Based on the team skill level, the program selects the outcomes for the actions that will challenge the team appropriately for the level they are working with.  The higher the level the more critical decisions a team will be faced with.  Each action has the possibility of different outcomes each time, so it is rare to have 2 scenarios alike.  This is done to mimic a real situation, no 2 patients (even twins) will be alike.

Every action that the team makes is documented to create a debriefing which each member of the team as well as the facilitator and educator can review.  If medical errors take place, they are logged to keep track of occurrences.  This program is designed to challenge your team skill level and can be scaled to push a team to improve.  Medical errors are opportunities to reflect and grow from, and therefore we encourage you to challenge yourself in a simulated environment to make these mistakes and learn from them.  Keeping track allows educators to evaluate data to provide targeted improvement such as medication safety or need for more procedural experience among the team.

This data should never be used in a negative way.

When scenarios are completed in the public version, the debriefings are uploaded to the server and are accessible only as a log for the facilitator to view.  They will be able to view the scenario performed, team skill level, date, unit, and how long the scenario took to complete.  They will not be able to view the debriefings once they are submitted.  Each of the participants are only identified by their role.  This will allow the team to still receive a full experience without access to the data.  We encourage you to use this program and show it to your administrators as they would benefit most from this data.  See our privacy policy for more details.

First, organizations will have full access to all debriefings and statistics available to them as soon as they are completed.  Organizations can also track which departments are using Steps Insitu, as well as a breakdown of how many RN’s, MD’s, NP/PA’s, or RRT’s are using the program.  This data can be used as evidence showing continued work towards becoming a high reliability organization.

Educators can view how many scenarios are completed on their unit, as well as what skill level they are completing them at.  Educators can track progress over time by selecting results between set dates and be able to identify key performers who can be promoted to facilitators to help run scenarios within the organization.

Facilitators can view the history of the scenarios that they have facilitated, as well as the scenarios they were participants in, including debriefings associated with scenarios.

Participants can view the debriefings, as well as the team skill level they performed them at, and the objectives selected for each scenario.  They can track their progress and see where they can improve, or where they excel.

Steps Insitu’s values are remarkably close to any high reliability organizations values as they share many common views.  An article written by Gamble (2013) in Becker’s Hospital Review on 5 Traits of High Reliability Organizations explains this well.

1. High reliability organizations are sensitive to operations. Transparency is the key here, the more information that we have, the more we can be aware of how we are doing among our organizations.  Steps Insitu wants to challenge your teams to be better, and to be better we must constantly push our abilities to find where we need to improve.
2. High reliability organizations are reluctant to accept “simple” explanations for problems. Steps Insitu not only provides a solid tool to perform simulation scenarios, but it also provides you with data and metrics that can be used to assess benchmarks, and performance metrics.  The more scenarios that are performed, the more data can be assessed.  Steps Insitu is constantly working to tailor this data in ways that are easy to access and understand.
3. High reliability organizations have a preoccupation with failure. By focusing on the Insitu part of simulation, we can challenge where work processes might break down.  One of our scenarios involving an extremely premature infant who is delivered just outside an emergency room can challenge even the most effective team and can often reveal anything from small inefficiencies to major failures including medical errors.  Our goal is to de-stigmatize failure, and to identify them in a safe environment to build systems to avoid future errors.
4. High reliability organizations defer to expertise. As Steps Insitu grows, so will our scenario library.  We will defer to the best in the simulation world to build scenarios which will challenge teams with realistic experiences with the ability to perform any action to the best of their knowledge.
5. High reliability organizations are resilient. Strong organizations do not give up in the face of adversity, and neither does Steps Insitu.  We build scenarios which will emphasize skill development and provide you with a better evaluation tool to improve transparency among staff.  Steps Insitu can be a valuable part of your action plan for improvement at your organization.

Gamble, M. (2013, April 29). 5 Traits of High Reliability Organizations: How to Hardwire Each in Your Organization. Retrieved from https://www.beckershospitalreview.com/hospital-management-administration/5-traits-of-high-reliability-organizations-how-to-hardwire-each-in-your-organization.html

We use zxcvbn password structure.  This means that since we do not generate passwords automatically for you, using traditional password requirements can actually end up producing less secure passwords because people most often tack on predictable patterns to the end to fulfill the requirements (i.e. there will be a lot of A1! at the end of passwords).  It all boils down to variety.  It is harder for a computer to guess a string of 4 words that have meaning to the user than it is to guess a password with requirements of 8 characters, one number and one symbol.  My developer shared a comic with me by xkcd which made sense.