Table 2 The online elective on safety culture
From: Providing an interactive undergraduate elective on safety culture online – concept and evaluation
Module / Content | Method | Video conference feature/Multimedia usage | Length [min] |
|---|---|---|---|
Day 1 | |||
Introduction, agenda, atmosphere, energy levels, introduction of team, participants introduce themselves | Frontal instruction and moderated group discussion using PowerPoint | Screen sharing (PowerPoint-Slides) | 30 |
Previous experience of medical errors or risks? Reflection in the group on own experience of error, risks, safety culture. | Discussion in break-out sessions, each involving four participants (15 min.). One person from each group reports on the group’s discussions/experiences | 45 | |
What is an error? German Coalition for Patient Safety – Error: " An action or omission that entails deviating from the plan, following a wrong plan, or no plan. Whether harm arises from this is irrelevant for the definition of an error." | First let individuals think for themselves (5 min), then gather results on a flipchart (5 min) | Digital flipchart | 15 |
Types of errors and incidents | Lecture | Screen sharing (PowerPoint-Slides) | 15 |
Example of interprofessional communication failure German Film "Everything humanly possible", min. 5:37–15:42. (Story in short: busy emergency department, malfunctioning interprofessional communication, sepsis patient dies due to a confusion) | Watch the film clip individually | Cover camera with piece of paper | 20 |
Reflection on film example (I): How do I feel? What, in my view, contributed to the event? Who is “responsible” for the death of the patient? (note: in discussion make clear that “responsibility” should not be the question here but how to prevent incidents from happening again and how to reduce risks) | Participants take different perspectives and reflect on questions (perspectives: female doctor, patient’s husband, female nurse) | Discussion in 6 breakout sessions (2 for each perspective) with 3–4 participants (15 min.) and subsequently in the whole group (15 min.) | 30 |
Explanation of the term "second victim" | Lecture | Screen sharing (PowerPoint-Slides) | 5 |
Short break | 5 | ||
Theoretical input: - Why should we talk about errors, incidents, risks? - Swiss cheese model - Eisberg model, contributing factors - Human factors vs. system failure | Interactive lecture with screen sharing (PowerPoint-Slides) and with involvement of whole group. Write down why errors occur (each for him/herself and then collect results on a digital flipchart | 15 | |
Feedback on the morning (too much, too fast?) | |||
Lunch break | 60 | ||
Introductory warm-up | Activation by exercising together, e.g. - Those that ate a warm meal for lunch must walk twice around their chairs! - Those that went outside during the lunchbreak can remain seated. All others do 3 squats. - … | 5 | |
Analysis of adverse events: How did it happen? | In the entire group, present and analyze an example that has been described in the media (train accident) | Interactive lecture with screen sharing (PowerPoint-Slides) and with involvement of whole group. | 10 |
Reflection on film example (II): How did the event occur? Watch the film clip again and make notes -When did something go wrong? -What factors contributed (write down contributing factors)? | Watch the film clip asynchronously and make individual notes. Afterwards, gather notes orally in the whole group | 30 | |
Energy levels? Short coffee break? | |||
Levels of preventive measures (weak, moderate, strong) Principle of strong preventive measures ("The system must ensure it is difficult to make an error."). Leadership involvement as strong measure. | Lecture | Screen sharing (PowerPoint-Slides) | 10 |
Reflection on film example (III): Develop preventive measures (error prevention and risk reduction) Which of the measures might prevent the next patient with sepsis from dying? | First think of one preventive measure for each level, then present these measures in breakout sessions with 3–4 persons, decide on two for each level (weak, moderate, strong) and present them to the whole group | 30 | |
Feedback and evaluation day 1 | In the entire group, evaluation via online link | 5 | |
Work up an incident report from the CIRS www.jeder-fehler-zaehlt.de (“every error counts”) chronologically, and think of at least one weak, one moderate and one strong preventive measure | Work in small groups of 1–4 persons (the groups can leave the video conference to continue working after they have decided on a report) | 150 | |
Day 2 | |||
Introduction: What do participants remember from day 1? | Digital flipchart | 15 | |
Which CIRS exist in Germany for which target groups? Describe how CIRS work | Interactive lecture with screen sharing (PowerPoint-Slides) Afterwards, each participant seeks web-based CIRS. Subsequently, collect the results and discuss them using a digital flipchart | 15 | |
Presentation and discussion of the CIRS cases and preventive measures that were worked on the previous day | 4 Breakout sessions. Groups present their cases and preventive measures to each other. In small groups, agree on the best preventive measure for each case | 35 | |
Short break | 5 | ||
How do critical incident reporting and learning systems work? Example: Frankfurt University Hospital’s CIRS | Interactive lecture with screen sharing (PowerPoint-Slides) | 90 | |
Preparation of a user comment with a recommendation for a preventive measure on www.jeder-fehler-zaehlt.de | Each group on its own | 15 | |
Lunch break | 60 | ||
Ice-breaker: Place a virtual stamp according to desired medical specialty (part of the body) and preferred place of work (map of Germany) | Stamps entered onto PowerPoint slides with the entire group (feature of the video conference system) | 15 | |
Feedback rules | Collection on a digital flipchart and discussion | 30 | |
Communication about critical incidents, errors, risks What would encourage people to talk about errors and risks? What is important to make people speak up in hierarchical structures? What makes good communication in interdisciplinary teams? | Role-play (4 scenarios in break-out sessions with subsequent feedback / reflection in small groups)—> Inclusion of students ‘ experience of errors. | Break-out sessions | 35 |
Individual responsibility and individual possibilities - Question: What will I do differently tomorrow? | In the whole group, one after the other Reflection | 30 | |
Feedback and evaluation day 2 | In the entire group, evaluation via online link | 10 | |
Any further questions? | In the entire group | 5 | |