Sequential Simulation (SqS) is the physical process of simulating selected aspects of a patient's care pathway. SqS has the potential to simulate an infinite number of scenarios and care pathways. Its application is wide and can be used for a variety of objectives, including:
- Enable progressive multidisciplinary training
- Aid those working in healthcare to visualise their role within the bigger picture
- Allow for critical evaluation of current and future systems
- Test changes and new interventions
- Help patients better understand current and future health systems
- Open a dialogue between patients and healthcare staff outside of the healthcare setting
- Give patients and those involved in their care an opportunity to voice their concerns or opinions around current and future systems
- Aid in the co-design and co-production of new approaches to healthcare
SqS can be undertaken in a variety of settings (dedicated laboratory, simulation suite/centre, replica clinical environment such as Distributed Simulation [DS], multimedia or in-situ simulation) as long as consideration to the context of each scenario is given.
It is outcome-oriented and can be applied to many different aspects of healthcare, for example training of technical and non-technical staff, care pathway re-design and quality improvement. The involvement of stakeholders and a range of expertise from the beginning is crucial in order to ensure authenticity and consistency throughout the process. Key considerations when designing an SqS include the selection of environments and participants, as well as the level of detail required to meet the desired objectives.
Sequential Simulation and its Applications
- Mapping current and future care pathways
- Training multidisciplinary teams to aid coordination and teamwork
- Training of nurses and junior doctors on effective handover
- Engaging front-line staff, patients, carers and managers in the design and implementation of new models of care
- Involving of patients, publics & healthcare staff in early stage research
- Public engagement activities, including hard-to-reach-groups, careers, science & ethics
- Developing community involvement in health care
Other factors that need consideration are the time span (hours, days, months, years) [physical and imaginary], time transitions (time warping), scenario pace, discrete or shared scenario information, embedded and simulated participants, maintenance of conceptual, emotional & physical fidelity (e.g. same patient, same limp, continuation of drug effects etc.) and the detail of the framing to name but a few.
Due to the complexities of simulating healthcare systems that incorporate multidisciplinary healthcare employees and a multitude of patient pathways, a robust and systematic approach is required. We have therefore developed a model based on empirical evidence that aids in the design process of a Sequential Simulation (SqS).
Progress and outputs
- Integrated care for GP receptionists
- Knife crime
- Integrated for Pharmacists
- Asthma and the multi-disciplinary team
- Camden Careers Conference
- The Time Travelling Operating Theatre
- Hounslow Clinical Commissioning Group
- Hammersmith & Fulham Clinical Commissioning Group
- Diagnostic Evidence Cooperation early research in a breath test for oesophageal cancer
- Deterioration of the acute patient
- Palliative care planning
- Mapping maternity services across North West London
- Central London Nurse OSCE training
Weldon, S-M., Kneebone, R., Bello, F. (2016). Collaborative Healthcare Remodelling through Sequential Simulation (SqS): A Patient and Front-line Staff Perspective. BMJ Simulation & Technology Enhanced Learning. [In-print]
Kneebone, R., Weldon, S-M., Bello, F. (2016). Engaging patients and clinicians through simulation: rebalancing the dynamics of care. Advances in Simulation. [In-print]
Weldon, S-M., Ralhan, S., Paice, E., Kneebone, R., & Bello, F. (2016). Sequential simulation of a Patient Pathway. The Clinical Teacher. [In-print]
Weldon, S-M., Ralhan, S., Paice, E., Kneebone, R., & Bello, F. (2015). Sequential simulation (SqS): an innovative approach to educating GP receptionists about integrated care via a patient journey – A mixed methods approach. BioMed Central Journal Family Practice. 16. pp. 108
Paice, L., Weldon, S-M., Ralhan, S., Bello, F., & Kneebone, R. (2015). Sequential simulation (SqS) of a patient journey: an intervention to engage GP receptionists in integrated care. International journal of integrated care. 15. http://www.ijic.org/articles/abstract/10.5334/ijic.2135/
Powell, P, Sorefan, Z., Hamilton, S., Kneebone, R., and Bello, F. Exploring Sequential Simulations potential as an educational tool in paediatrics. The Clinical Teacher, (2015): doi: 10.1111/tct.12391
Weldon, S-M., Kneebone, R., & Bello, F. (Forthcoming). Combining Sequential Simulation (SqS) with Distributed Simulation (DS) to address both simulation accessibility, and integrated healthcare training and education.
Weldon, S-M., Kronfli, M., Bello, F., & Kneebone, R. (Forthcoming). Sequential Simulation (SqS) – What is it and were does it fit in current simulation approaches? - A concept and systematic literature review.
Ralhan, S., Weldon, S-M., Kneebone, R., & Bello, F. (Forthcoming). Sequential Simulation Workshops: An Innovative Approach to Working Together (engaging front-line staff, patients and publics) to Develop New Integrated Models of Care.
Huddy, J., Weldon, S-M., Ralhan, S., Hanna, G., Kneebone, R., & Bello, F. (Forthcoming). Sequential simulation (SqS) of clinical pathways: a tool for public and patient engagement
Ralhan, S., Weldon, S-M., Kneebone, R., & Bello, F. (2016). Sequential Simulation Workshops: An Innovative Approach to Working Together (engaging front-line staff, patients and publics) to Develop New Integrated Models of Care. TASME Annual Spring Conference. London, UK.
Weldon, S-M., Bello, F., & Kneebone, R. (2015, June). Sequential Simulation (SqS) Concept & Applications. Presentation at UK Simulation in Nursing Education Conference 2015, Belfast, UK.
Huddy, J. R., Weldon, S-M., Ralhan, S., Bello, F., Kneebone, R., & Hanna, G. B. (2015, May 19). Sequential simulation of clinical pathways: a tool for public and patient involvement in diagnostic research. A poster presented at the UK Diagnostic Forum, Oxford, UK.
Paice, E., Weldon, S-M., Ralhan, S., Bello, F., & Kneebone, R. (2015, April 22). Patient produced simulation for education and training. Mini-course at International Forum on Quality and Safety in Healthcare, ExCel London.
Paice, E., Weldon, S-M., Ralhan, S., Bello, F., & Kneebone, R. (2015, March 27). Sequential simulation (SqS) of a patient journey: an intervention to engage GP receptionists in integrated care. Presentation at the 15th International Conference for Integrated Care, Edinburgh, UK.
Weldon, S-M., Coates, L., Kneebone, R., & Bello, F. Hounslow Whole System Integrated Model of Care Sequential Simulation (SqS) Workshops. A poster presented at the Health Education North West London - Simulation: Is a New Approach Needed? Conference, London, Uk.
Coates, L., Malik, N., Granados, A., Kelay, T., Weldon, S-M., Woodward, P., Kneebone R., & Bello, F. (2014, December 8). COLLABORATIVE CLINICAL EDUCATION: Our experience of moving simulation training from secondary care to the primary care environment. A poster presented at the Health Education North West London - Simulation: Is a New Approach Needed? Conference, London, UK.
Hewitson, R., Weldon, S-M., Sorefan, Z., & Corbet-Burcher, G. (2014, July 10). Using sequential simulation to demonstrate the concept of integrated care. A poster presented at The Royal Society of Medicines Innovations and opportunities in integrated child health Conference, London, UK.
Simulation Poster Competition Winner
Health Education North West London December 2014
Sequential Simulation in action
Breath test for oesophageal cancer
Using SQS to simulate the introduction of a new breath test for oesophageal cancer
Sequential Simulation explained
An introduction to Sequential Simulation
SQS for Hammersmith and Fulham CCG
Using SQS to help a Clinical Commissioning Group redesign its care model
Time-travelling operating theatre
A surgical trip through time
Miss Sharon-Marie Weldon
Miss Sharon-Marie Weldon