Abstract
In this methodological intersection article, we describe how we developed a new variation of the established tabletop simulation modality, inspired by institutional ethnography (IE)-informed principles. We aimed to design and conduct pilot implementations of this innovative tabletop simulation modality, which focused uniquely on everyday and everynight work, along with the factors that govern that work. In so doing, we aimed to develop a modality and preliminary findings that researchers and educators can use to simulate healthcare practices across longer episodes of care (i.e., time scales of hours or an entire day) and to detect the ‘latent social threats’ that can emerge during interprofessional clinical care.An interprofessional team designed tabletop simulation scenarios of interprofessional challenges during transfers of care on a labour and delivery (L&D) unit. Within each scenario, participants provided real-time explanations for their work and associated drivers, both independently and as a team. Thus, we combined ‘think-aloud’ and simulation principles to design tabletop simulation scenarios to elicit healthcare professionals’ descriptions of how they collaborate in their work on the L&D unit. We completed a total of five tabletop simulations with eight participants (obstetricians, N = 2; midwives, N = 2; nurses, N = 5).The conversations stimulated by the tabletop simulation scenarios and debriefs allowed us to generate a preliminary understanding of the texts that govern and organize clinicians’ everyday work processes. We generated data about longitudinal, multi-hour work processes in a condensed timeline, with opportunities to pause and probe, and with reduced focus on individual practitioner’s competence.We believe our innovative tabletop simulation approach allowed us to examine clinical work in ways no other simulation permits. Participants described how the scenarios opened a productive dialogue between professional groups and suggested this simulation-based approach might contribute to enhanced interprofessional understanding and cultural change. We suggest that others can adapt our low-resource approach to understand clinicians’ everyday work and to map how this work is governed by documents, like policies, with the end goal of facilitating system change and managing latent social threats.
Highlights
Simulation programs often oscillate between identifying latent safety threats and delivering training that targets individual and team competencies [1,2,3,4]
Our team explored methodologies oriented toward the study of ‘work.’ We present this exploration as an innovation that followed a broader institutional ethnography (IE)-informed study [5]
We posited that the discussion-based format of tabletop simulation would align with our aim to probe professionals about their work, including the perceived organizational, legal, social, and cultural influences. This speculation, paired with previous successes when using tabletop simulations at our hospital [3], led us to design a novel tabletop simulation that aligned with our IE-informed aims. In this methodological intersection article, we describe how we developed a new variation of the established tabletop simulation modality, as a response to our IEinformed study and insights from an interdisciplinary team
Summary
Simulation programs often oscillate between identifying latent safety threats and delivering training that targets individual and team competencies [1,2,3,4]. In shifting between these two core activities, simulation educators and researchers may not consistently consider a key driver of individual and team work: the taken-for-granted everyday and everynight work of healthcare professionals’ and how it is organized by social or structural forces. IE researchers typically aim their inquiry into how work is organized toward texts: the documents that function to connect everyday work with governing forces, such as policies, discourses, pay structures, laws, and/or models of care [8, 9].
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