TRIPLE PLAY 2014-2015

Added on Mar 24, 2015

Don't Harm Me

Recently, St. Peters Hospital completed their first Triple Play event. Seven crews of physicians, nurses, technicians, and support personnel performed in-situ simulation for malignant hyperthermia. St. Peter’s Hospital (inset left) is a 123 bed hospital located in Helena, Montana. The setting is even more beautiful than the picture. St. Peter’s is part of the HPI client community through the Mountain States Reciprocal Risk Retention Group (MSHRRRG) patient safety collaborative.

A Triple Play is three high reliability interventions bundled together for efficiency:

  • 1. Protocol – the care is confirmed to be the best evidence-based medicine, the process is simplified, and human factors are applied to policy, protocol, and job aids.
  • 2. People – the people are trained on roles defined by the protocol, clinical knowledge and skills, and nontechnical skills (as Tones for reducing power distance and Tools for preventing human error, especially in critically thinking and thinking together as a team).
  • 3. Training – the training is in-situ simulation as to perform facilities testing. (Facilities testing finds root causes of harm embedded in equipment, devices, supplies, and environment before the harm occurs.)


The Triple Play is the most efficient approach to building a high reliability organization. One pays only once for the simulation and receives 300% of the value – training on protocol, training on nontechnical skills, and facilities testing. This is the model for the next generation of patient safety culture interventions. And the best of several effects – the physicians are eager to participate because of the clinical simulation and then receive the safety culture training as a bonus.

Using a simulated patient, SimMan, the team had to recognize and then treat for malignant hyperthermia. SimMan survived all seven cases. The participants were far too immersed in the realism of the simulation to fake any safety culture habits – they had to use their everyday practice habits. (This was not always pretty – but always helped to improve patient care.)

Special thanks to:

  • Michelle Rush, Risk Manager, and Kathy McGuire, Clinical Educator, for their outstanding efforts in preparing for the simulation week. There is a great deal of work not only preparing the hospital, but also in setting up the observation room so other hospitals in the collaborative can learn through the observation of the brief, simulation, and debrief. Additionally, observers have the opportunity for discussion with InSytu and HPI within the observation room.

  • Cindy Irwin RN, RNC-OB, Dale Reisner MD, and their crew at InSytu in Seattle for running the simulations. Cindy and Dale are subject matter experts, simulation experts, and master facilitators at InSytu, formerly known as The Gossman Center for Advanced Healthcare Simulation at Swedish. They are consistently top-notch. InSytu works nationally and is our HPI simulation partner in the West.

  • Kathy McCoy and Sarah Darwin of Sentara Healthcare in Norfolk, VA for educating the MSHRRRG group on the Focus & SimplifySM  methodology. Although HPI invented Focus & SimplifySM  – Sarah and Kathy are the best in teaching the Focus & SimplifySM methodology.

  • Richelle Heldwein MPH, RT of Western Litigation who coordinates the collaborative on behalf of MSHRRRG.


Next up for the MSHRRRG collaborative is a Sepsis Triple Play for Mid-Columbia Medical Center, The Dalles, Oregon. Triple Play events have been completed at San Juan Regional Medical Center and Bozeman Deaconess Hospital (Adult Stroke); and Wyoming Medical Center (postpartum hemorrhage).