What makes a Simulated Participant Program Resilient and High Functioning?

Building productive culture is paramount in training simulated participants.

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A healthy culture has been shown to maximize outcomes and productivity while retaining a high performing resilient team. For this reason, significant effort is invested in developing the right culture for your organization. However, defining culture is ineffable for many organizations. If culture is difficult to describe and identify, it is also difficult to assess and/or change. The purpose of this article is to provide a research-based, time-tested model to analyze and improve the culture of your simulated participant (SP) program or, if you are new to SP methodology, develop a positive culture from the inception of the program. 

Though initially written for struggling health care organizations, Westrum’s seminal work, “A typology of organizational cultures,”1 is now integrated across a variety of industrial sectors such as software development, engineering, airlines, military, and lean manufacturing. The broad application of the model speaks to its impact on improving organizational culture. Through significant research, Westrum identified 3 different cultures: Pathologic, Bureaucratic, and Generative. He contends that the best culture, Generative, is when the leadership and team are both focused on accomplishing the mission and all information flow is optimized to accomplish the mission. A natural byproduct of this culture is a healthy, high performing, and resilient teams. 

Generative Culture outlines 6 aspects of informational flow that will inform and define the culture of your SP Program.

  1. Level the playing field

Foundationally, a successful culture for an SP Program is that the entire team recognizes SPs as an integral part of the team. Some programs may need to course-correct prior perceptions or biases of team members before moving forward with the remaining five aspects of a healthy culture listed below. If SPs are not given an equal seat at the table, (virtual or literal) programs will be plagued with poor quality and high turnover. Simon Sineck states, “If you hire people just because they can do a job, they will work for your money. But, if you hire people who believe what you believe [align with your mission], they will work for you with blood, sweat, and tears.” 2

If you are unsure, poll your SPs and ask them. Do they feel as though they are part of the team? Do they know and agree with your mission? Interview your SP Champion to identify if there are unaddressed power dynamics, needed professional development, or process changes that would improve culture and create trust across the program. For new SP programs, this foundational principle may be easier to tackle. However, for long-standing programs with a large SP pool, cultural change is going to take effort. The first step is to uncover the barriers to success. The is good news is research shows those team members who are responsible for day-to-day operations are aware of 100% of the problems and threats to an organization. In comparison, only 4% of an organization’s front-line problems can be identified by its leadership.3

  1. Collaboration

Does your SP program encourage collaboration? Do you have cross-functional teams or committees that include all stakeholders and flatten the inherent power dynamics within an organization? A good example of this is to include senior SPs or SP champions on the team when new simulations are developed, the curriculum is modified, or renovations are being considered. This practice of inclusion encourages shared responsibility for building, deploying, and maintaining excellence in your SP program.

  1. Encourage dissension

On the surface, it seems like dissension would harm the culture. However, if the culture is structured to suppress bad news or mistakes, there is no way to make programmatic improvements or identify quality assurance issues. Westrum would refer to your SPs as “messengers”, an individual who understands the mission and has a unique ability to identify small issues quickly before they become larger. For example, do you ask your SPs, for feedback on the simulations? What are their opinions on execution? Is there enough detail? Are we hitting the mark to make sure all of the facilitators are well developed? Are there any quality issues with the program management or flow of the simulation center? By training your messengers it is safe, even encouraged, to call out the small cracks, you promote psychological safety on your team and hear about small issues that are easy to solve before they become large problems.

  1. Shared responsibility

Do you ask and equip your SPs to share responsibility for quality outcomes? A Generative Culture places the responsibility of quality, reliability, and problem solving on the entire team. One way to improve the quality of your simulation program is to ensure that SPs understand the impact of their role on the team and share responsibility for the delivery of quality simulation education, stretching learners to the edges of their ability (but no farther). In our travels around the country, we quickly identified two large threats to a successful SP program: lack of standardization among SPs, and lack of succinct and impactful feedback that aligns with the simulation objectives. Shared responsibility requires that everyone on the team feels safe to share concerns, understands the mission, and most importantly has the required knowledge, skills, and abilities to contribute to the team. 

  1. Shift your focus

How does your team address lapses in quality or failures? A team’s response to failure significantly shapes the culture of an organization. The classic approach to mistakes in the workplace is to identify the guilty and punish them. The blame game creates a negative culture and motivates individuals to hide or cover up their mistakes. Organizations that can inspire a culture change through root cause analysis, human factors identification, and/or a systems approach, create a safe way to attack the problem rather than the person will motivate performance improvement and lasting organizational change. 

  1. Inspire innovation

I am old enough to remember the proverbial suggestion box to provide a platform for employees to communicate their ideas and suggestions. The problem was, I do not know if any of my ideas were even read by hospital leadership. What I do remember is recognizing a potential confidentiality breach with the way our ED handled patient charts. I discovered a potential solution while moonlighting at another facility and brought the idea to my head nurse. Not only did she agree with my analysis and suggested solution, she empowered me to lead the organizational change. This little project started an innovative fire within that inspires me to push past the status quo and look for better solutions. Avkin was born because I wanted a better solution for high fidelity simulation with SPs and there was nothing on the market. What does your organization do to spur innovation and encourage a spirit of inquiry? By encouraging your front-line team to explore new ideas, you are planting seeds of innovation that can lead to great outcomes or process improvements. Creating a culture of all ideas encouraged, and considered you release your team from getting stuck in habitual pathways and repetitive tasks which will improve retention, encourage collaboration, and inspire shared responsibility that will generate enormous value for your organization.

It is so exciting to see so many simulation programs committed to starting an SP program or expanding their portfolio of SP programs! I look forward to reading all about how different organizations shape a Generative Culture to build a long-lasting, resilient team that provides confidence and competence for our next-gen healthcare providers. Feel free to reach out to us if you are looking for ways to improve the culture of your SP program or you are looking for professional development opportunities for your SPs and faculty. 

Avkin’s SP Certificate program will take care of training SPs for you. Participants who finish the program will be trained with the best practices and be able to enhance learner outcomes. Learn more about the Avkin SP Certificate by clicking here.

1. Westrum, R. (2004). A typology of organisational cultures. BMJ Quality & Safety, 13(suppl 2), ii22-ii27.
2. Sinek, S. (2009). How great leaders inspire action. TED Talk. URL: https://www. ted. com/talks/simon_sinek_how_great_leaders_inspire_action. Accessed, 22, 2019. Minute 7:40-8:00
3. Yoshida, S., (1989) Quality improvement and TQC management at Calsonic in Japan and Overseas, Paper presented at the Second International Quality Symposium, Mexico.


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