From volume to value in health care: the work begins. We con-sider some examples of mutational phenomena along with possible adaptive and nonadaptive explanations. Any insight, improvement, and learning from such situations would have a large effect, as it would be applied frequently and by many. Zeigarnik B. Das Behalten erledigter und unerledigter Handlungen. He has actively integrated the safety theories and understanding of human factors in the basic education and especially in the simulation. In practical terms, debriefings in the LFS approach might benefit from: Seeing selected relevant aspects of the scenario recording more than once, as the focus of participants is often on the negative aspects, when they see the video for the first time. Workshops and courses or exercises for interviews often show how difficult it actually is to really listen to another person and to perform appreciative inquiry. Simul Healthc. Lahlou S, Le Bellu S, Boesen-Mariani S. Subjective evidence based ethnography: method and applications. 2015;5(10):e008345. We anticipate some effects will be difficult to capture with traditional study designs, because of the complex situations that the LFS approach addresses. 2017;23(4):404–10. Dieckmann P, Gaba D, Rall M. Deepening the theoretical foundations of patient simulation as social practice. In fact, safety requires an awareness of the complex processes that underlie routine practice, coupled with an ability to recognise problems at an early stage and head them off before they escalate into adverse events. What effect did the time pressure have—on the individuals, on the team, on their treatment of the patient? This difference in size is often explained as an adaptation for predation. Finally, what is routine for one team may not be routine for another: best (and good) practice can be shared. Finally, in the last few years, we have seen a change of focus in the systems approach in safety research [8]. Discussions of good performance should address all the context layers described above: What are the resources and conditions that enhance and enable the team’s ability to adapt? Consciously observing scenarios and collecting material for the debriefing that focus on adaptations and success. A picture of an anesthesia simulation to illustrate the different layers in an installation with examples. Peter is working with simulation since 1999. Kolbe M, Weiss M, Grote G, Knauth A, Dambach M, Spahn DR, et al. Porter ME, Larsson S, Lee TH. Crisis management in anesthesiology. Therefore, some of the suggestions may seem familiar. Reflecting on the mundane can trigger deep insights about control and prevention strategies and the rationale behind practice that often has been learned without deep reflection. 1983;3(1):49–63. We need to stay very good friends right now, because what we’re doing right now is depending completely on each other. All three context layers (embodied competences, social and organizational rules, and material aspects) can be used to systematically investigate and design scenarios that maximize the experience range offered to participants. Such systematic variation could be combined with existing scenario design methods [56,57,58,59,60,61]. The nurse is tall and reaches easily above the headboard of the bed. This is especially likely when the border of the corridor of normal performance is crossed [45]. In a next step, this reflexive discussion could center on ways of applying similar principles in different situations. , Spina JR, et al kneebone RL, hollnagel E. resilient health care: evolution... The ability to fly which are coming under Darwin ’ S theory of evolution to design more scenarios around situations. Of concepts in this way, a stronger feedback loop between training results and design! D. psychological safety and how to use to analyze simulation practice LeBlanc,. 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