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0151 Using simulation based education to tackle undermining and bullying issues at work: A service improvement project
  1. Makani Purva
  1. Hull and East Yorkshire Hospitals NHS Trust, Hull, UK


Background/context A baseline team analysis of an acute medical team demonstrated poor safety culture with issues of speaking up about concerns. Simulation based education is used to modify team behaviours to improve patient safety.1 Rarely is it used to address primarily bullying issues in the workplace. We present the results of a novel simulation exercise to address bullying and undermining issues in a clinical workplace

Methodology Four 2 h workshops for 40 staff were delivered. The three critical events used to replicate stresses of a busy ward included that of a diabetic patient whose BMs had been unmeasured for 8 h, a junior doctor bullied to assist with A and E pressures and a bed manager bullying the charge nurse for inappropriate transfer of an unwell patient. We embedded patient safety concerns and conflict situations to explore ability to raise concerns and deal with conflict.

Results We collated pre and post course confidence levels, qualitative feedback and interviews post workshop. Participants felt that their ability to deal with conflict in the workplace, collaborate with team members and care for ill patients had improved. Participants stated that the “scenario was so life like” and appreciated “how to tackle stressful situations” and listen” to other people’s views”.

Discussion We demonstrated that undermining and poor team morale can cause a team to function suboptimally. Following our results, work is underway along with changes to acute care pathway to improve culture and morale to bringing back a positive environment. We believe that simulation education is under used as a cultural transformation tool1 and hope that our experience will encourage others to follow suit.


  1. Gaba M. The future vision of simulation in healthcare. Qual Saf Health Care. 2004;13(Suppl 1):i2–i10

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