A Novel, Theory-Based Virtual Reality Training to Improve Patient Safety Culture in Department of Surgery of a Large Academic Medical Center: Protocol of a Mixed-methods Study (Preprint)

<sec> <title>BACKGROUND</title> Preventable surgical errors of varying degrees of physical, emotional, and financial harm account for a significant number of adverse events. These errors are frequently tied to systemic problems within a health system, including the absence of necessary policies/procedures, obstructive cultural hierarchy, and communication breakdown between staff. We developed an innovative, theory-based virtual reality training to promote understanding and sensemaking towards the holistic view of the culture of patient safety and high reliability. </sec> <sec> <title>OBJECTIVE</title> We aim to assess the effect of VR training on HCWs' understanding of contributing factors to patient safety events, sensemaking of patient safety culture, and high-reliability organization principles in the lab environment. Further, we aim to assess the effect of VR training on patient safety culture, TeamSTEPPS® behavior scores, and reporting of patient safety events in the surgery department of an academic medical center in the clinical environment. </sec> <sec> <title>METHODS</title> This mixed-methods study uses a pre- vs post-VR training study design involving attending faculty, residents, nurses, technicians of the department of surgery, and front-line HCWs in the operation rooms at an academic medical center. HCWs understanding of contributing factors to patient safety events will be assessed using a scale based on the Human Factors Analysis and Classification System. We will use the Data Frame Theory framework,17 supported by a semi-structured interview guide to capture the sensemaking process of patient safety culture and HRO principles. Changes in the culture of patient safety will be quantified using the Agency for Healthcare Research and Quality (AHRQ) Surveys on Patient Safety Culture™. TeamSTEPPS® behavior scores based on observation will be measured using the Teamwork Evaluation of Non-Technical Skills tool.20 Patient safety events reported in the voluntary institutional reporting system will be compared pre- vs. post-training. We will compare the AHRQ patient safety culture scores, and patient safety events reporting pre- vs. post-training using descriptive statistics and within-subjects two-tailed, two sample t-test with significance level set at 0.05. </sec> <sec> <title>RESULTS</title> Ethical approval was obtained in May 2021 from the Institutional Review Board of the University of North Carolina at Chapel Hill. Enrollment of participants for this study will start in Fall 2022 and is expected to be completed by early spring 2023. The data analysis is expected to be completed by July 2023. </sec> <sec> <title>CONCLUSIONS</title> Our findings will help assess the effectiveness of VR training in improving HCWs’ understanding of contributing factors of patient safety events, sensemaking of patient safety culture, and HRO principles and behaviors. These findings will contribute to developing VR training to improve patient safety culture in other specialties. </sec>