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Healthcare systems must continuously evolve, often allocating significant resources to create new clinical spaces that support changes in healthcare delivery. Opening these new spaces to the demands of medical practice is wrought with a diverse spectrum of challenges ranging from simple space configurations to complex multimodal, multidisciplinary processes. Training interprofessional teams using established hospital processes while incorporating new workflows in new clinical environments is extraordinarily complicated. Despite extensive planning for these spaces, weaknesses, inefficiencies, and even safety issues will likely remain - and potentially only reveal themselves after the first patients arrive. In-situ simulation training has been shown to identify latent safety threats and provide a solution to develop, test, and refine new processes, workflows, and spaces before full operation.[1][2][3][4][5] Healthcare simulation continues to rapidly evolve its methods to achieve valuable healthcare goals, including efficiency, quality, and safety. Moving from basic skill acquisition to more complex realms including knowledge translation, complex decision-making under stress, interprofessional team performance, workflow, and failure-point analysis, healthcare simulation is being applied to virtually every facet of care delivery. The use of fully immersive, high-fidelity, in-situ simulation to evaluate new clinical spaces reflects a natural progression and impactful application for these techniques and has shown to increase organizational learning.[6] Creating a simulation program to evaluate a new clinical space involves key steps and deliberate application to ensure successful implementation.

Space readiness = geography + processes + people + equipment + system integration Process for designing in-situ simulation to assess readiness: Form an interprofessional team Team members create/refine process maps and workflows Team members perform a needs assessment and prioritize potential issues that may arise in new space The simulation team and interprofessional team collaborate to determine program objectives Leaders/team members allocate appropriate resources (time, space, equipment, personnel scheduling) to ensure productive participation by all relevant parties The simulation team develops in-situ scenarios using process-based objectives, ideal workflows, and realistic stressors The simulation team assures the incorporation of elements highlighting safe design principles Dry-run scenarios with representative front-line personnel Pre-brief participants, emphasizing full immersion and a psychologically safe environment Run and debrief the scenarios maintaining focus on objectives Gather and record observations and participant feedback Evaluate findings using both qualitative and quantitative methods Generate recommendations based on analysis to assure readiness Repeat as needed Safe design principles: Control and eliminate sources of infection Minimize environmental hazards Optimize adjacencies Support patient/family involvement in care Ensure standardization Reduce communication breakdown Reduce noise Enhance visibility Reduce staff fatigue Automate where possible

Healthcare systems frequently need to create new clinical spaces to support changes in healthcare delivery. They often allocate significant resources to accomplish this. Opening these new spaces to the demands of medical practice has many challenges. Creating a simulation program to evaluate a new clinical space can help to ensure successful implementation. Forming an interprofessional team including front-line clinical staff, patient and family representatives, patient safety experts, quality officers, informatics specialists, architects, construction and facilities personnel, supply chain specialists, and environmental and safety services creates a realistic team that will be directly involved in the use of the new clinical space. Executive, administrative, and departmental leaders provide invaluable support and resource allocation while offering insight into various drivers, regulations, interdependencies, and overall vision. This interprofessional team will also help foster and maintain accountability throughout the simulation development and execution to provide meaningful output.