ATHLETES rarely set records during training. This is because humans need competition to test the limits of our ability. Competition increases effort, improves performance and sparks creativity. It reminds members of the same team that they are all working towards the same goal and motivates them to succeed together.
This is as true of stroke teams as of sports teams, say the Angels team in Malaysia. In March 2022, they invited three hospitals to battle it out in a Simulation Team Challenge that would, for the first time, leverage the benefits of friendly competition in the fight to improve stroke care in Malaysia.
The objectives, says Angels consultant and the country’s stroke care programme manager Elva Phan, were to identify gaps in the in-hospital pathway and create a scenario where the teams could learn from each other. They expected that competition would lead to higher levels of performance, strengthen relationships within teams and ignite team spirit.
The inaugural Simulation Team Challenge was a three-way contest between peers that took place at the simulation centre of Hospital Pengajar UPM (HPUPM) in Serdang, about 30 minutes south of Kuala Lumpur. In the mix were hosts HPUPM, which in 2020 became Malaysia’s first high-volume stroke centre with a dedicated stroke emergency unit and in 2021 won its first WSO Angels Diamond award. Up against them were two-times Diamond award winner Hospital Tuanka Ja’afar, whose stroke team notched up a world-class median door-to-needle time of 25 minutes at the heigh of the pandemic, and Hospital Sultanah Zahirah from the coastal city, Kuala Terengganu.
The competition kicked off at 8.30am on Friday 4 March when the teams were briefed by the facilitator, Drs Abdul Hanif Khan, and lead by the chief judge, 2022 Spirit of Excellence winner Dr Wan Asyraf Wan Zaidi, neurologist from Hospital Canselor Tuanku Muhriz UKM. They all had to manage the same case of suspected stroke involving a 41-year-old man with right gaze deviation and a mild slur observed in the preceding two hours. Their performance would be recorded and evaluated by four judges, with the results announced and discussed at an Angels Multidisciplinary Workshop the following day.
Teams could earn 25% in each of the following: pathway approach and NIHSS scoring, CT interpretation, decision making, and door-to-needle time, with a bonus 10% awarded for teamwork and overall excellence. The judging criteria reflected the key priority actions for optimal stroke pathway management. For example, in the evaluation of door-to-needle time, teams could expect to lose points if they opted to wait for more imaging after bleeding and large vessel occlusion had been ruled out, or if they moved the patient to the emergency department rather than commence treatment at CT.
For the competing teams, the following afternoon couldn’t come soon enough. That was when both in-person and online participants in the Multidisciplinary Workshop would have a chance to view the simulation videos and after comments by Dr Wan Asyraf Wan Zaidi, Dr Abdul Hanif Khan would announce the results.
Applause filled the HPUPM Auditorium as Hospital Tuanku Ja’afar was named the winner of Malaysia’s first Simulation Team Challenge. They had also clocked up the best DTN time with 15 minutes and 56 seconds, edging out HPUPM with 17 minutes and 11 seconds, and Hospital Sultanah Nur Zahirah bringing up the rear with an impressive 21 minutes and 48 seconds.
In the end, however, winning mattered less than the lessons each team had learnt from their rivals and would take back to their hospitals. Workshop participants had likewise enjoyed a front-row seat at a best-practice sharing session.
Elva reports that in the six months following the event median door-to-needle times for participating stroke centres had dropped from 64 to 56 minutes, and that other cluster hospitals had signalled their interest in replicating the competition in their own centres.
The Malaysia Stroke Council, whose president Associate Professor Hoo Fan Kee delivered the opening at the workshop, has also recognised the potential for a large scale team challenge to improve stroke team performance.
By raising the quality of stroke treatment in all participating hospitals, this is a competition where there are no losers, and where patients and their loved ones are the real winners.