How Can Simulation Improve Patient Safety and Outcomes?

[00:00:00] Jared: Hello everyone. And welcome to another insightful episode of the med+Design podcast, where we spotlight the pioneers and innovators shaping the future of healthcare. Today, we have the privilege of hosting Dr. John Vozenilek, the chief medical officer at OSF Healthcare. Dr. Vozenilek's name resonates deeply within the realms of biodesign, health equity, clinical simulation, and healthcare engineering.

His leadership at the Jump Trading Simulation and Education Center, the collaboration between OSF Healthcare and the University of Illinois has been instrumental in revolutionizing healthcare, education, and simulation. From his early days as an emergency medicine physician to his current roles bridging the worlds of medicine and engineering, Dr.

Vozenilek's journey is a testament to his dedication to pursuing the boundaries of what's possible in healthcare. His work characterized by innovation, collaboration, and a relentless pursuit of improving patient outcomes has left an indelible mark on the medical community. This episode will explore the depths of his contributions, the vision behind his initiatives and his perspectives on the future of healthcare innovation and simulation.

So without further delay, let's embark on this enlightening conversation. Welcome Dr. Vozenilek, or Dr. Voz as you're affectionately called. We're happy to have you with us.

[00:01:10] John: I'm excited to be here. I was just saying that I feel like I've been anticipating this for many weeks and been thinking about it a lot.

I'm eager to share and thank you for that really awesome intro. That was pretty cool. Thank you.

[00:01:23] Jared: Thank you very much. I guess we'll just, dig right in and talking a little bit about, your background. It's very interesting as an emergency medicine physician, and how did you choose emergency medicine, then eventually working into clinical simulation, education, how did that journey happen for you?

[00:01:39] John: Once upon a time, as any good story starts I was at an academic conference as I think I was a chief resident at the time or a brand new faculty member at Northwestern and was there with a big cadre of folks, and Northwestern is a really powerful emergency medicine training platform.

Really like an academic powerhouse and, we went to this academic conference and I encountered this GI Joe looking simulator thing. And at first I was like, what is this? It's like a huge GI Joe model of a person. And I thought, man, this is weird. And I like weird stuff.

So I was all in and yeah, I think I must've been junior faculty 'cause the chief resident at the time we engaged in a simulation. And man, it was hard, and we were sweating trying to get an airway into a GI, like this big, high fidelity human simulator, and there was an aha moment there where I was like, man, we gotta do this.

This is what we have to do. Because the engagement, the level of engagement, and, just the emotions, the physical and the emotional complex there were really present. I had always been interested in learning and so that was like the thing we must do.

So I built a bunch of simulation platforms for Northwestern Community Hospital and Downtown, and the more and more I did this I had a second aha moment. And that was in the design and development of solutions. That come about because of the clinical perspective that you get in simulation.

So in the one, in one case, the utility is about experience and training and ed that leads to behavioral change. On the other is an opportunity for total system change by looking at all the problem areas that occur in those simulations. So let me give you a tangible example. So as I said this first simulation of mine was about an airway.

Okay, we were putting in an airway into a manequin, the availability of the equipment, the training around the available equipment, the location of the equipment in the system of care. All of these things are pluses or minuses that either enhance or detract from quality and safety.

As an emergency physician, time is of the essence and everything trauma, heart attack, stroke, emergency, but even just in patient care in general, cause nobody likes to hang out forever waiting for a test or a study, there's always a sense of urgency to the work we do.

So it made sense. I've gone on to really develop this and I've really seen the value, especially in the training of students who would not otherwise have a perspective into the clinical environment. They hear about it. They watch TV. They see things. They even can go in, sometimes and be overlooking a shoulder.

But I'll get into that as we move forward, I'll tell you all about it.

[00:04:23] Jared: Excellent. And talking about something that you've developed, the Jump Trading Simulation and Education Center. You've played a pivotal role in that, being the founding director, executive director, my apologies.

And can you share with us, a bit of the vision behind it and the impact that it's had so far?

[00:04:39] John: Oh, yeah, you bet. So let's go on with that story. Northwestern built a big simulation program for them. It was primarily focused on education, but there was this element of engineering that came out of the engineering school there.

And I was minding my own business in this glitzy, beautiful sim center in downtown Chicago. And I was visited by folks from Peoria, Illinois. And let me tell you, I did not know what a Peoria, Illinois was. Okay, I come out of South Florida to Chicago for training but I became engaged.

They had a passion for training and development. The medical school at the University of Illinois College of Medicine at Peoria was present and active. They were involved in simulation, but they had a vision for just an enormous simulation program. And I said, that's great. I'll help you build it.

But when I started to interweave these other concepts of design and development and the opportunity statements that could be developed, they really got excited. And so I was permitted even before I was employed here to build a center that was purpose built to support innovation, not just to do training and ed, but to do innovation work and to do it systematically and for the benefit of patient care.

And so we have a 70, 000 foot simulation space here that has an ambulance and a little home inside the building all the way up through full neuro suites and hybrid OR

stuff. And, this place is constantly humming, but it's constantly humming with students and it's constantly humming with development ideas.

Even our ventures group use our space to de risk investments that they're interested in. It's really a robust and integrated and innovation platform.

[00:06:15] Ty: What a fun environment. Like, how cool is that?

[00:06:19] John: Oh, it's truly the coolest. I feel so blessed every day to be a part of this and be surrounded by people who really.

They get it, and medicine's a tough nut to crack, all physicians and nurses they're steeped in sacred, randomized controlled trials. So human centered design is about empathy and experience, and it actually doesn't subject itself to randomized controlled trials, because that's not the real life environment.

We are simulating real life environments to create meaningful insights to develop that empathic sense and then to develop things from that. We reveal problems in unique ways and we ask the why questions that then lead to solutions. And being surrounded by all this and having been blessed by generous philanthropists, who put, the oxygen into our fuel and made fire happen for us.

I'm just excited every day to come to work. Oh, that's so cool. Yeah. It just seems too, you're addressing one of the big shortcomings too with healthcare innovation. We've talked about this where, just that lack of empathy and deeply like you said, like asking why is this problem really existing versus trying to go down more of a let's see if we can put another robot in the space without trying to understand the context for it.

[00:07:30] Ty: Like it's a, it's such a cool program you're running. I'm so tickled. You're getting to share some of it.

[00:07:35] John: I'm excited. So again, medicine the typical academic simulation center across the country, and there are many now across the country, when I first started it was actually a little unusual but now every medical school, every nursing school has access to the simulation.

The typical use, however, is focused on the learner, right? The medical learner, medical student, nursing student. Okay, great, that's really great. But to engage students of other disciplines and here you know, we've had again, the advantage of some really solid philanthropy that has allowed us to engage for universities around us.

Bradley University, ISU, Illinois State University. University of Illinois Chicago and the University of Illinois Urbana Champaign and Urbana Champaign has such a strength in engineering and development we bring those students and we teach formally those students leveraging bio design, but then leveraging this contextual information that comes from experience.

And I'll give you one other little quick secret too. I love using simulation environments to allow the student to become that good observer. Okay. They already come to us with that novice heart, that novice view. But they're oftentimes fearful of making a mistake in a clinical environment for good reason, don't touch the sterile part.

Okay. Make sure you stand over there. Don't get in the surgeon's way. Okay. We use simulation to prepare them to be better observers by taking some of that like cognitive load away from these simple things. So we train them. We train them about sterile techniques. We show them the operating room in a simulated environment, then their minds are open, their eyes are open, they can use that cognitive energy to focus on problem statements and solutions that come from them and it's been transformative.

[00:09:21] Jared: Yeah, you touched on something that in my pre research about, clinical simulation. A conversation point that would come up was around the need to really calm your nerves as an educator facilitator in order to help the participants also feel less nervous about it.

And to me, I thought that was fascinating in the sense of it's a simulation. So why would even the participants feel some level of nerves about it? There's no risk to the patient. But nonetheless, I kept seeing this as a conversation point around as a facilitator, trying to be able to calm these folks nerves.

And what about this process would be so nerve wracking for somebody to go through it.

[00:09:59] John: Yeah. So I think that firstly there's a social pressure, to perform. Nobody wants to be that guy or that gal who flubs it up, even in a simulation. And medical students and nursing students in particular, they've been tested through many gates to get to where they are.

And so they have a sense of ownership, a sense of, let's say, look, there's some ego bound up in these moments of training. And when you bring a fully realistic, fully immersive clinical circumstance to life and then you say to a person, okay, now do it the way you should do it in real life. Okay there's tension, there's pressure, people sweat the adrenaline rush occurs.

And now you mentioned two things, so the adrenaline rush of the learner or the person in the experiential space. And the adrenaline rush of the facilitator. I want to talk about both because they're both very important, but the adrenaline rush of the learner particularly in these high tension situations is a trainable moment.

I'm always interested. I'm not military myself, but I'm always interested in the way people train for military decision making and, special operations and things like this. And you can imagine the pressure, the intensity. The snap decision making in combat situations.

In those training events, people learn to address the adrenaline and harness the adrenaline to create activity. And similarly, in these medical and clinical simulations, people come to grips with the fact their body is showing stress and they can recognize, ah, there's that adrenaline rush. I need to own that and channel it to something that's for the benefit of this patient.

One of the clear lessons learned that we teach emergency medicine residents in cardiac resuscitation or trauma situations, when you're feeling that stress, that's your moment. You take a deep breath and you start to explain yourself. What clinicians often do is they get up in their own heads and they're not communicating with that communication center gets shut off and they prefer action and that causes a team dynamic to change and people start to wander into their own space about what they're supposed to do next.

Okay, so we teach leverage that adrenaline, take a deep breath, start communicating. Okay, I'm doing this because, this is my working theory about what's going on and what's next people start to chime in and say, Hey, I have this observation. It's a little different than what you're saying.

How do we incorporate that new information? And that's how you get to better resuscitation, better care of patients. You could say, that's a micro that becomes a macro example across systems of care, frankly. Okay, so facilitators. Now, so you're a hardened ER training, doc. You're watching residents goof up.

And you're like, passionate about this. You have to set aside all of this. What we see people doing is they fail to ask the why questions when they're first facilitating. They just leap into sort of a didactic mode. Hey, next time don't do it that way, do it this way.

This is the way you're supposed to do it. They don't ask the why question. So tell me, why did you do it that way? I did it that way because in the open ended question, in that open ended format, it reveals the answer. Usually, the fact that people are very rational, they're very intelligent, they're making decisions, and maybe the decision wasn't the right one because there was something missing, or maybe even from the perspective of the facilitator, they didn't understand what was going on at that moment.

I have many examples and I feel like I'm rambling on here a bit. So you guys can tell me.

[00:13:34] Ty: This is fascinating. Yeah, please go ahead.

[00:13:37] John: We take our simulation equipment, we go and run it out to these small community hospitals. In real ERs, okay. And we put on a pediatric resuscitation. Let me tell you people especially for pediatric care the care of a child who's in desperate straits.

Emotion, you're bound up in this, like you really want to do a great job, even in the simulations. And we actually ran a series of simulations, which were designed to promote an understanding of the system's ability to take care of critically ill children, especially when an airway is necessary.

So the rescue airway. People got really upset with us. They thought that we had hidden the equipment that they needed in between cases, and we would never do this. That is not good for safe psychological learning. In fact, between two cases, as we did a debriefing, there was a new policy initiated.

Where they decided that they were going to store the equipment, the life saving equipment in a locked drawer. And it happened like at 8 o'clock in the morning. And across the hospital at 8 o'clock in the morning, people locked up that special equipment. When we ran the case at 815, they couldn't find the equipment.

The system problem was like a memo did not go out to everybody. Like the simplest thing was a major barrier to a life saving resuscitative team doing its optimal best. It was revealed by the simulation event.

[00:15:01] Ty: Oh, so it wasn't in a life saving event where it was needed, but rather in the simulation, you're able to catch it before it became a critical to a bad outcome.

[00:15:09] John: Right? Yeah. And that brings the 3rd phase of this whole thing. So we have the learner context. We have the design context. And now we have the system safety context. So we feed those critical events that are discovered. So in engineering, failure modes and effects and criticality analysis, right?

In medicine, root cause analyses, right? These are retrospective tools, for the most part, right? Failure modes, sit in a room and try to contemplate what would happen, okay, fine. But in simulation, you're actually seeing it come to life. And then we report those into our safety systems.

So that those who are in charge of system safety can actually take them and make them into actionable things that bring change. I promise you across our hospitals, we don't lock stuff up without making sure everybody's briefed on where that equipment is now, because we discovered the problem in simulation.

[00:15:57] Ty: And so you're able to then take that learning and then push that throughout the health system. Correct. And again, it seems like it's a critical connective tissue for what you're doing, right?

[00:16:06] John: Precisely. And all health systems and all hospitals, they have a incident reporting system.

It's essentially a mandate, right? But to connect the simulations into that, it was novel, right? They say, Hey, we discovered this in simulation. Our risk is high because if people can't find the equipment and it's solution, simple. Just make sure there's good communication. Yep.

[00:16:27] Ty: As you were talking about that, it reminded me of a Harvard Business Review article that was looking at the different branches of the military and how that background experience coming out of the military, the different roles and innovation that those lend towards.

And so if you were in more of a lower structured, like decentralized command, like the Marines or army where need to be able to react to local conditions, those leaders coming into a civilian world and innovation tend to do really well as startup CEOs. Because it was like reacting to local conditions and being able to pivot based upon like real time sensing and then if you were in more of say, like the Air Force or the Navy, then that extreme process control, you excelled at say large and more complex innovations that were like corporate like drug development and whatnot, where you had to follow a process and commit to that.

In order to deliver outcomes. I'm curious if you see an analog to that with from an emergency room physician standpoint and like the different specialties that go through your program and those perspectives and where I guess your clinical background might influence your approach to innovation.

That's just a came to mind for me as you were talking about that.

[00:17:40] John: A hundred percent. Now in our innovation center here, we have the embodiment of these themes because it isn't just our SIM team and our engineers that work here. And, so we have simulation specialists who put on really high quality simulations, across the spectrum of medicine and nursing

for sure. Then we have engineers that we employ primarily biomedical because they have a breadth and depth that's appropriate. We have computer scientists, we have designers and development 3d and other solutions. But we're also surrounded by performance improvement. So these are the sort of command and control elements to bring institutional change at scale.

And so the things that are designed and development here are the ideas and the solutions that are designed and developed. Then actually can go through a process to actually be integrated across the 16 hospitals or healthcare system and potentially beyond. There are other disciplines in this building and co located purposefully for that integrated innovation experience again, ventures, health analytics

so access to data. Our clinical intelligence division that works on machine learning and natural language processing all of these. Really really cool. 10 years old, but still emerging technologies in health care. They're all here so that we can take ideas and move them meaningfully forward.

And you need different types of backgrounds. So I would be the risk taker and the let's just get 'er done kind of guy in our system, but I'm surrounded by luckily a bunch of people. Okay, Voz, no we got to take that to our next committee. So we can begin to do the changes required across scale.

[00:19:18] Ty: Yeah, every successful team has a yes and a no and leadership. So we have all kinds of levers pulling us in different directions. Yep.

[00:19:27] Jared: So I did want to touch on your role with OSF healthcare as well as chief medical officer and, what are your primary responsibilities and also the main challenges that you're up against and opportunities that you're encountering in that role.

[00:19:40] John: So I work with other chief medical officers who are, so I'm a chief for innovation and digital health. And so I bring solutions across the ministry by collaborating with chief medical officers across our system at operating units, our hospitals and clinics who are actually in the day to day practice of taking care of patients and the influence and the development of ideas that happen in this innovation center and in our innovation hubs, which are located in several of our hospitals now.

As an effort to push beyond the boundaries of this bricks and mortar building, then take hold in those operating units. And it takes a lot of communication back and forth. It takes the review so we talk about pitch decks and I saw the podcast regarding the students in the Coulter College.

And I was a part of that recently. And it's really a joy for me too. So it's the constant sense of pitching, but you're not pitching for a VC or an investment, like a monetary investment. It's an investment of time and will and effort to create the change in the operating unit, which by the way, is massively constrained.

Massively constrained. So we're constrained by labor shortage. We're constrained by positive features like regulatory controls and other things. We're constrained by restrictions of flow of patients to get the care that they need in many cases for our Peoria based healthcare system, there's another constraint.

So social determinants of health and rurality. Rurality, just even getting to appointments and all of that is a constraint and so overcoming those constraints actually it creates a lot of meaningful work for our teams here.

[00:21:14] Ty: So you talk about I guess the pitch process, maybe an analog might be stage gate where you've got different levels of maturity for your presentation.

So it's meant for internal consumption.

[00:21:23] John: Meant for internal consumption. And like any good conservative system, there are energy gradients to get across at each stage. No good idea passes through the system without massive inspection and iteration across many disciplines. And you just have to be aware of that.

You gotta be bold and consistent, but at the same time, respectful of the fact that the change will take that kind of consensus.

[00:21:48] Jared: Something that you allude to as well was the balancing between what's best for the patient and then what's best for the providers as well.

And how does clinical simulation and advanced informatics, play a role in enhancing this balance between trying to, do what's best for both at the same time and advance processes, like how you're saying and innovate new processes as well.

[00:22:07] John: I think the answer to this is best by touching on one of our areas to illustrate. And the pandemic is a good one to take a look at. So our innovation center, I mentioned it's a big building. 70, 000 square feet of sim space.

There's another 100, 000 square feet of innovation space. When it hit, the first thing is okay because of the constraints of the disease and transmission, we need to slow down on a lot of the educational practice that we would have otherwise had. We just need to focus on cooperation

surrounded by innovators from every discipline and with a passion to ensure that we we're taking care of patients. We actually converted this innovation space into a telehealth hospital. So hundreds of providers that were, like, we took our auditorium and we converted it entirely into 120 desks, each six feet apart, so that you could take care of patients on the wire.

And we had stages and new workflows, so from patient care tech to nurse to physician to specialist in the building taking care of people online. Now the barrier of course, and it was actually getting things hooked up in people's homes with the constraint and concern of transmission.

And like, how do you invade people's homes? And bring them remote patient monitoring, and bring them hospital at home, and bring them all these solutions. So you may have the capacity at one side, but on the other end you need to anchor it. So we trained and employed, using simulations, community health workers.

And at first we called them pandemic health workers. We focused on the provision of new technical solutions that go into people's homes. We knocked on the door in our simulated house downstairs. We had standardized patients who are patient actors give conversation about, so you want to come into my home and you want to put in a temperature sensor in my home to take care of me?

Isn't that invasive? Have these conversations. Rapport building, communication skills, trust building around the technology and training around the technology took hold and we leveraged simulation to make this happen and then to push it out at scale. So we were taking care of 90, 000 patients across central Illinois in short order because we converted this innovation space into a practical space to train for the pandemic.

[00:24:29] Ty: That is so incredibly nimble. It was the fact that you can be like, just there's the paralysis of what do we do now? And there's no best practice and you were able to quickly start generating okay what if we take this approach and build something that could respond? That's so fast. It's just it's just such a cool story. I hope you got just like that story told in lots of places.

[00:24:53] John: It was an exciting time and honestly, and it'll sound a little oh, okay, here he goes again.

But the patient experience was at the center of this. What is the patient encounter? Many patients were going to be sick, but they didn't need to come to the hospital. The hospital's reaction was, hey, we need to protect ourselves from the onslaught. Okay, that's a very understandable concern, and it was realized in many spaces.

But that's not truly patient centered, that's system centered. Moving it back into the patient centered zone, what's best for the patient? We need to go out into the community. We were not equipped to do that. And so there's your problem statement, and the solution build was... let's leverage the simulation innovation space to make that happen.

The good news also from the story is that COVID quieted down. We had learned so much about telehealth. We actually built a separate telehealth hospital just up the street. They now employ about 700 individuals who provide telehealth across our entire catchment. The origin story, the birth of that is something we're proud of.

But now we've converted and created tools for chronic care management. So we talk about diabetes and the major hitters, hypertension, diabetes, cancer prevention. And so we've converted these same tools like that community outreach into tools that help us to sustain our communities in a more helpful way.

And again, the focus is on patient care and that's where being a clinician and, being chief medical officer, the medical part is. Like it's about people, let's remember that. That's what we got into this to do.

[00:26:20] Jared: And you've talked a little bit about, this like people initiative.

And I know that's something that the Peoria innovation hub has been working on as well. And it's a very commendable initiative. I've I really was curious of what's the vision behind it? How did it really come about? And how do you see it really impacting the wellness of these underserved populations that you're targeting?

And I'm sure there's been some noticeable impact already, like how you just talked about as well for the impact of what you've had with this work on the sickness side of things, but that's totally different.

[00:26:48] John: Let's contemplate this in this way and I again, I reflect on the Coulter experience for some of the inspiration for some of these things.

The 1st time I did the Coulter C ollege experience, I think it was 2015 there was another aha moment for me where so I'm an academic person. I'm like a professor of medicine, for University of Illinois, and I'm a professor of engineering at University of Illinois.

And I'm also, work as the CMO. But the idea of an academe is to produce papers, and produce generalized through knowledge transfer. That's one of the, PhDs are formed, DCs are formed for that purpose, right? That's the point of the realm.

Industry and the idea of sustainability through a proper investment was the aha moment, the discovery in working with students for the Coulter College experience many years ago. The other form of sustainability is to bring those ideas to commercial presence so that they can be sustained in a meaningful way.

And it can be developed and the ideas that come from a problem statement are reduced to minimum viable product then actually then can be supported long term and actually grow. So the idea of connecting this ideation the processes of ideation, the process of development, then bringing that into proximity so that entrepreneurship

can occur is the core principle of the Peoria Innovation Hub and the core vision of the University of Illinois. So they have created a, in Illinois and Illinois Innovation Network, which are these hub activities that are intended to draw from the academic environment and create investment that build businesses that roll to scale, right?

So that is one measure. And we've seen things from our programs of activity. Again, we're very blessed with philanthropy. One particular philanthropy provides about 4, 000, 000 a year and about 100, 000 per project funding where you pair a clinician and an academic to develop some new intellectual property, some new know how, and we've had good startups come out of that.

Some virtual reality companies, some software companies, but how do you harness that idea and then get it in front of investment to create sustainability? So they can move forward. That is the solution set that comes from Peoria innovation hub and from the Illinois innovation network. And it's a joy to be a part of that as well.

Honestly, our experience at Medtronic most recently where they sponsored the Coulter College, this was very much present. The origin story of that company, that enormous company that provides value I have no, nothing to disclose but is, a story of a need, right?

The development of the first pacemaker for children, in a massive power outage and look at the impact and the sustained impact across populations across the world because there was purposeful investment, there was growth and a sustained effort and development of new technology comes from that.

I love being a part of that type of ecosystem. That's where that's at for us.

[00:29:51] Jared: Awesome. Thank you for that. We've got a really interesting question in the chat as well. Going back towards the context of the pandemic and it's from Mark Doose, he says: I've been able to teach that ability to be nimble within the simulation environments.

For example, are there, sim trainings that demand a clinician slash student observe and respond to a situation they have not seen before in an agile and innovative yet safe manner. Curious if this may help spur innovations.

[00:30:20] John: Yeah, I think there's something to be said for this too.

So in a manner of speech there's some core principles here, so in emergency medicine you think you're taking care of a patient with condition X. But pretty quickly the data don't line up properly there are data that are outside of the paradigm that, you're taking care of the condition X.

It's actually the condition Y, which looks very similar to X, and you have to pivot because the therapies are different. And that idea of being able to be observant of the data and not to just become anchored on the data that supports your opinion. But to move beyond that and to assimilate that new information and move in a different direction is trainable.

It's trainable clinically. It's also trainable for design and engineering teams as well. I think on your prior podcast, the students said that they got input from a variety of sources like the clinicians were telling them to do different things and the different VCs are telling to do for different things.

And they assimilated that information. They kept to their core understanding of the solution. The value is providing and they went into a new direction. So I agree. These things are trainable. I think experience. Is the difference. You can more if it happens to you once and randomly it probably doesn't lay down those good like tracks and in your brain on how to react.

If you can train to this, you can become accustomed to it. You become non threatened by the new information. You're more able to assimilate it. Actually, frankly, it's akin to what I said about students encountering the clinical environment when you de escalate that cognitive load and just the new the state of the new.

It allows people to use their discipline and move forward both in innovation and education.

[00:32:00] Ty: That's really something you just have to experience. You can't just hear about it. You have to feel what it's like in that moment to have that cognitive dissonance of hearing just like conflicting inputs and then be able to chart your own path and make sense of those inputs you're getting.

[00:32:15] John: Yeah, I'm an apologist for personal experiential things and, you could say, Hey, I've watched a lot of VC pitches. So I feel like I could do one.

Not until you're standing tall, in front of the board and you're looking at the faces and there's some people going wow, and some excited, some not so excited. Until you've had that experience primarily. Yeah. And so simulating it. So the value proposition for our students is to bring them into these simulated I'm pitching an idea.

I'm pitching a device. I'm pitching for investment. Everything becomes smoother. They become more articulate, they become more focused. They're able to handle a question that was unexpected. Why is that? It's because of experience.

[00:32:59] Ty: And we definitely with our shared experience at Coulter College, we definitely saw that maturity happen between 1st presentation,

2nd presentation is just getting reps in as far as standing up, presenting an idea, figuring out what works and doesn't about it. So absolutely elaborating on that is fascinating.

[00:33:15] John: Let me pull something from the disciplines that you guys brought to the Coulter College. This idea of user centered design.

The idea of being able to be broad and thinking and then focus channel down to some viable potentials and then broaden out into all the different ways that those potentials can be executed and bring it down to minimum viable product. The butterfly model or the other models. Those things also are trainable I think, and we love working with user center designs in our designers in our space because.

It isn't you can see I love me some sticky notes it isn't all a theoretical exercise and notes on a board in the case of simulation, right? You can actually perceive, see, interview, why I noticed you did that. Why did you do that? We've always done it that way is 90%.

It's 90%. We've always done it that way. But anyhow, to be able to dissect that, to interview to make those sticky notes come to life, right? And the proposed journey like great journey maps, but actual simulations of journeys that patients are on is very powerful technique. I would say that for the Coulter training as one outlet for this.

I cajoled the students, and I want to say this on your podcast, too. There's so many simulation centers across the country now. If there is a student, an engineering or design student, or a student from any discipline, that's leveraging user center design to create change in their discipline.

And it relates to health care. They should reach out to their local SIM program because there are opportunities. And I'd be happy personally as a person who has been involved in this field for a couple decades now I'm happy to work out and reach out to those academic simulation centers and help to bridge the gap if there is one in creating simulations so that students and people who want to ideate can actually bring them to their local some program for development.

Our students came from, colleges and universities across the country. All of them have SIM centers. I'm pretty sure they didn't realize that those were tools and resources just as important as the Internet. And the library and all kinds of other resources at their fingertips.

[00:35:21] Ty: Yeah, I appreciate you being willing to put that forward.

And I know we know of some other simulation, but I think as far as, having that be a widespread use case for all innovation teams to be thinking about in healthcare and like speeding that because it is such a complex and with entrenched constraints you have to work through and using that in order to be able to accelerate the path to innovation and some of the stories you've shared are just so fascinating and it demonstrates the application of the principle.

[00:35:48] John: There are no end to the number of ideas that can come out of this type of process. And so the question is what is in our field? It's what is best for the patient, right? And how is the environment promote safety, make the right thing to do the easiest thing to do to reduce workflows that are

outside of the norm that lead to tracks that bring patients away from quality and safety. That's constant journey. So that's a great joy to be a part of.

[00:36:19] Ty: John, I think you mentioned you had some slides. You wanted to share and just keeping out of the time.

Was there something that you wanted to pull forward?

[00:36:25] John: I will let's see if I can do this elegantly here. So this is a real picture of a neonatal intensive care unit.

The wires, tubes. So this is a real charge nurse within one of our hospitals pictures taken with permission. This newborn, is not where you want to practice for the 1st time on anything. And likewise, when you bring engineers and designers into a space like this, oftentimes, the first thing that they realize is there's just an abundance of tubes and wires everywhere and they become fascinated drawn into this, where is Waldo of tubes and wires all over the place? Again, this is not necessarily the one solution. Invariably students kind of gravitate to that and all of a sudden I'm getting all these projects coming out. I'm like, how do you make the tubes and wires disappear? Okay, great. But, the workflows around this they exist for a purpose.

And so we talk through with contexts like these but instead of using the live environment where frankly, student involvement is obtrusive. The simulated environment is the place to go. And so here is the simulator here on the left and the next step is to figure out how to bring those experiences to a greater scale.

And so we're leveraging virtual reality, and we've created some, and this is a picture from our space. This is Dr. Matt Bramlett in the foreground on the right side. And we've co developed a solution in virtual reality that allows people to actually bring 3D objects in and to examine them more purposefully.

We use these today for congenital heart cases. So surgeons, live surgeons actually bring CT and MRI in through the virtual reality using tools like this. And then they plan surgeries that are happening just days and sometimes hours later by revealing the anatomy in unique ways. But the important part is bringing these experiences to some scale.

So in our future, and that's part of the mission set here, is to bring a scalability to the simulation technique through virtual reality, through augmented reality, and mixed reality. So that the image on the left, which is the child and the socio technical system around the child can be then recreated at scale through head mounted displays or augmented reality.

And so that's a portion of our journey as well. Let's see if I'm just hesitant to click this thing because it's going to jack me up. Okay. And to that effect we have another little story to share. So here on the left, this is team training as it exists in the simulation world.

So this is a team surrounding an infant child simulator. And here you see a simulated mom and a care team and the complex social technical system is revealed here as well. And so you can imagine that teams of engineers and students can look at this environment and realize that there are all kinds of problems to be addressed and ways to simplify, right?

Okay. So in the right most of this left photo here, we have a pediatric code blue cart. Okay. So I have to tell you a little story about the code blue cart, the code blue cart has all the life saving equipment locked up in it. And the locked up is a really essential term because. It's locked.

And so you don't like to unlock it because then you have to send it down a central supply to be restocked. So you don't routinely for training purposes, open that crash cart. And so the solution that was developed is to recreate the crash cart in augmented reality. So in the upper right of the left picture, we actually instantiate in augmented reality a crash cart.

It can be used on a mobile device. And by the way, these apps are offered for free. We put them on the App Store and Apple and Android for the benefit of anyone who wants to use them. It has three modes. You can explore the crash cart and free explore mode. You can have a timed event or you can have a scenario driven event.

And what happens in our creates efficiency for our trainees. Okay. So we don't have to we can send the app to their home and say, tomorrow, you're going to practice pediatric resuscitations. We want you to know everything in the crash cart before you come so that we can focus on the team training events.

Okay. These augmentative solutions help us not just for the educational event, but also help the designers to realize spaces that are locked inside of health care, right? Unlocking those spaces and bringing those unlocked solutions to scale is part of our mission set.

The other image on the bottom right is routinely, whenever there's a new device or solution that's been introduced into our system, and we do get a lot of resuscitative or lifesaving solutions from military purposes and other things. We actually simulate them first. So to help our trainees spread the word about the proper use of device, how it should be integrated into the system, how it should be stored, et cetera.

And all that is part of our agile system to improve.

[00:41:22] Ty: And I'm just so tickled to see the 410 medical LifeFlow infuser there.

[00:41:27] John: Oh, yeah, again, no conflicts. But

[00:41:29] Ty: and that's one where we had Galen Robertson on the podcast earlier, and we designed the first prototypes for the LifeFlow there.

So it's just neat. Yeah.

[00:41:38] John: All the way back around.

[00:41:39] Ty: Yeah, I have one over. Hold on, let me grab it here.

[00:41:43] Jared: I knew Ty was going to be super excited to see that in there. It's the lifeboat! We're there!

[00:41:48] John: Yeah, this is no setup team, I'm telling you. Oh, just a cool coincidence, yeah.

Very cool. Yeah. Maybe not coincidental, because I think, brilliant solutions like this they come into play. And then systems like ours who want to integrate that brilliant solution need a platform to disseminate and show people how it's best used. And there's a reason this exists, I think.

But again, those images are intended to tell a story about our current state. The types of work we're doing and then what we think are the barriers to be overcome in our discipline for spreading the word, for bio design, for design development for those interested in improving and it can I put in a plug for one other thing, the engagement of youth.

The SIM platform is a beautiful platform, and we have a robust SIM program run here by know Noelle Adams, our vice president for academic partnerships. To go very young so to grade school and high school to allow people to realize that their talents and gifts can be used to help people. Even if you're not, you don't want to be a doc groovy.

You don't want to be a nurse groovy. You want to be an engineer. You want to be an artist. You want to do math and science. However you want to do it, you can come into healthcare and help people. And so contextualizing that and showing people how, beautiful lines form the life flow device. And why not use your talents for good? And we hope we're inspiring youth at scale as well. Definitely inspiring us.

[00:43:14] Ty: This is such a phenomenal, just it's so cool to learn what you've been, what you've been building. So

[00:43:19] John: that's very kind. I appreciate you.

[00:43:22] Jared: I know we're getting closer to the end over here.

Something we talked about is the current state of what's going on in the simulation space, but as somebody that for yourself that's really been at the forefront of it kind of the entire time where do you see the simulation space going for the next decade, for clinicians and physicians and hopeful innovators?

[00:43:40] John: So I'm going to say something that is not a popular opinion. So our simulator devices they're computer peripherals for the most part, right? What computer peripheral in today's state hasn't changed in the last, say, 5 years, 10 years, 15 years? So the G

I joe mannequin that we were using when I was a resident, and that's a long time ago based on my gray hair. That is pretty much not changed in that duration. And their computer peripheral. So you're like, wow, how is that even possible? And it's true. Now, wireless were improvements.

It creates some greater durability flexibility as well. But. Frankly I think there's a call to action for our simulator companies to actually, innovate as well. New sensors the use of mixed reality, I think is clearly something that needs to happen. This is why we've invested in our internal innovation space and augmented reality and mixed reality and virtual reality.

And again so the solutions that we're hopeful for bring scale. We have a great big simulation center and deep gratitude to this healthcare system and the philanthropists that helped to build it, but how many of these do we really need? How many giant SIM centers do we need? I think we need scalable solutions that bring these types of experiential environments to the small community hospitals.

To the rural locations to clinics across the country, and frankly, we're very eager to partner with institutions that are interested in quality and safety at that scale. That's what I think our future looks like. I think also frankly, and especially the insight that we gained in working with our colleagues at University of Illinois and engineering.

The ability to use sensors of variety of types and structured light and all kinds of things to just have hands off, but still be able to record movement and information about efficiency need to be developed for these training and educational purposes as well.

[00:45:35] Jared: Wow. Something I did see before I ask you the last question is that I saw that someone would be hopeful that there would be some level of artificial intelligence integration where you can actually simulate a real person, like talking back to you on the other side and like conversing with you as you're going through this experience.

And I thought that could be an interesting everyone just AI stuff. And I thought that could maybe be something interesting,

[00:45:58] John: right? I sat through a demonstration of an avatar based artificial intelligence driven large language model driven. So I don't know if I got enough buzzwords in there, but anyhow this tool.

Was able to come up with a conversation around a particular disease state by ingesting textbooks of medicine on the disease state. But then we were able to say, okay, now read it back to me at a high schoolers reading level. And it conformed and changed the way that the speech and the tech.

Then we said, okay if I was the doc, what would I have to, how would I explain this? To a patient with low literacy, and then it modifies it and brings it so the field is moving massively and rapidly. And we do see that these tools will be integrated actually, I think, within it within 1 year.

If not even sooner because they're so powerful and in medicine, one of the great challenges is, you know, we take care of people. We do a good job, especially when they're in a hospital. And then they leave us. For And a lot of times they're not really, they can't recall what they're supposed to do next or exactly what happened and et cetera.

And you can imagine how these types of intelligent avatars and other things could explain, re explain, keep people on the right track and also alert when things are off track. So yes.

[00:47:17] Jared: Coming in the near future. Also, not even the next decade, like we're talking about next year. No

[00:47:22] John: I'm looking at some stuff right now that I want to integrate actually in calendar year 24.

I'm looking forward to seeing that as hopefully we get to learn more about it as you launch it. And, just as we're wrapping up here, you've been an educator for quite some time and you've been influencing sort of the next generation of folks to come after you even with stuff like Coulter College.

[00:47:42] Jared: And for these like earlier stage physicians, clinicians, bioengineers that trying to follow in your footsteps of innovation and, trying to actually change patient care. And they want to sit in your seat one day. What would be a piece of advice that you'd have for them?

[00:47:56] John: Begin mentoring early. Be in the experience. One thing that we've touched on frequently here is that the experience drives value. Get out there, start mentoring. There are many programs today where they need the input of medical students to advise engineering teams or residents in training or others to advise. And I would direct people to look for those opportunities to practice that skill because, it is a skill and it can be acquired over time. So get involved right away. And then the other thing that I said, and I will hold true to my promise.

I will work with. Academic medical centers have simulation programs across the country to try to help people gain access to simulation as a particular tool for design and development. If they desire it, I'm more than eager for them to reach out. And I don't know how you guys want to do that, but we'll.

I can share my will help facilitate those.

[00:48:45] Ty: Absolutely. There you go.

[00:48:46] Jared: Yes, indeed. And on that note, Dr. John Vozenilek, thank you for the work that you do. Thank you for the taking the time out, to talk to us as well and share your experiences. It was super insightful. And I know we definitely learned a lot and hopefully everyone that joined us learned a lot today as well.

And good luck on your future endeavors. We know you're mid career right now. So we're excited to see the rest of the impact that you have in front of you.

[00:49:06] John: Outstanding. I really appreciate the time with you guys. Good to see you.

[00:49:09] Ty: Good to see you too. Thank you.

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