Continuous Improvement Cycle Research Articles

Reliability, availability and maintainability analysis of a bag production industry based on the six sigma DMAIC approach

PurposeThe purpose of this paper is to implement the six sigma (SS) strategy in a bag sector under actual operating circumstances based on defining-measure-analyze-improve and control (DMAIC). During the project, several statistical tools and methods have been used efficiently to create inferences. Thus, to measure and enhance system efficiency, the author calculate reliability, availability and maintainability (RAM) indices. Based on this research, the author show how the SS method and RAM analysis are very helpful in determining maintenance intervals, as well as in planning and organizing the appropriate maintenance strategy.Design/methodology/approachThis study introduces the step-by-step application of the DMAIC methodology for the identification and reduction of bag production line downtime and examines the present operations management. Thus, statistical techniques are used to analyze the failure and repair database. Pareto analysis, histograms and descriptive statistics at the machine and line-level of the historical data were conducted. Trend and serial correlation testing validated the hypothesis of independence and identical distribution of database was performed. In addition, with their best fit allocation, the RAM of both the bag production line and its machines was estimated at separate mission times.FindingsThe main goals of the applied method are to understand the nature of the downtime patterns and to accurately and quantitatively estimate the RAM characteristics of the bag production system. The assessment defines the production line's critical points, requiring further enhancement through an efficient maintenance approach. Therefore, by improving plant efficiency and safety, the author can decrease unplanned downtime and equipment failures.Originality/valueThis research is expected to serve as an attempt to conduct SS DMAIC methodology through RAM assessment and its impact on system efficiency under actual circumstances. The benefit of the methodology is that the manufacturing process is continuously monitored by suitable indicators, the use of which leads to a continuous improvement cycle.

Workplace violence against nurses in health care and the role of human resource management: A systematic review of the literature.

To provide insights into how workplace violence has an impact on nurses and to inform human resource management about developing comprehensive strategies to manage and mitigate violence. A systematic review of the literature to appraise contemporary studies, source data and synthesize findings for human resource management to implement practices to mitigate violence against nurses in the healthcare sector. Searches were conducted using ProQuest, Business Source Complete (EBSCO), Emerald Insight, PsycINFO (ProQuest), ScienceDirect, and Google Scholar. Our search was delimited to refereed journal articles and government reports over the last 15years from 2004-2019 and included a total of 71 articles. The research team systematically reviewed each article and relative reports, eliminating any not considered relevant to nurses. This systematic review is associated with and reflects contemporary issues around nurses, violence, and human resource management practice. In the studies we found high incidents of violence against nurses in the workplace. However, human resource management fundamentally services as an administrator, managing compliance and does not do enough to methodically mitigate and manage acts of violence in the workplace and its effects on nurses' mental health. This systematic review contributes to the literature on violence in health care and proposes that human resource management must explore and implement practices towards mitigating violence against nurses. This systematic review will influence how human resource management currently manages violence against nurses and the increasing number of persons requiring health care due to the ageing population and decline in the number of nurses. It will also have an impact on action research to engage in a cycle of continuous improvement that supports eliminating violence against nurses (and all others) in the healthcare sector.

Evaluation of medication errors in electronic medical prescriptions and proposal for correction

Worldwide, the annual cost associated with medication errors is estimated at US$ 42 billion or almost 1% of the total global health expenditure. In Brazil, analysis and measures to minimize these errors has not been well studied. Thus, the present study identified the errors in electronic medical prescriptions and proposed strategies to minimize such errors. A total of 1980 medical prescriptions were analyzed in a hospital, with 196 beds and 11 sectors located in Votuporanga, SP, Brazil. The errors were listed: Via, Frequency, Time, Duplication, Absence, Diluents, Dose, Medication, and Infusion. The statistical analysis was applied, with a significance level at 5%. The 2621 found errors correspond to 49.49% of the prescriptions analyzed; 23.68% contained only one prescription error, 11.06% had two errors, and 14.75% included three or more errors. After the evaluation stage, some errors were corrected, and some improvements were suggested. The correction of dose error decrease of 68% and 30% occurred in the consumption of two drugs. For the correction of diluents and time errors, an assertiveness was generated in all the prescriptions analyzed. A cycle of continuous improvement is proposed for the indicators of medical prescription errors based on four main principles of planning, performing, analyzing, and correcting. The starting point for this process should always be the diagnosis of the main prescription errors. This cycle should be applied annually to reduce prescription errors, thus, offering better treatment to patients and optimizing hospital resources.

Transforming Education Through Instructional Coaching in the Mayan Highlands of Guatemala

Significant efforts have been made to improve the educational system in the Western Highlands of Guatemala to foster economic growth and social development in the country. However, given the country’s linguistic and cultural diversity, challenges in terms of coverage and quality of education persist. Inadequate teacher preparation training, and the absence of an induction and pedagogical coaching system for new teachers are some of the impeding factors. The U.S. Agency for International Development (USAID) has executed targeted educational projects to support the National Ministry of Education in strengthening the human capital in education. A transformative pedagogical leadership and coaching model was developed that focuses efforts from an oversight system to a mentoring system that strengthens leadership and the capacities of teachers in the application of innovative methodologies that contribute to educational improvement. This model allows for a continuous cycle of improvement to teaching by providing new teachers with feedback on teaching practices in the classroom and opportunities for teachers to self-reflect and be empowered in their own learning process and professional growth. This approach has shown positive effects with respect to teaching practices at the school-level; however, additional measures are required to gain the support of stakeholders to expand its implementation to bilingual and multicultural contexts to maximize the country’s potential to improve the quality of education.

Proposição de um modelo para aprimoramento do sistema de gestão da qualidade

A pesquisa propõe uma sistemática de aprimoramento de um Sistema de Gestão da Qualidade (SGQ) em pequenas e médias indústrias através da aplicação das metodologias Seis Sigma (SS) e Lean Six Sigma (LSS). Como objetivo principal da pesquisa, tem-se o desenvolvimento de um modelo de referência inédito que visa a redução da variabilidade dos recursos restritivos, diminuição de perdas, ineficiências e desperdícios, otimização do trade-off custo-qualidade dos produtos e processos, além da consolidação do conceito de Indústria 4.0. Os componentes metodológicos contemplam a pesquisa bibliográfica, descritiva, tecnológica e qualitativa. O modelo proposto, na sinergia entre Produção Enxuta e Seis Sigma, robustece e prolonga a longevidade de um sistema da qualidade industrial já existente através de ciclos de aprimoramento contínuo (kaizen) realizados com base em três grandes conjuntos de atividades orientativas e sequenciais, de modo a estabelecer a lean quality como apoio estratégico por toda a rede de operações.

A hybrid software processes management support model

Abstract The growing trend in agile approach to software development today shows a tendency towards combining practices from different approaches and methodologies. This trend can be explained by the difficulties in managing agile processes. A potential solution to these challenges could be a multi-agent model of software development process of supporting management in the cycle of continuous product quality improvement. The AGent-Object MOdel (AGOMO) was constructed to investigate this idea and an experiment was carried out in which a typical medium-sized project developed using hybrid methodology was reproduced. This article describes the first phase of research, in which replicative adequacy of this model was demonstrated, thus opening avenues for further research related to project management support.

Syphilis testing performance in Aboriginal primary health care: exploring impact of continuous quality improvement over time.

Data from 110 primary healthcare clinics participating in two or more continuous quality improvement (CQI) cycles in preventive care, which included syphilis testing performance (STP) for Aboriginal and Torres Strait Islander people aged between 15 and 54 years, were used to examine whether the number of audit cycles including syphilis testing was associated over time with STP improvement at clinic level in this specific measure of public health importance. The number of cycles per clinic ranged from two to nine (mode 3). As shown by medical record audit at entry to CQI, only 42 (38%) clinics had tested or approached 50% or more of their eligible clients for syphilis in the prior 24 months. Using mixed effects logistic regression, it was found that the odds of a clinic's STP relative to its first cycle increased only modestly. Counterintuitively, clinics undertaking the most preventive health CQI cycles tended to have the lowest STP throughout. Participation in a general preventive care CQI tool was insufficient to achieve and sustain high rates of STP for Aboriginal and Torres Strait Islander people required for public health benefit. Improving STP requires dedicated effort and greater understanding of barriers to effective CQI within and beyond clinic control.

Toward a Person-Centred Learning Health System: Understanding Value from the Perspectives of Patients and Caregivers.

What matters most to people who use healthcare? What matters to their caregivers? How do we use this information to support ongoing quality improvement in the healthcare system? In this paper, we explore three concepts from the current healthcare discourse, intended to drive health system improvements: person-centred care, value-based healthcare and learning health systems. We propose that key tenets from each of these concepts should be combined to create a person-centred learning health system (PC-LHS). We highlight two key points: First, in achieving a PC-LHS, the experiences, priorities and values of patients and their caregivers should be continually collected and fed into data systems to monitor ongoing quality improvement and performance benchmarking. Second, the information collected in determining value must include important contextual factors - including the social determinants of health - as patient health and well-being outcomes will ultimately be shaped by these factors, in addition to health system and disease factors. In summary, improving value for patients and caregivers, by capturing the things that matter most to them, within their life contexts, needs to be part of the continuous quality improvement cycle that lies at the heart of a learning health system.

Implementing learning health systems in the UK NHS: Policy actions to improve collaboration and transparency and support innovation and better use of analytics.

Learning health systems (LHS) use digital health and care data to improve care, shorten the timeframe of improvement projects, and ensure these are based on real‐world data. In the United Kingdom, policymakers are depending on digital innovation, driven by better use of data about current health service performance, to enable service transformation and a more sustainable health system.This paper examines what would be needed to develop LHS in the United Kingdom, considering national policy implications and actions, which local organisations and health systems could take.The paper draws on a seminar attended by academics, policymakers, and practitioners, a brief literature review, and feedback from policy experts and National Health Service (NHS) stakeholders.Although there are examples of some aspects of LHS in the UK NHS, it is hard to find examples where there is a continuous cycle of improvement driven by information and where analysis of data and implementing improvements is part of usual ways of working.The seminar and literature identified a number of barriers. Incentives and capacity to develop LHS are limited, and requires a shift in analytic capacity from regulation and performance, to quality improvement and transformation. The balance in priority given to research compared with implementation also needs to change.Policy initiatives are underway which address some barriers, including building analytical capacity, developing infrastructure, and data standards. The NHS and research partners are investing in infrastructure which could support LHS, although clinical buy in is needed to bring about improvement or address operational challenges.We identify a number of opportunities for local NHS organisations and systems to make better use of health data, and for ways that national policy could promote the collaboration and greater use of analytics which underpin the LHS concept.

Sistema de información de apoyo a la medición de indicadores de trayectoria escolar en educación superior

The quality of higher education programs is determined by being evaluated by an accrediting body, which establishes that different indicators must be met. However, in some institutions, processes are not systematically executed for the evaluation of these indicators, or the measurements are not carried out, having to request reports from administrative instances, which are delivered in a format that is sometimes unclear. Not understandable. This is the case of the university under study, for which it was proposed to design a support system for the measurement of indicators related to the school trajectory. To carry out the development, the Methodology for System Design (MEDS) was used, obtaining the description of the reality of the process, through the black-box model, the root definition and its conceptual model of the ideal process, as well as a control panel of indicators, which was prepared following the proposal of Kaplan and Norton. Finally, a Decision Support system (DSS) was designed based on the academy report that was already used in the Institution, whose application was systematized using a form on google, and creating a dashboard where the data is displayed transformed into useful information for decision making, since they can be visualized in a clear and understandable way. The indicators measured were classified into four categories: academic performance, defection attrition, and lag. To conclude, the importance of implementing the proposed information system is mentioned, to know the direction in which these indicators are taking and to make improvements in the future so that the institution enters a virtuous cycle of continuous improvement.

Mergers of primary care organizations: a systematic review of the literature

Abstract Background Mergers as large-scale collaborations in primary care organizations have become a commonplace in developed countries to offer economies of scale and more efficient delivery of care to population. The aim of this systematic review is to summarize the scientific evidence on the relationship between the increase in the size of organizations providing primary care services and their performance. Methods The PICO model was adopted and three electronic databases (Medline, Scopus, ISI Web of Knowledge) were searched using appropriate keywords. Screening by title and abstract and data extraction were performed by two independent investigators. Articles, written in English, evaluating the performance after increasing the size of an organization were included. Selected articles were assessed for quality and risk of bias using the National Institutes of Health Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. Process and outcome quality indicators were used for evaluation. Results From a total of 1337, 12 studies met the inclusion criteria and 103 indicators were identified: 59.2% did not show any variation, 33.9% improved significantly after the merger, 6.9% worsened after the merger. In particular, diabetes care did not show any statistically significant variation in 40.0 % of the indicators, while 10.0 % showed an improvement and 10.0% a worsening in clinical outcomes. A significant negative association was found between practice list size and reported non-urgent or urgent doctors’ availability (P < 0.05, both). The process of merging also created perceptions of takeover and had a negative effect on staff. Conclusions The effects of mergers are conflicting and there is little evidence that the performance is associated with the size of the structures involved. Assessment on the impact of primary care mergers should to be related to the population needs and the context where these processes are carried out. Key messages Merging processes may lead to contrasting results. To assess periodically and systematically the impact of mergers in a continuous quality improvement cycle.

Sharing, Adaptation and Organization of Open Educational Resources: Exploring the Teachers’ Attitude of Sukhothai Thamathirat Open University, Thailand

The Open Educational Resource(OER) is based on culture of sharing and learning, encouraging the teachers to adopt existing OER, adapt and share with others to keep up the cycle of collaboration and continuous improvement. Understanding teachers’ attitude towards the use of OER and comparing data across institutions may help to recognize the issues that impact OER take-up. The major objectives of the paper is to study the teacher’s attitude towards OER at Sukhothai Thamathirat Open University(STOU), Thailand. The teachers’ attitude towards OER scale with a five-point scale from strongly disagree to strongly agree was used in this study. Based on the scale, adaptation & use of OER and sharing of OER can be identified. The questionnaire was distributed to the faculty of STOU. There were 32 respondents of STOU considered for analysis. Data captured through online form.The data have been analyzed quantitatively by implying statistical measures. The frequency measures were used to present the demographic as well as other data along with chi-square test. The analysis was done in SPSS. Teachers of Thailand are encouraged to share OER for their professional enhancement and personal satisfaction. It is interesting to find that majority of them are motivated to share and contribute to OER for dissemination of ideas in a knowledge society.

Military Surgical Team Communication: Implications for Safety.

Medical error is the third leading cause of death in the United States, contributing to suboptimal care, serious patient injury, and mortality among beneficiaries in the Military Health System. Recent media reports have scrutinized the safety and quality of military healthcare, including surgical complications, infection rates, clinician competence, and a reluctance of leaders to investigate operational processes. Military leaders have aggressively committed to a continuous cycle of process improvement and a culture of safety with the goal to transform the Military Health System into a high-reliability organization. The cornerstone of patient safety is effective clinician communication. Military surgical teams are particularly susceptible to communication error because of potential barriers created by military rank, clinical specialty, and military culture. With an operations tempo requiring the military to continually deploy small, agile surgical teams, effective interpersonal communication among these team members is vital to providing life-saving care on the battlefield. The purpose of our exploratory, prospective, cross-sectional study was to examine the association between social distance and interpersonal communication in a military surgical setting. Using social network analysis to map the relationships and structure of interpersonal relations, we developed six networks (interaction frequency, close working relationship, socialization, advice-seeking, advice-giving, and speaking-up/voice) and two models that represented communication effectiveness ratings for each participant. We used the geodesic or network distance as a predictor of team member network position and assessed the relationship of distance to pairwise communication effectiveness with permutation-based quadratic assignment procedures. We hypothesized that the shorter the network geodesic distance between two individuals, the smaller the difference between their communication effectiveness. We administered a network survey to 50 surgical teams comprised of 45 multidisciplinary clinicians with 522 dyadic relationships. There were significant and positive correlations between differences in communication effectiveness and geodesic distances across all five networks for both general (r=0.819-0.894, P<0.001 for all correlations) and task-specific (r=0.729-0.834, P<0.001 for all correlations) communication. This suggests that a closer network ties between individuals is associated with smaller differences in communication effectiveness. In the quadratic assignment procedures regression model, geodesic distance predicted task-specific communication (β=0.056-0.163, P<0.001 for all networks). Interaction frequency, socialization, and advice-giving had the largest effect on task-specific communication difference. We did not uncover authority gradients that affect speaking-up patterns among surgical clinicians. The findings have important implications for safety and quality. Stronger connections in the interaction frequency, close working relationship, socialization, and advice networks were associated with smaller differences in communication effectiveness. The ability of team members to communicate clinical information effectively is essential to building a culture of safety and is vital to progress towards high-reliability. The military faces distinct communication challenges because of policies to rotate personnel, the presence of a clear rank structure, and antifraternization regulations. Despite these challenges, overall communication effectiveness in military teams will likely improve by maintaining team consistency, fostering team cohesion, and allowing for frequent interaction both inside and outside of the work environment.

Gregory A. Adams, MHA

Gregory A. Adams is executive vice president and group president for Kaiser Permanente, reporting to the chairman and CEO. He has direct responsibility for all 8 Kaiser Permanente Regions, serving more than 12.3 million members and operating 39 hospitals and 701 medical office facilities. In addition to his group president responsibilities, he serves on the organization's national executive team and executive committee. Adams started his career with Kaiser Permanente in 1999 and has held a number of executive leadership positions within the organization, including president of the Northern California Region. Prior to joining Kaiser Permanente, Adams held several executive roles in the health care industry, providing strategic and operational leadership for hospitals, health systems, and medical groups throughout the country.

Partnership through co-creation: Lessons learnt at the University of Adelaide

This paper describes three exemplars of practice inspired by emerging evidence that student-staff partnerships have the potential to significantly enhance many areas of higher education. Students and academics at the University of Adelaide have successfully implemented this collaborative approach across a range of learning and teaching contexts. The Design Thinking Framework, developed by the Hasso Plattner Institute of Design at Stanford University, was utilised at a faculty, program, and course level to frame each of the exemplars, due to its implicit approach to creativity, collaborative development, and achievement of solutions. The iterative nature of the framework facilitated a review cycle for continuous improvement in each Students-as-Partners’ initiative. Analysing the outcomes of each exemplar has identified common hallmarks of successful partnership, and these indicators have the potential to contribute to the growing body of evidence that defines best practice in this pedagogy

Twelve tips for assessing medical knowledge with open-ended questions: Designing constructed response examinations in medical education

Medical knowledge examinations employing open-ended (constructed response) items can be useful to assess medical students’ factual and conceptual understanding. Modern day curricula that emphasize active learning in small groups and other interactive formats lend themselves to an assessment format that prompts students to share conceptual understanding, explain, and elaborate. The open-ended question examination format can provide faculty with insights into learners’ abilities to apply information to clinical or scientific problems, and reveal learners’ misunderstandings about essential content. To implement formative or summative assessments with open-ended questions in a rigorous manner, educators must design systems for exam creation and scoring. This includes systems for constructing exam blueprints, items and scoring rubrics, and procedures for scoring and standard setting. Information gained through review of students’ responses can guide future educational sessions and curricular changes in a cycle of continuous improvement.

Scaling Up Safer Birth Bundle Through Quality Improvement in Nepal (SUSTAIN)\u2014a stepped wedge cluster randomized controlled trial in public hospitals

BackgroundEach year, 2.2 million intrapartum-related deaths (intrapartum stillbirths and first day neonatal deaths) occur worldwide with 99% of them taking place in low- and middle-income countries. Despite the accelerated increase in the proportion of deliveries taking place in health facilities in these settings, the stillborn and neonatal mortality rates have not reduced proportionately. Poor quality of care in health facilities is attributed to two-thirds of these deaths. Improving quality of care during the intrapartum period needs investments in evidence-based interventions. We aim to evaluate the quality improvement package—Scaling Up Safer Bundle Through Quality Improvement in Nepal (SUSTAIN)—on intrapartum care and intrapartum-related mortality in public hospitals of Nepal.MethodsWe will conduct a stepped wedge cluster randomized controlled trial in eight public hospitals with each having least 3000 deliveries a year. Each hospital will represent a cluster with an intervention transition period of 2 months in each. With a level of significance of 95%, the statistical power of 90% and an intra-cluster correlation of 0.00015, a study period of 19 months should detect at least a 15% change in intrapartum-related mortality. Quality improvement training, mentoring, systematic feedback, and a continuous improvement cycle will be instituted based on bottleneck analyses in each hospital. All concerned health workers will be trained on standard basic neonatal resuscitation and essential newborn care. Portable fetal heart monitors (Moyo®) and neonatal heart rate monitors (Neobeat®) will be introduced in the hospitals to identify fetal distress during labor and to improve neonatal resuscitation. Independent research teams will collect data in each hospital on intervention inputs, processes, and outcomes by reviewing records and carrying out observations and interviews. The dose-response effect will be evaluated through process evaluations.DiscussionWith the global momentum to improve quality of intrapartum care, better understanding of QI package within a health facility context is important. The proposed package is based on experiences from a similar previous scale-up trial carried out in Nepal. The proposed evaluation will provide evidence on QI package and technology for implementation and scale up in similar settings.Trial registration numberISRCTN16741720. Registered on 2 March 2019.

Using quality improvement tools in the investigation of prolonged turn around time and improving the efficiency in the core laboratory

We developed an evidence-based continuous quality improvement (CQI) cycle for laboratory safety as a method of utilizing survey data to improve safety in a public health laboratory setting.•Expert Opinion: The CQI cycle begins with the solicitation of laboratory staff input via an annual survey addressing potential chemical, physical and radiological hazards associated with multiple laboratory activities. The survey collects frequency, severity and exposure data related to these activities in the context of the most pathogenic organisms handled at least weekly.•Gap Analysis: Step 2 of the CQI cycle used survey data to identify areas needing improvement. Typically, the traditional two-dimensional risk assessment matrix is used to prioritize mitigations. However, we added an additional dimension – frequency of exposure – to create three-dimensional risk maps to better inform and communicate risk priorities.•Mitigation Measures: Step 3 of the CQI cycle was to use these results to develop mitigations. This included evaluating the identified risks to determine what risk control measures (elimination, substitution, engineering, administrative or PPE) were needed. In the 2016 iteration of the CQI cycle described here, all mitigations were based on administrative controls.•Evaluation and Feedback: The last step of the CQI cycle was to evaluate the inferred effects of interventions through subsequent surveys, allowing for qualitative assessment of intervention effectiveness while simultaneously restarting the cycle by identifying new hazards.Here we describe the tools used to drive this CQI cycle, including the survey tool, risk analysis method, design of interventions and inference of mitigation effectiveness.

Kajian dan Rumusan Projek Infrastruktur Jaringan pada Industri Hospitality

The Hospitality industry is increasingly improving its services to be able to grow as a tourism sector grows. The indication of the growth of the industry can be seen from the rise of international chains that enter or participate in developing their business in Indonesia. In principle, the Chain Hotel is a group of Hotels that is a hotel chain with services that are equal after star hotel equivalence. For that hotel owners who will join a chain of hotels that have been formulated by the chain hotels and usually refer to standards that apply globally / globally. The terms of information technology, chain hotels have implemented standards that follow World standards. This is a technology that is leading to the information system. This is a concern of every hospital industry player to implement. Thus this research is expected to provide infrastructure standards for hotels, especially according to the appropriate ANSI / TIA / EIA standards. The Research Methodology used a continuous development improvement cycle where the cycle is formed into 4 stages, namely Research Formulation and Requirements Analysis, Problem Design and Solutions, Analysis and Discussion of Formulation of Solutions and Suggestions in Framework of Continuous Improvement. The results of this study formulate a template and the contents of a network infrastructure project document in the form of a structured caling system (SCS) and ANSITIA /EIA

Goals, Recommendations, and the How-To Strategies for Developing and Facilitating Patient Safety and System Integration Simulations.

The aim of this article is to outline overall goals, recommendations, and provide practical How-To strategies for developing and facilitating patient safety and system integration (PSSI) simulations for healthcare team members and organizations. Simulation is increasingly being used as a quality improvement tool to better understand the tasks, environments, and processes that support the delivery of healthcare services. These PSSI simulations paired with system-focused debriefing can occur prior to implementing a new process or workflow to proactively identify system issues. They occur as part of a continuous cycle of quality improvement and have unique considerations for planning, implementation, and delivery of healthcare. The Delphi technique was used to develop the recommendations and How-To strategies to guide those interested in conducting a PSSI simulations. The Delphi technique is a structured communication technique and systematic process of gathering information from a group of identified experts through a series of questionnaires to gain consensus regarding judgments on complex processes, where precise information is not available in the literature. The Delphi technique permitted an iterative and multistaged approach to transform expert opinions into group consensus. The goals, recommendations, and How-To strategies include a focus on project management, stakeholder engagement, sponsorship, scenario design, prebriefing and debriefing, and evaluation metrics. The intent is to proactively identify system issues and disseminate actionable findings. This article highlights salient features to consider when using simulation as a strategy and tool for patient safety and quality improvement.