How Can a Simulation Program be Organized and Operated and What Does

it Cost?

Michael A. Olympio, M.D.

Director, Patient Simulation Laboratory

Wake Forest University

Specific Objectives

• What does it take to set up?

• What are some alternative models?

• What are the costs involved?

• What partnering relationships are helpful?

• What are the sources of funding?

Visit SimCenterextol virtues

attend meeting

"SimFair"publicity

equipmentexperts

Advocate:Information

StrategyContacts

PCSimulationOptional

Machinetroubleshooting

workshops

Videotaping:human

performance

Retreat:Concept Approved

No fundingNo time

Chairmanfostersinterest

BudgetDesign

CompromiseCurriculum

Go Live!

TechnicianInstructors

Director,SimLab:

Set standards

Chairmanmandates

project

Buildinga

Consensuswithinyour

Department

What qualifications helped me?

• Stable, supportive family• Enthusiastic personality• Home-grown 17 years• Mechanical interests• Chair, Equipment Committee• Chair, Education Committee• Chair, Incentive Plan• Member, Clinical Competence• Hobby: Construction projects

Alternatively, You Might Consider:

• Authoritative, power-based• Established, external figure• Someone who delegates• Engineer, scientist, researcher• Medical school educator• Academic nurse anesthetist• Well-funded military contract• Private MD-MBA-Industry

Responsibilities of the Director

• Define the mission• Design the laboratory• Supervise construction• Select multimedia• Order supplies• Negotiate everything• Promote and market• Secure funding

• Maintain budget• Set educational goals• Define the curriculum• Maintain the lab• Schedule utilization• Learn how to simulate• Train instructors• Maintain enthusiasm

Negotiating Win-Win Strategies

• Location of the Patient Simulation Lab– temporary versus permanent locations

• Designing and Outfitting the Laboratory– location, size, image, extras, multimedia

• Multidisciplinary and/or multi-institutional

• Cooperating with Industry

• Director’s clinical responsibilities persist

Initial Facility: Problems

• Main corridor

• Control room too small

• Wasted reading room

• Isolated de-briefing

• Don’t need conference room

• No storage space

Discussion of: general layout, flow pattern, briefing room features, communications, data ports, video, medical gasses, computer rack, storage,

office, control room, one-way glass, extras, large groups

Partnering Justified Facility• Medical students• EM, ANES, ENT, IM,

and CCM Residents• Community schools• OR, PACU Nursing• Nurse anesthesia• CME Visitors• Flight team, EMT’s• Risk management

Planning and Approval How Long Does it Take?

• January 1998: STA evaluation of simulators

• March 1998: Simulation fair / Faculty retreat

• August 1998: Proposals to Chair, Vice President, Dean, and Facilities Planning

• September 1998: Approval of Program Planning Guide

• December 1998: Initial site and architectural plans

• January 1999: Estimates of developmental costs

• February 1999: Announcement to Faculty retreat

• March 1999: Funding approval; budget prepared

14 Months

Initial Facility Budget

$0

$20,000

$40,000

$60,000

$80,000

$100,000

$120,000

$140,000

$160,000

$180,000

Constr Simltr MultiM Equip Surplus Negot'd

$416,929.00

Contractual Agreements• Department of Anesthesiology

– Director’s time in the simulation lab

– Additional two days per week

– 50% lab maintenance after the first year

• North Carolina Baptist Hospital– 50% of initial facility expenditures

– 50% of ongoing expenses (including salaries)

• Wake Forest University School of Medicine– 50% of initial facility expenditures

– Basic Dollar Support

Alternative Arrangements• Center for Research in Human Simulation

– Virginia Commonwealth University Allied Health

– Dean of Allied Health supported project

– Organized by CRNA’s

– Internal contracts for $$, including med school

– Pending contracts with NASA

– Renovated operating room

– Program and arrange MD training, NOT content

• Military Contracts– Major center in Texas: $10,000,000

– 8 simulators, virtual reality, corporate funding

– 25,000 square feet

Design and Construction How Long Does it Take?

• May 1999: Delivery of simulator Final site selection: architect

• June 1999: First training sessions

• September 1999: Finalize construction documents

• December 1999: Demolition ends; Begin construction

• April 2000: Install communicationsRelocate simulator

• May 2000: Begin operations in new center

12 Months

AssignmentAM PM

Monday OperatingRoom

OperatingRoom

Tuesday SimulationDevelopment

Simulation

Wednesday OperatingRoom

OperatingRoom

Thursday AcademicTime

Simulation

Friday SimulationDevelopment

Simulation

Initial Schedule Subsequent:2 days OR3 days Simulation

Problem:Production PressureDevelopment on:

weekendsvacationpost-call week

Solution:TechnicianFellowOther Faculty

What about your colleagues in the Operating Room?

• Define your mission and responsibilities• Take full-time call with weekends• Work later on the days you are there• Clarify whether you will be replaced• Provide faculty mentoring and training• Generate revenues, funding, industry support• Activate research protocols for generalists• Put your own heart and money into the lab

xxxxxxxxxx

Actual Facility Expenditures

$0

$50,000

$100,000

$150,000

$200,000

$250,000

Constr Simltr MultiM Equip Surplus Negot'd Dont'd

Budget = $416,929.00

Actual = $637,189.00

It’s not a gift; It’s not a donation.It’s a PARTNERSHIP with Industry

• Start with your equipment committee

• Evaluate and compare their products

• Give professional, constructive feedback

• Attend factory biomedical seminars

• Develop joint educational seminars

• Lecture and write about their products

• Allocate time to their employees

FY01 Operational Budget: $18,494.00Additional 40% Tech Salary: $15,310.00

Additional 40% Faculty: $80,000.00

$0

$500

$1,000

$1,500

$2,000

$2,500

$3,000

$3,500

$4,000

$4,500

AnesDrugs

IV GenPstgOfficeCopyGas

MealsPhone

FOSSoftMtgsSTA

FY01 Projected Revenues: $57,700.00

$0$2,000$4,000$6,000$8,000

$10,000$12,000$14,000$16,000$18,000$20,000

CorpExt-RConsult

Anes-RENT-R

ER-RSRNAPACUOSC ORN

Z. Smith Reynolds Foundation

Major Challenges to Overcome

• Integration / selection of multimedia• Training other faculty instructors• Formal CME educational experiences• Unrestricted educational grants• Incorporating research into teaching• Implementation of full-scale simulation• Faculty development courses• Ongoing technical support• Communication and scheduling

In Summary: Lessons Learned

• Do it right the first time• Prepare realistic budget• Mobilize support• Choose effective leader• Written agreements• Negotiate everything• Compromise• Hire consultants

• Supervise construction• Go digital• Advertise and promote• Don’t expect income• Don’t depend on others• Start simulating early• Communication!• Commitment