The Women's Guild Simulation Center based at Cedars-Sinai Medical Center in Los Angeles is using simulation to deliver more than education. The approach to simulation is crossing many organizational barriers, ensuring its impact is felt across the entire organization.

The 10,000 square-foot simulation center has been built to reflect the actual clinical environment at Cedars-Sinai, benefiting from two fully functional operating rooms, along with ICU, OBGYN, Trauma and NICU/PICU environments. Additionally the center benefits from a fully integrated audio-visual system that supports recording, annotation and video playback.

Recognition of latent errors, enhancing team communication, incorporation of new equipment/technology into workflow and environmental configuration are projects the simulation center is facilitating. An approach to delivering the best possible simulation experience is undertaking a number of key tasks.

• Not suspending reality — Providing an environment that is similar to the real daily work environment
• Bringing the actual team together — Fostering team-based learning.
• Simulation debrief — A process to focus on clinical management, nontechnical skills and actual environment. All to improve to patient safety and workflow.

Providing the latest in clinical care involves ensuring that clinical teams work together. The use of simulation to bring these teams together prior to higher-risk surgeries allows services to detect problems that would only be encountered after an event.

By integrating simulation into the planning process of higher-risk events, we are providing the opportunity for clinicians to highlight concerns together in an environment that will not impact patient care. We are able to mimic real-life disasters and promote a positive team-based response that will lead to more efficient and timely intervention, ultimately saving lives.

Work initially undertaken has shown significant benefits with reduced numbers of adverse events, better outcomes for patients who recover faster and staff who are empowered to communicate and express concerns openly.

The work initially undertaken in the congenital heart program for small babies has now expanded into multiprofessional simulations. These focus on the management of sick patients throughout the entire preoperative treatment phases from the preoperative assessment to the operating room to handoff in the intensive care unit to recovery in the ICU.

The multimodality team training ensures that intersecting teams communicate efficiently and effectively. It also allows improvement in team interactions — for example, the operating room team and the ICU team.

The benefits of staff coming together outside of a real clinical environment — sometimes for the first time — allowing them to simulate and reflect are powerful drivers for change. The building of relationships and dealing with concerns relating the hierarchy and communication not only impact on patient safety but also staff satisfaction.

The benefits of simulation across organizations can be validated on numerous levels:

• education
• organizational development
• patient safety
• finance
• operations

The sometimes-limited use of simulation to deliver training that provides an element of reflection limits its visible benefits to wider groups that can and do benefit. The investment in simulation facilities can bring more benefits than possibly initially realized. The development of such facilities in the planning process benefits from wider involvement of groups within the administration than planning teams may consider.

The approach being taken at Cedars-Sinai Medical Center ensures the benefits of simulation impact positively on the multiprofessional teams in whatever location they are located. Those individuals taking part in the simulation are valued, and the need to communicate is expressed with supportive, encouraging educators and clinicians.