Healthcare Design Process

Hazard ratio: How simulation can detect latent safety threats before they happen

By: Andrew Petrosoniak, MD, MSc (MedEd), FRCPC

“Hindsight is 20/20” is a common phrase used when referring to the knowledge of an outcome only after the fact. In safety-critical industries where safety is paramount, a phrase like this simply doesn’t work. Instead, all efforts must be taken to predict, test and redesign potential flaws that could result in a bad outcome. Imagine if a car manufacturer decided to forego crash testing a new model and then once on the road, the owner is involved in a minor collision and the car explodes. Only later is it discovered that there was a design flaw with the electrical system that malfunctioned upon impact from a minor fender bender. Had this car been subject to the usual crash testing process, this very easily may have been avoided.

This car malfunction can be described as a latent safety hazard or threat (LSTs). Specifically, these LSTs are issues that are previously unrecognized and can materialize under certain conditions and threaten the safety of those using the system or product. More simply, these can be described by the cliché, “it’s not a problem until its suddenly a problem.

The link between crash testing cars and healthcare simulation

These LSTs are not exclusive to industry but also exist widely in healthcare. Our research has sought techniques to accurately identify these safety threats and hazards in medicine given the potential impact on patients. A key technique in our approach is the use of simulation or the recreation of clinical events using a broad range of tools including table-top exercises, role-playing, patient actors and computer-controlled manikins.

Using simulation allows us to proactively identify LSTs before a patient can be harmed. This can be equated with crash testing a car, as described above prior to certification to ensure that it is road-worthy. In “crash testing” complex clinical situations using simulation, LSTs can be both identified and remedied. Most importantly, no patients are harmed in the process. This can also be used during the design of clinical spaces. By recreating clinical scenarios, designers can observe how patients and clinicians interact and what safety threats they may encounter. Key outputs include design changes that promote safer behaviors, systems and processes.

How can we ignore the opportunity to get ahead of potential problems that threaten patient safety? The answer is, we can’t. It’s hard to argue against its value given our priority towards providing the best and safest care possible.

Andrew Petrosoniak is an emergency physician, trauma team leader, simulation specialist and principal at Advanced Performance Healthcare Design (APHD). NORR and APHD are collaborating to rethink, recalibrate and reimagine the design process of healthcare facilities and spaces through simulation to inform the final architectural design.