If there is one thing that stays the same at SFGH, it is constant change. We change the way we perform our work duties on a monthly if not weekly basis. There is usually a looming imperative driving immediate change that eclipses all other previous practices, working or not. The drive for change far exceeds our institutional agility to respond in a meaningful way.

Patient care occurs via a complex chain-reaction machine that has evolved over time and is highly complex and variable. Its success comes not from its sytematic nature, but by the constant corrections of skilled healthcare workers. Many of the rule-based interventions that have been created as regulation bears down on us add complexity and expense to the requirments of patient care. They are static in nature and often obstructive in dynamic situations. They hindering the capability of humans to play their crucial role in providing quality care.

Simulation can and should be used extensively to test new work environments, processes and policies before patients are subjected to them. Simulation is used successfully and integrally in many other high hazard industries. We use it primarily for education at SFGH, often to rehearse for rare events. I propose that we use simulation to refine everyday practice, much of which we could be doing better, but don't have an effective way to engage multiple disciplines around a common goal. Simulation engages the people who know what they actually have to do to take care of patients and can create a more functional link between administration and front line workers.