Simulation for Targeted Education, Process Improvement, and Systems Integration (STEPS): A Novel Approach to Health Care Quality Improvement Using In Situ Simulation.

Background: To meet Joint Commission maternal safety standards and facilitate the implementation of acute care obstetrics telemedicine (TeleOB) consultation services throughout one health system, the authors developed a novel in situ simulation framework called STEPS: Simulation for Targeted Education, Process improvement, and Systems integration. STEPS addresses education, process improvement, and systems integration objectives within each simulation scenario, a three-in-one approach to in situ simulation that has not been previously described.

Methods: The STEPS framework was used to design and implement multidisciplinary in situ simulations in six emergency departments and four labor and delivery units in two states. Simulations and debriefs were facilitated by simulation education-trained faculty. Opportunities for improvement (OFIs) were addressed by appropriate leadership teams. Participants provided feedback via a voluntary survey after each simulation session.

Results: A total of 136 OFIs were identified. Many OFIs were observed in more than one simulation session or across multiple sites, but 33 were distinct (9 distinct educational OFIs, 16 distinct process improvement OFIs, and 8 distinct systems integration OFIs). OFIs were assigned to appropriate personnel to design and implement mitigation strategies. Simulation faculty followed up with site leadership about two weeks after each simulation session to provide feedback and review the status of mitigation efforts. Of 162 participants, 91 (56.2%) completed the post-session survey. Of those who responded, 96.7% reported increased confidence in managing similar cases in their own practice. Many also noted improved familiarity with telemedicine resources and workflows.

Conclusion: The STEPS approach is a novel and effective way to simultaneously meet education, process improvement, and systems integration objectives in each simulation scenario and across a large health system.