Standardized Technical Communicators: A Novel Simulation Center Staffing Model
Authors
Kathrine C. Branch, PhD, MSN, RN, CHSE1, Douglas J. Ayers, BSN, RN, CHSE1, Sharon K. Baker, BSN, RN, CHSE1.
1 - Grand Valley State University, Grand Rapids, Michigan
The authors declare no conflict of interest.
Corresponding Author
None
Brief Description
Many healthcare and government organizations are concerned about a growing shortage of healthcare workers. In response, educational institutions are under pressure to produce competent and qualified healthcare graduates. However, as academic programs increase the number of learner cohort sizes, institutions face challenges such as staffing shortages and limited clinical placements. To address these challenges, institutions have increased the use of simulation to provide learners with clinical practice experiences. Unfortunately, the increase in demand for simulation in healthcare program curricula also increases the workload of simulation staff. In response to the increased demand, the Standardized Technical Communicator staffing model enables simulation centers to meet the needs of healthcare programs while maintaining high-quality experiences for learners.
Introduction
In today’s economic environment, simulation centers face several challenges when trying to expand services or accommodate increased demand without the significant accumulation of additional resources. One such challenge is establishing adequate staffing. This article provides a focused review of how Standardized Technical Communicators have been defined and incorporated into the standard operating procedures of a large, interprofessional, university-based simulation center for over half a decade. The use of Standardized Technical Communicators has
demonstrated to be an innovative, economical, and effective staffing model to address staffing gaps and enhance both faculty and learner experiences.
The concept of asking employees to do more with less often leads to employee burnout, low productivity, low satisfaction, and higher attrition rates (Brunner, et al., 2019; Esteve, et al., 2017; Russell et al., 2020). Over the past decade, Grand Valley State University’s (GVSU) Interprofessional Simulation Center has grown from its original 6,409 square feet footprint in one building to today’s 67,828 square feet footprint spread across three buildings on the University’s Health Campus. During this timeframe, the number of learners and academic programs utilizing the Center has grown exponentially. On average, the Center provides over 1,500 simulation-based events with over 8,000 total learners in attendance every year. Incorporating Standardized Technical Communicators allows the Center to adequately increase services and meet demand without needing to significantly increase the workload for existing staff or the number of full-time, benefits-eligible staff members.
Discussion
Terminology
The title of the Standardized Technical Communicators was informed by terminology in the Society for Simulation Healthcare’s (SSIH), Healthcare Simulation Dictionary (Lioce et al., 2020). This innovative role is a blend of a Standardized Patient and Simulation Technology Specialist. Defined by SSIH, a Standardized Patient is, “An individual trained to portray a patient with a specific condition in a realistic, standardized, and repeatable way and where portrayal/presentation varies based only on learner performance” (Lioce et al., 2020, p.49). A Simulation Technology Specialist is defined as “An individual who provides technological expertise, instructional support, and advocacy in healthcare simulation” (Lioce et al., 2020, p.47). The Standardized Technical Communicator is an individual trained to support the facilitation of healthcare simulation by portraying the “voice” of the patient simulator/mannequin and operating the patient simulator software allowing for patient data to be communicated in a realistic, standardized, and repeatable way whereas portrayal and patient data presented varies based only on learner performance.
Employee Classification
Standardized Technical Communicators are classified by the university as temporary, hourly paid, non-benefit eligible employees. Scheduled hours are based on simulation event types, the number of simulations running simultaneously, and Standardized Technical Communicators’ availability. The hourly pay rate for Standardized Technical Communicators is the same wage Standardized Patients are paid at the university. Standardized Technical Communicators are community members, who typically do not have a professional healthcare background. In terms of recruitment and hiring for this position, word of mouth or referrals from existing Standardized Technical Communicators is most effective. The position requirements include a high school diploma, completion of a criminal background check, and a signed acknowledgement and agreement to adhere to the policies and procedures outlined in the GVSU Standardized Technical Communicator’s Manual. Although it is not required, most of the current Standardized Technical Communicator employees have some form of experience in local theater, voice acting, or broadcasting communications which enhances realism or accuracy in portraying the voice of a patient during a simulation. In addition, it is advantageous if prospective Standardized Technical Communicators have previous experience working as a Standardized Patient, as well as an understanding of simulation-based methodologies and fundamentals. However, no prior experience in simulation is necessary for a Standardized Technical Communicator to be successful. Preferred work experience includes the ability to work independently, coordinate multiple tasks, technologically savvy, good organizational skills, flexibility with job tasks, and the ability to maintain effective working relationships with faculty, supervisors, team members, and students.
Standardized Technical Communicator Onboarding
Currently, the GVSU Interprofessional Simulation Center has a pool of 11 Standardized Technical Communicators, in addition to its pool of over 200 pediatric and adult Standardized Patients. Upon hire, individuals are encouraged to choose a specific role either as a Standardized Technical Communicator or Standardized Patient as scheduling conflicts may arise from individuals signing up for the entire semester and indicating their availability for both roles. It is the responsibility of the Standardized Technical Communicator to ensure they do not double-
book themselves for simulation events. Due to the investment of time and resources required to adequately train new employees, it is important that the Standardized Technical Communicator Program maintains a high retention rate of employees. Maintaining a smaller pool of Standardized Technical Communicators allows for Center staff to build rapport with each employee. The professional relationships help the Standardized Technical Communicators feel supported and identify as a member of the team. The Standardized Technical Communicator role may be preferred over Standardized Patient work because the Standardized Technical Communicator is not in direct contact (no physical exam component) when interacting with learners nor has to memorize specific details of a patient scenario. Standardized Technical Communicators are stationed in a separate control room, with video access to learners, while maintaining immediate support from Center staff as well as direct communication with faculty. Additionally, the Standardized Technical Communicators have opportunities to work a wide variety of events and hours because patient demographics are not a limiting factor when scheduling for events.
Adequate onboarding of a Standardized Technical Communicator is an investment. The process is dependent on the experience and technology comfortability of the employee. The average onboarding process includes a one-hour orientation which includes a tour of the facility and time to review the Standardized Technical Communicator manual with a Center staff member. Following the orientation, three shadow shifts are scheduled. During the shadow events, the new Standardized Technical Communicator is paired with a Center staff member or an experienced Standardized Technical Communicator with at least one year of experience. The objective is to provide exposure to simulation events and observe the role of the Standardized Technical Communicator. Experienced Standardized Technical Communicators model how to communicate with faculty, students, and other Center team members. Finally, a “supported” event is scheduled. During this time, the novice Standardized Technical Communicator is shadowed by a Center staff member for evaluation and immediate feedback following each simulation event. On average, the total onboarding process is 13 hours. It is most effective to begin the onboarding process near the start of the semester. This method allows the Standardized Technical Communicator to begin training and follow along with a cohort of first-semester students who are in a course featuring simulations with fundamental cases. Typically, fundamental simulation cases are simplified, low stakes, and have basic technology management compared to final semester simulation events which are more technologically demanding. The fundamental simulation events allow the Standardized Technical Communicator to build confidence and understanding of the job responsibilities and communication skills needed to provide an optimal simulation experience. The duration of the training time/onboarding process may be altered as needed by the professional judgment of Center staff members.
Like the training of Standardized Patients, Standardized Technical Communicators are trained by Center staff members on each simulated case. Training is often provided in person. However, it has been found most effective to produce training videos for each simulation case. The Standardized Technical Communicators can view the videos before or at the beginning of their scheduled work session. This process also ensures the training provided for each case is standardized. The case-based training videos are password protected and accessible to the Standardized Technical Communicators through the Center’s website. After the Standardized Technical Communicators view the training videos, they are provided training by Center staff on
the type of patient simulator software they will be utilizing for the simulation case they will be facilitating during their work session. GVSU simulation cases are produced based on an algorithm, which are designed so that the Standardized Technical Communicators are cued on when to move from one programmed state to another state in the software, based on the learners’ patient care actions during the simulation. All GVSU simulation cases are also designed to include talking points that Standardized Technical Communicators use as verbal content to serve as the “voice” of the patient.
Daily Responsibilities
The primary responsibilities of the Standardized Technical Communicators include being the “voice” of the patient simulators/mannequins, operating the patient simulator software through pre-programmed states as learners progress through patient simulator-based events, and manipulating patient simulator vitals software used during standardized patient-based simulations. The facilitation and use of technology allow for patient data to be communicated in real-time based on learner actions or the scripted progression of the case. This often eliminates the need for Standardized Patients to use physical exam cue cards during simulations. Additional duties include the resetting of simulation rooms after learner encounters in preparation for the next round of learners. As with all Center staff, it is expected that Standardized Technical Communicators will display professionalism and adhere to the Family Educational Rights and Privacy Act (FERPA).
Before the start of any simulations, the Standardized Technical Communicators have a checklist of items they work through to ensure all technological components intended for use during their assigned simulations are in working order, including microphones, speakers, and vitals monitors. During the facilitation of simulations, the Standardized Technical Communicators work in the Center’s control room and utilize the Center’s communication system to broadcast the “voice” of the patient through a microphone in the control room, to a speaker at the head of the bed, in a specific patient care room. The GVSU Interprofessional Simulation Center has 14 inpatient care rooms, an operating room, a three-bed ward, and one maternity suite with 12 Standardized Technical Communicator stations in the control room. The Standardized Technical Communicator stations are designed so that any station’s hardware and cables may be routed to coordinate with any of the patient care areas previously mentioned in the Center. Faculty observing simulations have remote access from the faculty observation room which is conveniently located adjacent to the Center’s control room. This allows faculty to speak with their assigned Standardized Technical Communicator either in person or through commercial instant messaging software. To troubleshoot any technical issues or answer any medical-based questions that the Standardized Technical Communicators may have, a full-time Center staff member, with a health-related professional background remains in the control room while simulations are being conducted. The high capacity of stations in the control room allows for 12 simulation patient care areas to be utilized at one time. If needed, one single Center staff member can manage 12 Standardized Technical Communicators at one time. However, it has been found that a staffing ratio of one Center staff member to four competent Standardized Technical Communicators to be optimal.
After a simulation event is completed, the Center staff will debrief with the Standardized Technical Communicators to address any concerns regarding the event and how it might be
improved if the event is repeated. Evaluation procedures are being implemented in the form of quality assurance initiatives. These include designating time to review recordings of simulation events to ensure that the assigned Standardized Technical Communicators appropriately completed all expected job responsibilities. For example, Center staff will monitor that the vital signs were changed at the correct time based on the learners’ interventions or that the Standardized Technical Communicator appropriately and accurately expressed the patient’s case symptoms, while portraying the “voice” of the patient.
Standardized Technical Communicator Justification
Faculty feedback at GVSU has been positive regarding the use of Standardized Technical Communicators. Although there is no research surrounding the specific role of Standardized Technical Communicators, current evidence regarding the role of Simulation Technologists reflects faculty feedback about the use of Standardized Technical Communicators. Smaller simulation centers typically demand faculty fulfill multiple roles such as directing the flow of the simulations, changing inputs of simulator software, observing the performance of students, and resetting the room after encounters (Sibbald et al., 2019). These duties add workload and stress to faculty and may interfere with student evaluation and learning opportunities. Evidence supports the use of Simulation Technicians and similar roles. Simulation supportive staff allows faculty to focus on observing the actions of learners, adding annotations directly into the learners’ simulation video recordings, and taking note of educational opportunities to review during the simulation debrief which occurs immediately after the encounter (Lowther & Armstrong, 2023).
The decision to use Standardized Technical Communicators is made during the planning phase of simulation design. Through tabletop meetings with faculty and Center staff, resource usage is decided based on the type of simulation, level of fidelity, number of students, number of simulations running simultaneously, and timing of the simulation event. It should be noted that faculty prefer to use Center staff to fill the role of the Standardized Technical Communicator when possible. Center staff are more desirable due to their expert knowledge of simulation methodology, technology, and medical knowledge. However, it is not always feasible or cost-effective to use Center staff instead of hiring temporary Standardized Technical Communicators. Over the past fiscal year, Standardized Technical Communicators were utilized an average of 1,733 hours, which cost approximately $26,000. The total cost of using Standardized Technical Communicators is significantly lower than a full-time, benefit-eligible, Center staff.
Considerable challenges in the implementation of the Standardized Technical Communicator staffing model include the time invested and the lack of medical knowledge of the temporary employees. It is difficult to designate Center staff time for one-on-one training sessions when onboarding Standardized Technical Communicators. If multiple simulation events are running simultaneously, often the Center staff are pulled away to address and troubleshoot any technical issues. A favorable solution is to pair the Standardized Technical Communicator trainee with a competent Standardized Technical Communicator who utilizes best practices and is willing to take on the additional responsibility of training. It is the judgment of the Center staff which Standardized Technical Communicators are best suited for training new employees. Without a health-related education, the Standardized Technical Communicator may not be confident in appropriately responding to unanticipated student actions during a simulation. It is the
responsibility of the Center staff to be present and available to assist the Standardized Technical Communicators with any medical-related questions. The instant messenger software between the Standardized Technical Communicator and faculty is another means for medical questions to be answered, if needed. Additionally, faculty are capable to utilize an intercom feature, which is included in the Center’s video streaming software, to interject into the patient care room during a simulation, if needed. Overall, the utilization of Standardized Technical Communicators to accommodate demand and offset workload in the Center far outweighs the challenges posed by the incorporation of another category of temporary employees in the delivery of simulation-based education at the university.
Conclusion
The utilization of Standardized Technical Communicators at GVSU has produced several advantages besides being able to expand services and accommodate increased demand. The advantages include a successful way of filling staffing gaps, especially when obtaining approval and funding for additional full-time, benefits eligible positions is difficult, they allow for numerous simulation cases to be run simultaneously, and eliminate the need for most physical exam cue cards. Additionally, it permits faculty to observe and critique the simulations in real-time while intentionally focusing on learners’ actions and embedding annotations, as to what they have done well or need to work on, into the learners’ recorded simulation videos, which can then be used to enhance debriefing or help guide learner reflection activities post simulation. Another advantage of Standardized Technical Communicators is that many of those hired are professional actors who provide an enhanced level of realism as the “voice” of the patient, like a pediatric patient voice, crying or intense pain. Finally, a few of the greatest advantages of utilizing Standardized Technical Communicators are that they promote a very collaborative work environment, lead to overall long-term employee satisfaction, and free up time for Center staff to be continuously innovative in providing simulation experiences.
References
Brunner, B., Igic, I., Keller, A. C., & Wieser, S. (2019). Who gains the most from improving working conditions? Health-related absenteeism and presenteeism due to stress at work. The European Journal of Health Economics, 20(8), 1165–1180.
Esteve, M., Schuster, C., Losada, C., & Albareda, A. (2017). The effects of doing more with less in the public sector: Evidence from a large-scale survey. Public Administration Review, 77(4), 544–553.
Lioce L. (Ed.), Lopreiato J. (Founding Ed.), Downing D., Chang T.P., Robertson J.M., Anderson M., Diaz D.A., and Spain A.E. (Assoc. Eds.) and the Terminology and Concepts Working Group. (2020, September). Standardized patient. In Healthcare simulation dictionary (2nd, Publication No. 20-0019). Agency for Healthcare Research and Quality. https://doi.org/10.23970/simulationv2
Lowther, M., & Armstrong, B. (2023). Roles and responsibilities of a simulation technician. In StatPearls. StatPearls Publishing. http://www.ncbi.nlm.nih.gov/books/NBK558949/
Russell, M. B., Attoh, P. A., Chase, T., Gong, T., Kim, J., & Liggans, G. L. (2020). Examining burnout and the relationships between job characteristics, engagement, and turnover intention among U.S. educators. SAGE Open, 10(4).
Sibbald, M., Caners, K., & Wang, B. (2019). Managing cognitive load in simulations: Exploring the role of simulation technologists. Canadian Medical Education Journal, 10(4), e48– e56.