‘You don’t see what I see’: Co-designing simulation to uncover and address cognitive bias in healthcare

Abstract

Educational challenge

Each year, adverse events are reported in healthcare, of which many relate to healthcare workforce cognitive bias. The active involvement of workforce and consumers in the review and co-design of effective training for the healthcare workforce to recognise, monitor, and manage unconscious bias is required.

Proposed solution

We used participatory action research to co-design an innovative, interprofessional simulation based on ‘real world’ clinical incidents and lived experiences to improve the delivery of safe, high quality, consumer-focused healthcare. Following ethics approval, content analysis of serious adverse patient safety events involving cognitive bias was conducted. These data informed audio-recorded interviews with the healthcare workforce and consumers to explore their experiences of cognitive bias. Following thematic analysis, key themes of communication, stigma, diagnostic overshadowing, and fragmented systems were uncovered. Guided by consumers, these themes were interwoven into a simulation scenario that included real places, stories, and verbatim quotes delivered through mixed media artefacts. This heightened the immersive and experiential learning that aimed to uncover unconscious bias and help learners recognise its impact on clinical decisions and practice.

Potential benefits and next steps

To our knowledge, this is the first interprofessional, co-designed simulation to specifically address cognitive bias in current and future healthcare workforce. Plans to translate this research into a practical framework on how to work with key stakeholders (including consumers) to identify ‘real-world’ health service risks and co-design targeted simulations to address these gaps are described, including lessons learned.

Keywords:

• Co-design
• consumers
• cognitive bias
• implicit bias
• simulation

Acknowledgements

The authors extend their gratitude to participants who shared their experiences of cognitive bias and partnered in the co-design process. We acknowledge Dr Sue Sinni in project conceptualisation and funding from Monash Nursing and Midwifery Research Development Grant and Peninsula Health.

Disclosure statement

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the article.

Additional information

Funding

This work was supported by a Monash University School of Nursing & Midwifery research development grant and matched in-kind contribution from Peninsula Health.

Notes on contributors

Gabrielle Brand

Gabrielle Brand, PhD, Associate Professor, School of Nursing and Midwifery, Sub-Faculty of Health Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Victoria, Australia.

James Bonnamy

James Bonnamy, MNurs, Research Fellow, School of Nursing and Midwifery, Sub-Faculty of Health Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Victoria, Australia.

Samantha Dix

Samantha Dix, MNurs, Senior Lecturer, School of Nursing and Midwifery, Sub-Faculty of Health Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Victoria, Australia.

Julia Morphet

Julia Morphet, PhD, Professor, School of Nursing and Midwifery, Sub-Faculty of Health Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Victoria, Australia.

Renee Molloy

Renee Molloy, MNurs, Lecturer, School of Nursing and Midwifery, Sub-Faculty of Health Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Victoria, Australia.

Joy Davis

Joy Davis, MN (Education), Education Lead Simulation and Learning Design, Peninsula Health, Victoria, Australia.

Holly Challis

Holly Challis, MNurs, Safer Care Consultant, Peninsula Health, Victoria, Australia. Safer Care Victoria, Victoria, Australia.

Alison Watts

Alison Watts, MHSM, General Manager, Peninsula Health, Victoria, Australia.

Michelle Daniel

Michelle Daniel, Consumer Participation Manager, Peninsula Health, Victoria, Australia.

Pauline D’Astoli

Pauline D’Astoli, OAM, Consumer Advisor, Peninsula Health, Victoria, Australia.

Steve Wise

Steve Wise, BEnvDes RBI MPhotogIII, Medical Photographer, 27Creative Photography Design, Perth, Australia.

Samantha Sevenhuysen

Samantha Sevenhuysen, PhD, Adjunct Associate Professor, School of Nursing and Midwifery, Sub-Faculty of Health Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Victoria, Australia. Director Education and Training, Peninsula Health, Victoria, Australia.