA. “The wall that runs just outside of the Simulation Center, therefore, is a timeline of significant events in the history of simulation, from flight simulation to the first human manikin in 1960 right up to the present.”
The Simulation Center is located in the heart of the existing hospital, across the elevator lobby from the cafeteria. “It’s a great location from a few standpoints,” says Flad Architects' Principal, Laura Serebin, AIA, LEED AP. “Many facilities locate their simulation centers offsite, which hinders their utilization. Another benefit is that there are many other immediately adjacent amenities, such as restrooms, conference/meeting spaces, and food service. We didn’t need to provide those within the actual Simulation Center block, which left us with more square footage to work with.”
In addition, a children’s hospital, VA hospital, school of medicine and public health, nursing school, and school of pharmacy are all collocated with the facility, placing the Simulation Center in the heart of a very active area.
The location also helps with the overall feeling of integration and team building, so important to a successful program. “I would sacrifice square footage for location,” says Keeler. “I would trade 12,000 square feet of space off campus for 6,000 square feet where we are now in a heartbeat.”
The UW Health Clinical Simulation Center includes operating and trauma rooms which are similar to those in the hospital; a skills lab, where users can practice procedures such as suturing or laparoscopy; debrief and observation rooms, for video review of procedures; and patient rooms where students can build their patient and interdisciplinary communication skills, working to develop a good “bedside manner,” as well as establishing team roles.
“These are not things they teach you in medical school,” says Keeler, “but these skills are essential for anyone practicing medicine. Prior to building the Simulation Center, there were employees who had worked in the facility for 10 years or more, some of whom had never seen their coworkers without the mask on, so to speak. Through the design process of the Simulation Center, we really started team building and integrating the program, as well. As I tell the clinicians, we create the environment here for them to teach and learn in.”
Technicians and instructors can observe students from adjacent control rooms behind one-way mirrors, and can manipulate the manikins, for example, by raising blood pressure or even sending it into cardiac arrest; some of the models breathe in medical gases and respond to drug treatment.
These manikins allow Simulation Center users to learn through hands-on exercise how to insert catheters and breathing tubes, tie stitches, and just about anything else they might observe in actual practice.
The space flows from the entry and administration spaces to the right side of the racetrack design with debrief/meeting environments, then around to the left side which features a wider corridor—to better replicate those found in hospitals—and clinical settings.
Support and storage spaces are clustered at the backside of the racetrack for easy access and aesthetics, with localized storage areas in each of the rooms for additional convenience. Between the flexible rooms and the varied environments, there is hardly an area of practice that cannot be accommodated.
Planning for maximum flexibility
“We wanted the Simulation Center to be extremely flexible so it could be used for multiple purposes," says Katen-Bahensky. “At first, we could not foresee all the ways our center could be used, but we now know its use is almost limitless.”
With that concept in mind, the design team ensured that the Simulation Center would be as flexible as possible for maximum usefulness and utilization.
“We surveyed key departments and individuals in the facility who were already doing simulation, then looked at the survey results t
o see how we could make best use of the space, considering that some departments were doing similar activities. This allowed us to plan space to serve several different departments by remaining flexible,” says Serebin.
This flexibility also extends to access; as there is a significant learner population using the Simulation Center, the space was designed with a secondary entrance to accommodate secure after-hours access.
This simple design idea has already made a world of difference to users at UW Health.
“Before the center opened I would have to try to find an open patient care room in the hospital—increasingly difficult—and then move all the equipment, set up, and breakdown by myself,” says Director of Simulation for the Department of Pediatrics and the Division of Emergency Medicine, Joshua C. Ross, MD, FAAP. “I was competing for space in patient care areas, and the total time to prepare for simulation training was increased by at least one hour. Now, all I have to do is go to the Simulation Center and everything is all set up, and I can focus on the teaching. Having dedicated debriefing rooms and the opportunity for video review is also a great improvement. The design of the center replicates actual patient care areas, yet, as an educational area, has all the technology and space to teach and debrief.”
From her point of view, Katen-Bahensky sees nothing but positives following the opening of the Simulation Center: “UW Health is on the journey to become much more patient and family-centered. The capabilities of the Simulation Center allow us to practice patient-centered rounding, having difficult discussions with families, and bringing technology into the patient-provider discussions. We are also becoming a Lean organization, and the Simulation Center allows staff to simulate how a room would be set up in a new facility, how to reduce wasted steps before applying these changes to the entire organization, how best to reduce waste, develop new processes and skills with new equipment, and assess the impact of change all in one location without disturbing the ongoing care of patients.”
The impact on the culture within UWHC has been profound, as well. “I have been a practicing clinician, scientist, and educator for more than 15 years,” says Clinical Director Carla Pugh, MD, PhD. “The UW Health Clinical Simulation Program represents the realization of a new way of thinking in healthcare. I am now working side by side with a wide variety of healthcare professionals, scientists, and innovators who believe in the same goal: creating the future we once dreamed of. This is truly a new day.”
Similarly, Pugh advises other organizations who are considering a simulation program to “create a culture, not a center.”
“The decision to develop the UW Health Simulation Center is one of the best we have made in recent years,” Katen-Bahensky concludes. “What we have done here is only the beginning. We cannot even start to imagine the difference that the Simulation Center will make to the future of healthcare in Wisconsin and beyond.”
To view a flipbook of Flad Architects' design for the UW Simulation Center, visit Flad's website under the Design Thinking section of Insights (www.flad.com/insights). For further information, visit www.uwhealth.org.
Completion Date: July 2011
Opening Date: November 2011
Owner: UW Health
Architecture and Interior Design: Flad Architects
Structural Engineering: Flad Structural Engineers
Acoustical, Audiovisual, and Telecommunications Consulting Services: Shen Milsom Wilke
HVAC, Plumbing, Fire Protection, Medical Gases, Electrical: Grumman/Butkus Associates
Simulation Consultant: SimMedical
Construction: Tri-North Builders
Photography: Philip Prowse Photography; John Maniaci/UW Hospital and Clinics
Total Building Area: 6,500 square feet