Anatomy of a Simulation Space: Designing for the Future of Healthcare Training

Simulation spaces are high-tech, realistic environments designed to train both students preparing for careers in healthcare and medical professionals learning new skills. These environments require both the functionality of real healthcare spaces and classroom elements for teaching and learning, allowing users to practice skills, learn new procedures, or explore techniques that will be applied in real hospital settings.  

In the latest episode of Side of Design from BWBR, guest host and Project Manager Jarett Anderson opens the door to the exciting realm of simulation spaces. Joined by BWBR Principal Leigh Streit, Senior Planner Rich Dunham, and Senior Project Manager Brian Lapham, the discussion delves into the unique functionalities, design considerations, and emerging trends in these innovative facilities.

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Chapters

• 0:00 Exploring Simulation Spaces in Healthcare
• 14:59 Flexible Simulation Spaces for Education and Healthcare
• 25:39 Future Trends in Simulation Spaces

Transcript

Matthew Gerstner: 0:00 

This is Side of Design from BWBR, a podcast discussing all aspects of design with knowledge leaders from every part of the industry.

Jarett Anderson: 0:08 

Hello and welcome to Side of Design from BWBR. I'm your guest host, Jarett Anderson. On this episode we'll be peeking behind the curtain at simulation spaces, high-tech, realistic environments in which to train the next generation of healthcare professionals. Joining the conversation from BWBR are Principal, Lee Streit, Senior Planner, Rich Dunham, and Senior PM, Brian Lapham. Hi, everybody. 

Leigh Streit: 0:33 

Hello, Jarett.

Jarett Anderson: 0:33 

So, I think we should just dive in here. I'll throw it out to the room. You know what are some examples of the kinds of spaces and functionalities that we mean when we think about simulation spaces, and what simulation spaces are.

Leigh Streit: 0:49 

You know, I think there's a space that I think of immediately, with simulation spaces, that is probably most specific, like an OR, or a delivery room. But really taking a step back, I think simulation spaces encompass a broad spectrum of spaces, to the point where you could really say what is it we're trying to learn and practice and create a space for them. So from that perspective, one of the more unique spaces I've heard talked about is the back of the ambulance for EMS training. Additionally, you've got residential, like apartment-style spaces for OT and home health. You've got patient rooms for nursing. It really seems like it could go on and get even broader.

Jarett Anderson: 1:38 

Yeah, for someone not familiar with simulation spaces right, it's kind of, in some ways, it's a black box in a sense, and whatever happens inside that black box is you're training for something right, and that can be a healthcare, a specific procedure. Uh, you're just talking about, you know, even it's a, it's an ambulance, right. So that is a different type of space and mobile space. But, and then there's the brick and mortar version of that as well. You know, Brian, what is your, what is your take on that initial question?

Brian Lapham: 2:11 

Yeah, most of my experience has been on higher ed campuses thinking about nursing and other interdisciplinary uses, and so the patient room becomes the first thing, or a skills lab. How do they train nurses for the next generation? But it's also virtual reality and augmented reality, VR, AR, the black box. You might be doing some other kind of technology or trying to simulate something, but in the nursing education world it's been fun to work at large public universities to small private universities and also community colleges, tech colleges. Everyone has the need for this interdisciplinary space that people can practice and then practice together. It's not just the nursing program or the other technicians, but everybody uses that space at some point. And so how do you bump into each other or not bump into each other, and how do you design it effectively? That's very interesting.

Jarett Anderson: 3:04 

And Rich, I'll throw that same question back over to you.

Rich Dunham: 3:06 

In my experience with specific linkages of simulation setups that we have created for reduction in medical errors and training as well. They're also looking at different types of procedural strategy changes when they're treating a patient. We have examples where we've looked at trauma rooms, for instance, that are set up exactly like their current trauma rooms within this very large tertiary level one trauma room. So that's a really critical linkage that is part of the simulation and reducing errors. It's really pretty exciting when we were working with the team a physician who is the director of the SIM Lab for this pretty large couple of treatment spaces a trauma room and then a debrief space, which was essentially a part where they record all of the interactions the students are going through when they're training and they review that at the end of a session. So there's all kinds of different factors or pieces of the space that you would need potentially large meeting space, recording control rooms, the actual simulation rooms, things like that. So it's a pretty exciting type of setup and it was pretty important to this particular healthcare group.

Jarett Anderson: 4:33 

Nice. And that starts to get at this next question. That actually leads into this one in terms of why do you think this work is important? You know, Rich, I heard you mentioned errors, right, and that kind of a thing which in the medical realm is a real thing. It's a real thing for the patient, it's a real thing for the patient's families, it's a real thing for that healthcare client as well, right, in terms of lawsuits or those sorts of things. And if there are those sorts of errors, the SIM Lab or you know, some labs sometimes have different names, like skills lab or practice lab or something like that as well right, they allow that trained professional or that student to go in there and practice a specific skill to overcome what's potentially an issue on campus or with that health care client or with that risky procedure, or it's just room for improvement.

Jarett Anderson: 5:25 

One of the ways I've heard this conceptualized in some ways is, like, you know, you have a professional sports team of some kind and you know you go to their facility and they have a practice facility. Right, there's batting cages, there's jugs, machines that throw footballs at you and you catch 100 of those a day, and that kind of a thing, right, or it's music. People practice that and do that, and it's no different in some ways in the medical community, where you can have these spaces and, you know, practice and hone your craft that much further in an environment that has a certain level. And I'll use the word fidelity here that we might want to talk about. You know, we've heard Brian talk about virtual reality, we have heard Lee talk about physical spaces and Rich talked a little bit about physical spaces as well. Can you talk a little bit more about fidelity and what that means?

Rich Dunham: 6:12 

Well a term. I would may turn it a little bit on its sideways, but process improvement is also a huge part of this setup. In the particular group of rooms that we were generating and putting together as a team, we worked very, very closely on what their needs were, but there was essentially a group of spaces that they can basically fine-tune new processes or older processes for an improvement that's needed and I think that's something that we all you just use the sporting analogy for repetition and improvements through repetition, and that's a huge factor in learning procedures and things like that that might be new or are existing procedures that need to be improved.

Leigh Streit: 7:06 

One thing to add to that you know these spaces a lot of them, you know, especially when you consider ORs, Traumas, etcetera. They're expensive to build, but when you consider the importance of good outcomes in healthcare, investing in space to teach and test individuals and even teams, it's invaluable. Right Before for them, it becomes the real deal.

Jarett Anderson: 7:31 

And you know, you could argue that budget is a challenge on any project, in some sense too right. But here, in some ways there's well, I guess in many situations, but here specifically there's an investment, a potential return on that investment as well. Right, that's very tangible to realize in terms of patient outcomes, in terms of learning objectives. And I think that means different things at different institutions, Brian. What do you think that means at the educational level, for example?

Brian Lapham: 8:02 

There's a lot going through my head on this, even just even, just the. I don't know if this is really addressing your question, but one of your questions about why is this work important? And I come back to that one, because it's everybody needs it. You know, everybody needs healthcare. Everybody will interact with nurses and healthcare professionals at some point in their life, and we want them to be fantastic and know how to do their work and to do it well and so have the ability to practice. And from the higher education side, everybody needs it.

Brian Lapham: 8:30 

So these are growing programs, nursing programs, for example, and the other health sciences are. The world needs those, and so we need more students in those, and so if an institution can have that program, it's very positive for the institution, especially where we're seeing a lot of higher education enrollment dipping across the nation. But nursing is consistently increasing. So recently we helped a private school only about 6,000 students. They have work to create a nursing program from the ground up, just started it brand new, and so there was a lot of programming, figuring out how much space do you need? How many graduates are you going to have? What is your cohort size? How can you grow into this what space do you need? Initially, maybe, and then a couple of years later, you can plan to design and build a phase two and it's off and running now and very successful. But I think, even if everybody knows that everybody needs this, it feels like a big hurdle to an institution to say how could we start this, but it is possible.

Jarett Anderson: 9:28 

And it's a really a different modality of learning too. Right, as you're interacting, whether or not you're the person doing the teaching or the person being taught how you're interacting with that, you know. Is it a virtual reality? What sort of simulation is it? Is it a very highly developed physical model? There's so many different ways that it can happen. How do you help clients decide which way to go and what's right, or do the clients tend to have in their minds already an idea of what they think might be best?

Leigh Streit: 10:03 

minds already an idea of what they think might be best. I think on the higher end side, you know, one of the factors that sort of starts planning for us is what's required from a program accreditation perspective, and I would say the educators and administrators of that program have a really, really good understanding of those accreditation requirements. And so then for us it's a matter of coming in on the planning side and sort of picking up at that point, maybe proposing to pivot, but always making sure that we're in alignment with what's required for accreditation Right.

Brian Lapham: 10:38 

Yeah, often they've got something that you know. They have some sort of program or some start of something already, so they've got a trajectory. They've got a plan already that we're augmenting. It's again possible to start fresh and brand new, but even then the faculty are probably coming from a different institution or something where they've got experience with certain things. Whether it's all virtual cadavers, for example, or synthetic cadavers or real cadavers, you know those have an impact on space needs and whether you're going to invest in one of those avenues or you want to have all three, and what does that look like? And the size of your institution, and a lot of you know what space you might have available or what infrastructure you might have available. All of these things can relate to the planning.

Jarett Anderson: 11:22 

Brian, you just used a word that that you know. We'll say that again. Right, you know cadaver, which that is part of medical research. Right, people donate their physical body to this and that that's a real deep thing. Right, that somebody would donate their body to science.

Rich Dunham: 11:40 

I can add a little bit more.

Rich Dunham: 11:41 

This is more more in the high-tech side of things, so in simulation labs that we're putting together for a client we actually use high-tech mannequins that are recording in real time the procedural steps that they are also taking as a student and the professionals that are guiding them. They're capturing video of the whole procedure and so they're downloading all of that as well, and then they go back and review their steps that they were taking. So it's again, it's one of those things to reinforce process improvements and learning, especially when you've got advanced students or professionals that need a little bit of tuning in terms of their the way they're handling a procedure and, as I mentioned before, if they are changing their steps into procedure, they'll they'll use the simulation and the mannequins to really fine tune that. So it's an interactive, iterative process. Again, repetition is one of those things. That's your friend.

Jarett Anderson: 12:49 

Right and dealing with tissue versus dealing with a digital working in a digital space, if it's like a digital cadaver table, for example. You know those have different tactile responses and feedback for the person participating in that right, and I think there's different modalities or different aspects of learning are engaged in those things too right For that specific person. So it depends upon the process being improved, I guess, or what the learning objectives kind of are. So that brings us to you know what design considerations really then come into play when designing for simulations and what are some of the unique challenges perhaps that you've all had to address over what design considerations really then come into play when designing for simulations, and what are some of the unique challenges perhaps that you've all had to address over the years?

Brian Lapham: 13:36 

I can start. I think one of the biggest influences, at least in the kind of work I've done on the higher ed side or the healthcare side, is the quantity of students you're looking to push through there. What size is the cohort? Because everybody's going to be using these simulations spaces or the skills lab, and so at what time in the scheduling of it all, how much space do you really need, which relates to the cost of building that space is based on how many students you have moving through there. So that's a first factor, and the second factor would be the level of fidelity or technology.

Brian Lapham: 14:07 

Rich is talking about these very high fidelity, very expensive mannequins that can do a lot, have a lot of technology. Versus long ago or even still today, some people will use I'll call it a dumb mannequin. You know there's no technology, it's literally just a model of somebody lying on the bed and so you have to pretend. You know, you have to simulate, you have to really imagine some of what they're doing, and both have a place still in design. And the same thing with the amount of simulated services. We can put true oxygen and suction or vacuum compressed air type things built into the building, or it could be completely you flip a switch and you pretend that suction is happening. Or you flip a switch and it turns a light on in the room but it doesn't actually do anything outside the room. And so there's levels of simulation or levels of what is real versus what is simulated or virtual that can really have an impact on the cost of the project.

Leigh Streit: 14:59 

I'd add to that that on the educational side the goal is usually to make the environments as much like the actual, the real healthcare environment as possible. And so you know, in the past I know we've borrowed planners, so to speak, from our healthcare practice to make sure that you know, when we're going to invest in a new OR simulation space, that we're getting the most current idea, understanding, design, planning of the healthcare world brought over to the educational side. And I think you know with that we sort of start from a lot of fundamental healthcare building blocks, if you will, fundamental healthcare building blocks, if you will. You know, I think, about FGI guidelines, using that in an educational space, right In a B occupancy, to plan your space and then talk about where, if it's a renovation, you might need to depart and what that means in any other places you might need to depart from the actual healthcare environment, what that means for your project and for that program.

Rich Dunham: 16:07 

Yeah, it's one of those things that we were looking at setting up a classroom setting that was flexible, that they could actually hold the classroom, a small gathering space, and turn that into a treatment space. But what was interesting was that they wanted live gases for medical gases, so that there was a great deal of practicing as well. Because they were going to practice resuscitations, they were going to do live what I would call kind of pre-surgery setups, learning how to do that. The monitors were live. There was a whole lot of feedback that they were getting that were much more sophisticated than, say, 10 years ago or even five years ago in terms of what the actual experience is like when you have somebody who needs resuscitation skills and strategies.

Rich Dunham: 17:00 

The part that we really wanted to achieve was a great deal of flexibility in the simulation spaces. So those rooms whether they're a treatment room or an examination room or a trauma room or an OR there was some flexibility in terms of giving them multiple options for use of equipment and spaces for those different setups, for use of equipment and spaces for those different setups. One of the things that I think is the hardest thing to get your arms around is the storage needs for your mannequins, the storage needs for all those types of setups so that you don't just overbuild, and you need to right-size the suite that you're creating for the simulations.

Leigh Streit: 17:46 

I'm glad you brought that up, Rich, because I was thinking, you know we'll be remiss if we get through this without talking about storage and other support spaces for this right. We've been talking about the exam rooms, the ORs, skills labs, but people are surprised by the amount of storage that's needed to support these spaces as well as other functions. If your simulation program includes standardized patients, then you've got another set of rooms and flows that you need to design around. You need a place for those patients to come into the facility to get changed in private. The educators may also want them to have a discrete access to an exam room so that students may not know first of all who or if there will be a live actor in their simulation. So you know there's. There's the support spaces, right, that are critical to the function of these.

Brian Lapham: 18:49 

Yeah, not to again, but it is important enough that all three of us do mention this storage and support spaces, cause I would agree I'd written that down beforehand that storage is important because some things will be stored in the rooms, in the sim rooms. You know this sim room is intended to be used as a maternity room, so we'll always store that stuff in there. But then there might be other things that need to be stored nearby or immediately adjacent to the room, or some things could be down the hall or in the basement, and so, yeah, really getting a handle on what is that and how many do we need, you know again, if we have two sim rooms, or eight, or 16 or four, you know, does that directly relate to the same number of those other support spaces or can we combine them? You know, as you get more support, can you have less of those? Uh, there's a lot of programming and you know scheduling that needs to be reviewed for defining and quantifying all those spaces yeah, storage does take on a whole big part of the conversation.

Jarett Anderson: 19:45 

That is definitely important in all this Right, and then it leads exactly in kind of over to the space itself and how adaptable and flexible those spaces. A skills lab, a sim lab, can and might need to be, depending upon how much space is really available for it, right, like in the in the healthcare setting. What's very interesting is, you know, we finished a, a sim lab project and we sent it off for permitting and we got flagged by the AHJ because they didn't read that it was a simulation space and they were like wait a minute, you don't have this, this and this, which would mean these guidelines. We had to be like hold on, there's no patients in this space. This is an educational thing going on here. So that was a little bit of a unique, you know, thing that's happened a couple times and you try to get ahead of that right because you've had the meeting with the AHJ beforehand, but somehow somebody else reviews it, they see it, they flag it and you move, move through it nonetheless, like there's a a sense there that while the simulation space is representative of a trauma room, is representative of a procedure space, it's not always one for one in terms of how much space it takes up. You can have a series of headwalls, you can have movable panels, you can have a lot of things in that space that let it do more than just one job. Right, and that happens with storage and how that scene, if you will, gets changed and what tools come in there and how it gets used. How that, you know. I'll go back to that black box analogy of it too. Right, like in some situations that might need observation and that other thing you might need a more dialed in specific prescribed space. But then there might be something more zoomed out that might be more. It's, you know, some procedure that's happening on a table somewhere and you just need the right amount of table, the right amount of equipment around it, the right amount of camera that's recording something, the right amount of audio that's catching something that can then be reviewed later by somebody. You know there are all these different ways to enable adaptability, flexibility in those spaces, which I find them intriguing that way, and I also find them intriguing because they combine this crossover of education and healthcare right, like there are, you know, things that Brian was talking about with you know cadavers and we're standing up this sort of a practice for this. We need to push this many people through. Well, those same things exist in the healthcare sim world as well. And then, how do learning objectives get met right? Our educational planners and our educational practice. We're very concerned about how people learn right and why that happens, and hearing lessons learned there and moving through, moving and capturing those lessons and disseminating those, if you will, in the healthcare world is a lot of fun as well.

Jarett Anderson: 22:36 

There's a little bit more latitude potentially in terms of when these spaces can be used. You know they potentially can be used 24 hours a day in the healthcare world. If there's one interesting obstacle we had to overcome was kits. For example, there was a specific procedure that this one client wanted to use in the vending machine that we came up with. They wanted to have kits that were set up and somebody hits you know, essentially like F7 and da, da, da, da da. And then here's your kit, for now you can go and practice the thing that you need to practice right, just like that kind of ball players hitting 25, hitting 25 curveballs or whatever it is to try to overcome that.

Leigh Streit: 23:03 

I really enjoy when our markets mix or when, when the when we cross over from one market to another right this, this isn't the only instance, but it is certainly an interesting one where education and healthcare can share experiences and collaborate.

Jarett Anderson: 23:35 

Right, and you know part of all this, too, is safety, and you know safety comes down. You're practicing safe practices, right, something that we haven't talked about. We did talk about storage, which seems benign in some ways, but it's not. Safety is not benign either, and that's a big part of what happens in simulation. It's the safety of the patient, it's the safety of the practitioner and the safety of a family member and everything else. That's part of process improvement as well. Ideally, as this all happens and you're practicing it in the educational realm before you get to the professional realm, hopefully, when you're in the professional realm, you're honing those things or figuring out emerging trends, which leads to my next question about emerging trends and tech. Now you know technological advancements. What are some things that are here today or coming down the line that you think are interesting about some spaces?

Brian Lapham: 24:25 

Well, one thought about an emerging trend. I don't know if it's really emerging, but we talked about flexibility and adaptability, both initially, day one. We're designing these sim spaces so that they can be used for different activities, potentially by different groups. But then also, in 10 years, how can we design this space, especially if it's a new construction? We get to set the location of structure, for example. But even in a renovation, how can we create a space that the owner can renovate in 10 years without shutting down the whole suite? What are they going to maybe need to renovate?

Brian Lapham: 25:01 

To think ahead to some of the technology, for sure, is always advancing. Where is that server room? Where are the monitors, any of that kind of stuff? They can relatively easily upgrade things. Or, if they have to move walls, doors, windows, what is that going to do? To create another Sim Space, or to take one and make it specialized, or to take a specialized one and make it flexible? All of those things are things that we think about and want to understand During the design. We're talking to the first tenants in some ways, but the construction is likely to outlast some of the people using it. So we just want to stay aware of that adaptability for the future.

Rich Dunham: 25:39 

I think another thing that is critical to setting up the SIM Lab appropriately and right-sizing. It is where you're dealing with outlining the program needs. For instance, we had a reception and administrative function within the Sim Lab mundane, but they were looked at as part of five to six simulation spaces plus meeting spaces, plus locker rooms. For instance, small break area that was incorporated into a large meeting space. That was flexible for different types of seating arrangements. Those are, they sound a little mundane but they were really critical to the training mission and education mission that the hospital had. Those are some of the things that would also be part of the storage needs for these. I mean the mannequins. Think about them. They're it's like a little Mercedes Benz that you're storing and you have different. You have a child, you have an adult, you have a teenager and they're different sized mannequins and they're all connected in terms of. I don't know, Brian, if you see a lot more VR, and Leigh, in terms of virtual environments.

Leigh Streit: 26:59 

I definitely see a lot of institutions talking about it, planning for it. I think, to come back to the almighty dollar, the economics of it, that is an equally, if not more, challenging thing to do, but I guess I would think, as the costs come down, a VR space or VR capability is inherently pretty flexible, and so my expectation would be that that is used more and more. Is it going to take the place of a simulated patient room? Not sure, but for all of the other aspects of education, I do expect that to increase.

Jarett Anderson: 27:42 

The other thing that's very interesting as well, because it doesn't just come down to hey, we have these goggles and this thing and it takes this much space.

Jarett Anderson: 27:49 

It's like, what is the software that they're running and does it meet the mission of what they're trying to do?

Jarett Anderson: 27:54 

And, you know, do they have the ability to tailor the you know VR simulation itself to something that they want to do, or tweak that?

Jarett Anderson: 28:05 

Or you know, how is that working with that company, which gets something outside of somewhat our expertise that we need to be cognizant about, though, right, like cool, you need vr, but we also need to understand why you kind of need that.

Jarett Anderson: 28:14 

Right, because there's a VR experience there too, but there's also a validity going back to tactile things, and you know, working with your hands and you know, learning that way, and that to me you know, from an emerging trend standpoint, is going to be the thing that's really interesting to me is what are the things that are the simplest that we need and what are the things that are pushing the edges of technology? Right, there's a, there's a huge gradient there between, you know, a tactile, physical experience and a high, super high fidelity virtual experience, or you can even go to like. There's a different angle to that. When you talk about a robot trainer or you know that kind of a thing as well, right, like where you know that side of where's that technology going and how is that working in healthcare rich like, and how procedures might be done in the future, and that kind of a thing like you know someone sitting remote somewhere else doing the operation, for example.

Brian Lapham: 29:16 

Yeah, I think it's about the right tool for the job. You know, and we've seen virtual environments where, like in the medical device field, you know you can, virtually, you can place your device into a virtual human and then you can see it. You can go in there almost the old children's books, magic school bus right where you jump into the body and you can zoom around and see, oh, we should rotate this device a little bit. Or oh, we need something else here, and so there's that application bit. Or oh, we need something else here, and so there's that application.

Brian Lapham: 29:45 

But I think in the higher ed example we see virtual environments happening on the early end. So your first and second year students that are entry level, they're doing something. You can teach an entire class something with virtual tools relatively easy. But then as the upperclassmen get into more hands-on activities, like Jared's saying, you really need that hands-on experience. So if it's hands-on with virtual cadavers or real cadavers, for example, or you're in the sim lab, it's just a progression of what you're doing. So depending on the school, the institution you know what sort of teaching models they have and how many students they have different tools can be the right application.

Jarett Anderson: 30:21 

And that's exciting to think about. I think right All the different applications and the way different institutions want to use them in their simulation I mean, there's no one way to do this, which I think is one of the exciting things about this as well and then just the broad range of skills that there are to be had and practice and simulated as well.

Rich Dunham: 30:41 

One of the things that surprised me in the early stages of planning a sim lab was the amount of control spaces that you need for the technologists to record everything and the size of your servers to capture all of that information. When we were planning what I would say is a pretty small simulation lab with six simulation spaces, and then, with those six spaces plus the large classroom and small classroom, we had two distinctly different control rooms and they each had a staff of two to three in each of those control rooms. So part of that was planning for the future as well. They had not actually kind of gone into the threshold of virtual reality. They did not have like a DaVinci robot training, which I thought that was kind of surprising with, given the fact that we were doing a trauma room. But you know, usually we'll see that when you're in a surgical suite or a surgery setup and I think those are really fascinating when you think about where's the future going.

Rich Dunham: 31:54 

These you know, making, practicing and the perfection of their medical arts is just pretty amazing thinking about all these different setups. It is very expensive and I think that when they counteract that by saving lives as well as saving the institution from any kinds of frivolous lawsuits and things like that, so these simulation labs really are practically driven to create a setting that gives them this ability to perfect their art.

Jarett Anderson: 32:30 

Right, and there's a lot of, to use an overused word, there's a lot of synergy there in terms of the outcomes right for a simulation space, and some of those are just happening and being absorbed and you know, there is an accounting likely to that that you're saying Rich as well, that that can be captured as well, and we're almost at time here and we didn't even talk about BSL levels.

Jarett Anderson: 32:58 

But you know, and those sorts of things, when it comes to safety within these spaces, there's a lot still here to unpack and who knows, we might come back and do another one of these segments here in a little bit and get to re-ask the emerging trends question and some of these things. Again, I think there's constant learning that our group is doing and constant sharing as well, back and forth, and you know I look forward to checking in with you guys and the rest of our teams in the future on this one as well. So you know, thank you all today for your time and for your insights. Until next time. See you on the other side.

Matthew Gerstner: 33:31 

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