Table 1 Global healthcare challenges identified during consensus consultation phase
From: Global consensus statement on simulation-based practice in healthcare
Theme | Subtheme | Challenges |
|---|---|---|
Healthcare systems | System design | Systemic/societal issues impact healthcare Short term planning with regard to training and workforce Insufficient workforce resource for patient volume and burden-of-care Political pressures |
Distribution of care | Vast global inequities in healthcare quality and access as well as in training for healthcare professions Variable patient care distribution across hospitals, primary care and rural care Redistribution of healthcare also impacts social care Primary care and community care sector unable to cope with demand Increased number of referrals from primary care to specialist hospitals Lack of patient-centered collaboration between community health services and hospitals | |
Demand on services | Long waiting lists and extended waiting times in Emergency Departments Hospitals continually at over-capacity, with subsequent risk to patients Long waiting times for diagnosis in pediatric/young adult mental health Increasing amounts of mental health issues in general and specifically after covid Need for wellness plans in geriatric and younger age groups: teenagers and children Increasing complexity of the case mixes Burden of: - chronic non-communicable diseases - infectious diseases associated with vectors in tropical regions or those with sanitation problems - injuries related to general trauma and violence - Trauma victims and mass incidents | |
Funding | Uneven distribution of budget across care areas Financial limitations and budget cuts Financial restrictions impact on continued education of healthcare staff, in particular IPE - Inadequate preparation of unqualified healthcare workers - Insufficient funding for simulation programs - Sustainability of simulation programs | |
Organizational culture and leadership | Inadequate leadership Low interest in promoting best practice Political pressures affection prioritization Insufficient investment in staff development (CPD) Low priority given to educational activities Inadequate support for staff with neurodivergence | |
Safety culture | Blame culture Work as imagined v work as done Loopholes in patient safety | |
Education | Insufficient opportunities for interprofessional education in healthcare environments Insufficient time allocation for staff to attend simulation training opportunities Inadequate recognition of the value of simulation Inadequate workforce promotion pathways when working in simulation Lack of instructors/trainers/preceptors in healthcare settings Insufficient number of training positions In some settings, low volume of patients may be insufficient to maintain clinical competencies Progressive limitation in real world clinical training at undergraduate and postgraduate levels | |
Technology | Transformative consequences for the future of healthcare Lack of regulation for its introduction in healthcare Variable digital skills/readiness within workforce Slow adoption curve for change and technology in healthcare Need for innovative data management and interpretation methods, including modeling, analysis and simulation | |
Staff | Burnout | Deep gaps in pay Low pay, low morale, insufficient study leave Healthcare work is progressively less valued by the wider society Poor work-life balance Clinicians’ use of unpaid time to teach and learn Inadequate preparation of new healthcare professionals for the reality of their working life Violence at the workplace |
Availability | Difficulties in staff recruitment and retention Staff relocation International impact of migration of healthcare providers (emigration leads to skill loss, immigration requires credentialing and onboarding) Aging workforce | |
Healthcare practice | Changing scopes of practice Defensive medical practice Inadequate skills in interruption management Limited exposure to healthcare environments during pandemic in undergraduate education and consequences in care Differences in communication, application of knowledge and practice | |
Patients | Demographics | Aging population with increasing healthcare needs Intercultural context, ethnicity differences and disproportions in health Socioeconomic differences and their impact Geographical inequity |
Interaction with services | Changing expectations Patient empowerment: involvement in decision-making, access to care records and results | |
Outcomes | High mortality and morbidity rates Maternal-perinatal morbidity Young adults falling through the cracks of society (unemployed, unschooled etc.) Malpractice/iatrogenic injury/complication/error related litigations |