Proactive Risk Assessment Using Simulation to Optimize the Institute for Healthcare Improvement Framework and Improve Safety

Proactive Risk Assessment Using Simulation to Optimize the Institute for Healthcare Improvement Framework and Improve Safety


Georgina Ottaviano, BSN, RN-BC; Huy Huu Nguyen, BSN, RN, CHSE

Introduction: Proactively analyzing risk by using analytical tools such as the Failure Modes Effects Analysis (FMEA), rather than using retrospective analyses such as Root Cause Analysis and peer review, is becoming more prevalent in health care management. Simulation is proving to be an effective method to proactively probe for failure points and to identify strategies to mitigate risk. Applying the Institute for Healthcare Improvement (IHI) FMEA tool to multidisciplinary simulation scenarios taking place in the actual clinical setting has proven effective in our organization for proactively identifying patient safety risk and developing accountable action plans designed to improve outcomes. This approach has provided guidance in determining where educational efforts and process improvement plans would best be focused.
Methods: Multidisciplinary teams of stakeholders initially met to review objectives, introduce and score the IHI tool, and schedule the simulation(s). The simulation was conducted in-situ using a high-fidelity patient simulator. The stakeholders then met to discuss and rescore the FMEA, and identify action items.
Results: Participants and leaders scored the process as valuable, because it proactively identified potential areas of risk and vulnerability. This method was also effective in prioritizing and focusing education and training based on the FMEA scoring, leading to efficient use of valuable education resources.
Conclusion: Using medical simulation in this manner can be an effective tool for teams to identify and mitigate vulnerabilities proactively. This process can be applied to all areas of a health care organization.


The Kaiser Permanente National CME Program designates this journal-based CME activity for 4 AMA PRA Category 1 Credits. Physicians should claim only the credit commensurate with the extent of their participation in the activity.


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