It is not understood how cardiopulmonary resuscitation (CPR) training, specifically the representation of sex in CPR manikins, contributes to inequitable outcomes in cardiac arrest survival. The aim of this study was to identify the sex and chest wall secondary sexual characteristics of CPR manikins on the global market. The secondary aim was to identify if manikin manufacturing companies had a publicly available sustainability policy or equivalent, and if these covered products were manufactured. We conducted an observational descriptive study of the secondary sex characteristics and named sex of CPR training manikins available on the global market, and equity, diversity and inclusion (EDI), human rights and sustainability policies of the companies that manufacture them. Nine CPR manikin manufacturers were identified. Twenty CPR manikins were included for analysis. Of the 20 manikins, 75% were identified as male (n = 8, 40%) or no gender specified (n = 7, 35%) and all these had flat torsos-one had a breast overlay available. One company had a 2020 sustainability report that addressed EDI for the workforce only, and a 2023 report addresses this for products manufactured. Adult CPR manikins available globally are largely homogenous, flat-chested and do not have secondary sex characteristics or a named sex. One company had a sustainability report that referenced workforce only and has since committed to EDI for products manufactured. We urge CPR training providers and manufacturers to collectively promote a rights-based approach to healthcare aligned with the commercial determinants of health by committing to improving the diversity of CPR training manikins.

In situ simulation (ISS) programs deliver patient safety benefits to healthcare systems, however, face many challenges in both implementation and sustainability. Prebriefing is conducted immediately prior to a simulation activity to enhance engagement with the learning activity, but is not sufficient to embed and sustain an ISS program. Longer-term and broader change leadership is required to engage colleagues, secure time and resources, and sustain an in situ simulation program. No framework currently exists to describe this process for ISS programs. This manuscript presents a framework derived from the analysis of three successful ISS program implementations across different hospital systems. We describe eight change leadership steps adapted from Kotter’s change management theory, used to sustainably implement the ISS programs analyzed. These steps include the following: (1) identifying goals of key stakeholders, (2) engaging a multi-professional team, (3) creating a shared vision, (4) communicating the vision effectively, (5) energizing participants and enabling program participation, (6) identifying and celebrating early success, (7) closing the loop on early program successes, and (8) embedding simulation in organizational culture and operations. We describe this process as a “longitudinal prebrief,” a framework which provides a step-by-step guide to engage colleagues and sustain successful implementation of ISS.

Background Healthcare simulations generate moments of ‘cultural compression’ through which we transmit core values about our professional identities and the families we care for. The engagement of healthcare consumers in this process is useful to evaluate the values we transmit and ensure authenticity in the narratives we share. Methods A simulation package on febrile neutropenia and port access was written by healthcare staff in consultation with the parent of a child with leukaemia. Healthcare consumer review was focused on the representation of the simulated parent within the simulation scripts. The child and his mother assisted in the development of supportive video resources on family perspectives on port access and demonstration of the procedure. Results The involvement of healthcare consumers in the development of the scenario had positive impact on the design and the supportive resources, both of which created opportunities for patient advocacy and reinforced the centrality of healthcare consumers within the healthcare team. Conclusions Healthcare consumer collaboration in scenario design was achievable and impactful without significant increased cost. We hope to promote the benefits of healthcare consumer consultation in simulation design to improve the pursuit of educational and cultural learning objectives.

Building a new healthcare facility is complex and poses challenges in delivering a facility that is fit for purpose and designed to minimise latent environmental and process errors. This article summarises what the disciplines of Human Factors/Ergonomics and Simulation can offer to the design and testing of new hospital builds. It argues the incorporation of both disciplines throughout the planning, design, commissioning and operations phases of the building project can minimise latent safety risks to promote patient safety and staff well-being across the building lifecycle. Future directions and policies should include incorporation of human factors design and mandatory process testing before opening.

Background Shared leadership is associated with improved team performance in many domains, but little is understood about how leadership is shared spontaneously in maternity emergency teams, and if it is associated with improved team performance. Methods A video analysis study of multidisciplinary teams attending a maternity emergency management course was performed at a simulation centre colocated with a tertiary maternity hospital. Sixteen teams responding to a simulated postpartum haemorrhage were analysed between November 2016 and November 2017. Videos were transcribed, and utterances coded for leadership type using a coding system developed a priori. Distribution of leadership utterances between team members was calculated using the Gini coefficient. Teamwork was assessed using validated tools and clinical performance was assessed by time to perform a critical intervention and a checklist of required tasks. Results There was a significant sharing of leadership functions across the team despite the traditional recommendation for a singular leader, with the dominant leader only accounting for 58% of leadership utterances. There was no significant difference in Auckland Team Assessment Tool scores between high and low leadership sharing teams (5.02 vs 4.96, p=0.574). Time to critical intervention was shorter in low leadership sharing teams (193 s vs 312 s, p=0.018) but checklist completion did not differ significantly. Teams with better clinical performance had fewer leadership utterances beyond the dominant two leaders compared with poorer performing teams. Conclusions Leadership is spontaneously shared in maternity emergency teams despite the recommendation for singular leadership. Spontaneous leadership emerging from multiple team members does not appear to be associated with the improvements in team performance seen in other domains.

Once considered solely as an educational tool in undergraduate education, simulation-based education (SBE) now has many uses. SBE is now embedded in both graduate and undergraduate nursing education programs and has become increasingly accepted practice in hospital orientation and transition-to-practice programs. Newer applications include ongoing professional education, just-in-time training, teamwork development, and systems testing. This article highlights the changing landscape of SBE and describes elements critical to its successful use, including facilitator competencies, the necessity of providing a psychologically safe environment to enable learning, and the importance of addressing other safety concerns, such as the possibility of accidentally introducing simulated equipment and medications into real patient care.

Maternity emergencies require effective leadership due to their time-critical high stakes nature, and like many emergency teams are recommended to have a singular leader. Midwives possess many of the skills required for leadership, but the extent to which they contribute to leadership in emergencies is unknown. In this video analysis study of 16 interprofessional teams responding to a simulated post-partum hemorrhage, a functional view of leadership was applied to determine midwifery contribution to leadership. The number and type of leadership utterances by team members during an emergency response was assessed, and midwifery and doctor leadership utterances compared. Midwives contributed just over 40% of all leadership utterances, indicating the occurrence of interprofessional shared leadership, despite the recommendation for a singular leadership. While the number of leadership utterances per scenario was similar for midwives and doctors, midwives contributed less to utterances of a clinical nature compared to doctors but a similar amount of non-clinical leadership. Further exploration of the factors which influence midwifery leadership in emergencies and the impact it may have on patient care is warranted.