Background: Major trauma care is complex and requires individuals and teams to perform together in time critical,\nhigh-stakes situations. Scenario-based simulation is well established as a strategy for trauma teamwork improvement, but\nits role in the relational and cultural aspects of trauma care is less well understood. Relational coordination theory offers a\nframework through which we aimed to understand the impact of an established trauma simulation programme.\nMethods: We studied simulation activities using a narrative survey of trauma providers from anaesthesia, emergency\nmedicine, medical imaging, surgery, trauma service, intensive care, and pre-hospital providers at Gold Coast University\nHospital, in conjunction with data from an ethnography. Data analysis was performed using a recursive approachâ??a\nsimultaneous deductive approach using the relational coordination framework and an inductive analysis.\nResults: Ninety-five of 480 (19.8%) staff completed free-text survey questions on simulation. Deductive analysis of data\nfrom these narrative survey results using the RC framework domains identified examples of shared goals, shared\nknowledge, communication and mutual respect. Two major themes from the inductive analysis--â??Behaviour, process\nand system changeâ? and â??Culture and relationshipsâ?---aligned closely with findings from the RC analysis, with additional\nthemes of â??Personal and team learningâ? and the â??Impact of the simulation experienceâ? identified.\nConclusions: Our findings suggest that an established trauma simulation programme can have a profound impact on\nthe relational aspects of care and the development of a collaborative culture, with perceived tangible impacts on\nteamwork behaviours and institutional systems and processes. The RC framework-shared knowledge, shared goals and\nmutual respect in the context of communication that is timely, accurate, frequent and problem-solving based-can\nprovide a common language for simulation educators to design and debrief simulation exercises that aim to have a\ntranslational impact.
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