December 3, 2020By Lindsey Nolen

Simterviews: Lynn Welch | VP of Business Development & Marketing, EMS

Lynn Welch is the Vice President of Business Development and Marketing at Education Management Solutions, now a part of Collegis, LLC. She currently serves as the Chair of the Corporate Roundtable and on the Board of Directors for the Society for Simulation in Healthcare (SSiH). Her unique background experiences with federal defense, global marketing, business development, sales leadership, and volunteer efforts make her a rare champion for the healthcare simulation industry. met virtually with Welch in November 2020 to learn more about her and her important work.

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HealthySim: For those new to clinical simulation, please tell us a little bit about yourself? What is your role with the company/institution? What are your professional goals?

Lynn Welch: For the majority of my career, my experience in simulation was on the military side. I had the great fortune to start during some of the earliest days of the immersive gaming side of simulation. I worked at a nonprofit government think tank for the first 13 years of my career, and got to be embedded with a team that was building many of the immersive environments for the first generation of the “man-in-the-loop” gaming simulators. We did a lot of that work for the Defense Advanced Research Projects Agency (DARPA). I actually had the opportunity to be a beta tester for the first generation of the Microsoft Xbox. So I had a pretty interesting adventure on the military simulation side of things, building immersive databases for the National Guard to train for domestic preparedness. I’ve also worked on reconstructions of critical military battles, such as the Battle of 73 Easting, which was the first tank battle in the first Gulf War.

I gained more experience on the immersive gaming side of simulation, moving on to work in emerging technologies for Homeland Security applications. About eight years ago, I got a call from a recruiter to come and join EMS and return to simulation, this time in the healthcare space. I have loved it ever since. It’s been a fascinating field to dive into, and I really love how we’re beginning to see the convergence of gaming and the traditional hands-on healthcare simulation models with the high-fidelity patient simulators. We’re also beginning to see standardized patient training blending with hybrid immersive gaming environments – with a lot of the interesting online workflows developing, especially in the wake of COVID-19.

At EMS, we’re very focused on supporting our clients (who are also our partners), to keep the clinical simulation training going, even in the middle of COVID-19. The state of Pennsylvania shut our team down when COVID set in on March 12. Within 24 hours, our entire company of about a hundred people was up and working online. We got the shutdown order Thursday night, and Friday I drove back to where I live in Fairfax, Virginia. That weekend we started work across our marketing and product development teams. Within two weeks, we launched our virtual OSCE platform, and had it fully developed with full integration and live video conferencing. This is so that standardized patient-driven clinical exams could continue in a fully virtualized format.

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Since that launched, we have had well over 70,000 hours of training done in our Virtual OSCE telemedicine platform. It’s been a really exciting time at EMS. I run our marketing team, and also our R&D contracting arm. This is a part of our federal business sector that is part of my team. We have been shoulder-to-shoulder with our developers seven days a week since the onset of COVID-19. It’s been fascinating to see how quickly our entire industry has come together between schools of medicine, nursing schools, allied health and the vendor industry, to really problem-solve and jump in to find new ways to reinvent how healthcare simulation is being delivered.

My number one priority is to keep innovating with my teams and with my company to make sure we continue moving healthcare simulation training forward. The thing about healthcare simulation is it’s not optional. This is a core requirement to graduate nurses, doctors and allied health professionals. There has never been a time when this was more critical. There has never been a greater need to increase our clinical staff. It’s just wonderful that we’re all in the middle of this industry that’s helping make that happen and keep that moving forward. It’s a real privilege. When you look back over a career, you really want to ask, “What did I do that made a difference?” I think this is a time when everyone, whether on the vendor side, the academic side or on the hospital side of healthcare simulation training, has a chance to make a difference. It’s a really unique time, and I’m so glad I’m in this industry right now.

HealthySim: What brought you into the field of healthcare simulation? What previous experiences are supporting your work in simulation?

Lynn Welch: I’ve been in the simulation world for a long time. I started my career as a graphic designer. I was doing a lot of page layout, photography and videography work, and I was working at a government think tank called the Institute for Defense Analyses. They were starting to build these simulations and immersive environments in a different division, but they were getting bad feedback from their client. They were putting soldiers through these simulations with these digital environments, and they said they saw the value in doing so. They were walking and running on omni-directional treadmills, and they would see this full immersive cave with this big virtual simulation environment, but it didn’t look realistic.

The environment didn’t have the shading. It didn’t have what we, as artists, would immediately see as a gap. And what is turnkey today? Google Earth can build these in five minutes now, but at that time they’d never been done before. So the simulation division decided to find an artist. They found me down in the graphics department and brought me upstairs, and they just put me in the simulator and let me go. I said that it was really fascinating, but not realistic. I explained that there was no suspension of disbelief without visual realism. They put me on the team. I was, interestingly enough, the only female on that team for several years. There used to be very few women in simulation at all. That’s wildly changed over the course of my career.

What really hooked me into simulation is when I was traveling around the country under contract to the U.S. government to create virtual models of several U.S. cities. One of these models was built in advance of the Winter Olympics in 2002 in Salt Lake City. We built all of downtown Salt Lake City and several other areas of the country, and some international cities for first responder training. This was so they could train collectively in these virtual environments. What hooked me forever on healthcare simulation was 9/11. We had built a database of lower Manhattan after the 1993 bomb incident at the World Trade Center Towers. We had built all of that area in great detail before 9/11 happened.

There was one Civil Support Team with the National Guard that got on site to respond. They were able to fully identify whether or not there was any chemical or biological impact from the events on 9/11. The only reason they entered is because they had the database we had created. They’d already been training in it, and they took that database and were able to map out what was closed as they were traveling down from upstate New York. They were able to engage the Coast Guard, get on a boat, go in by water and walk up through Battery Park. They told us this story right after 9/11. When you find out that something you built had an impact and made such a difference, you’re never leaving simulation. I’ve been in simulation ever since, except for a couple of years of hiatus when I was working on the Homeland Security side.

HealthySim: Tell us about your experience working on the M1 Abrams Tank Simulator Program which was so effective during Desert Storm and how that influenced your career?

Lynn Welch: That was the first simulation I worked on. What was exciting about that is that it was really a seminal event, because it was the first time the United States ever sent a tank brigade into battle that had trained in simulation. They were wildly outnumbered when they crossed the border and began that initiative, but were wildly successful. Part of that was due to the fact that afterwards in interviews, they stated they knew the terrain. They said, “I knew where I was going. I knew where the enemy tanks could be.” We had run through every scenario of where they could be, and they were exactly where we thought they were going to be. H.R. McMaster led that battalion, and he went on to have an outstanding career in national security.

It’s great when you can have a small part to play in some of these really game-changing events. That initiative also led to the formation of the PEO STRI in Orlando, which is now the home of military simulation. There was testimony before the Senate Armed Services Committee back in 1992. I remember going up there. I was about 23 years old, and I was helping run some of the simulators as they presented this to the committee. That led to the establishment of congressional budgeting for PEO STRI, making it an official program of record. That really started growing simulation. Ironically and interestingly enough, I’m participating in a healthcare panel at I/ITSEC this year, which is the largest military simulation exposition. It’s interesting to be a panelist now, because I still remember the first I/ITSEC I ever went to, when we were crawling around on the floor for weeks ahead of time doing the hard wiring to run the first distributed military simulation game. It’s interesting to see that come full circle.

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Lynn Welch in front of an aircraft simulator used for combat medic evacuation training.

HealthySim: What do you see as the biggest challenges we are currently facing across the simulation industry as a whole?

Lynn Welch: I would say access and scalability. Access to the healthcare simulation training tools is a challenge, with so many brick-and-mortar simulation centers being shut down. Scalability has been a problem since I was 21 and first starting in this industry. There’s only so many simulators and so much time available to each individual to train on a simulator. The more repetition you have, the greater the mastery of whatever the subject matter is. Scalability has always been an issue that shows so much promise, and where I really see COVID-19 changing the game. It’s accelerating our space ahead five years. People have had to become so innovative and collaborative about how they use the tools they already have.

Let’s say I have a cell phone – how do I use that when I’m stuck in my house? How can I use my cell phone in a different way? How do I use open-architecture tools? How do I re-imagine those? How do I migrate my education workflows to accommodate clinical simulation in a fully virtual format? How can I knit in hy-flex environments where I’m combining online learning platforms with really high-intensity, interactive video and standardized patient actors? How can I start blending and knitting in virtual and augmented reality, to leverage tools on my cell phone to create realism and reinforce learning concepts? I think that we’ve cracked open a door that isn’t going to close.

HealthySim: What needs to happen for healthcare simulation to move to the next level of utilization? What is holding the healthcare simulation industry from being as integrated and supported as the aviation simulation industry?

Lynn Welch: I think we all have to continue being creative. I think that the tools have to be easy to use. They have to be intuitive, and they really have to embrace a more open architecture. This needs to be done so we’re not as dependent on a specific device or manufacturer, so that there’s more open sharing of learning outcomes, and the basic concepts around those learning outcomes. We can let the analysis, the data and the outcomes guide technology development.

I was the Chair of the Corporate Roundtable for the Society for Simulation in Healthcare when Covid-19 set in. All of the round table members gathered to put out a call to consider what we could do. What do we have? What can we quickly adapt from a technology standpoint to help our whole industry? We put up a COVID-19 resources page, and that became a very collaborative space. Then SSH and Lance with jumped in and really started pushing collaboration. We were really picking up new ideas, pushing them out and helping everyone to communicate. I think that’s critical. It’s not about a technology provider like my company, EMS, doing things in a silo. It’s how we collaborate together and build the products that make a difference.

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Lynn Welch “suites up” before running EMS equipment at a Navy site in 2013.

As for the healthcare simulation industry becoming as integrated and supported as the aviation simulation industry, mandates need to occur. If you look at the aviation industry, they realized they had some critical safety errors. Then there were mandates, both federal and within their own groups and organizations, where they adopted particular requirements. These were intended to drive a reduction in critical safety issues. If you look in the healthcare space, we have less of that on the professional healthcare side. On the academic side, the value of clinical simulation is acknowledged, and it’s been integrated into the curriculum and the education flow. You’re seeing that expanding rapidly across all areas of allied health.

Medical simulation is growing rapidly on the academic side. It is growing organically in active practice on the healthcare professional side and across the major healthcare systems, but there’s no mandate for it. There’s no organized requirements around it. There are small pockets, but there’s no overarching acknowledgement that there is a critical patient safety issue. Here is where healthcare simulation plays a part, and the overall plan and mandate for how it should be implemented across healthcare systems and disciplines doesn’t exist. Until that bridge is built and closes the gap between how academia and healthcare systems jointly embrace healthcare simulation, you’re going to have some limitations, and you’re not going to see the real reduction in patient safety errors that you could have otherwise.

HealthySim: What would be your greatest advice to people just starting out in healthcare simulation?

Lynn Welch: If you are passionate about what you’re doing and what you love, you’re going to be a success. Someone told me this when I was very young: “Do what you love, because you’re going to spend 80% of your time at work.” Make sure you have a passion for what you do. I would encourage you to look at all aspects of simulation; there’s a huge career field within medical simulation. Each year, I participate in a STEM outreach in my local community, where I go into a school on a career day and talk about healthcare simulation. I have been doing this for five years. I have yet to walk in and speak to those eighth-graders, ask who has heard of healthcare simulation, and have a child say they have.

When I talk about healthcare simulation and the different kinds of careers you can have within it, people are pretty astonished and kids are interested. One of the things I think we have to really do to grow healthcare simulation is to really look at developing a strong STEM program. We need to start recruiting. If you look at how our industry is growing, and the gap in highly-skilled SIM operators and technologists, we don’t have a generation of high schoolers and middle schoolers saying off the bat, “I want to go into healthcare simulation”; it’s not a known field. I think that’s something that we as a community need to look at. With whom and where do we need to partner? Where are other really strong technology STEM programs that we could partner with to make sure healthcare education has a place at the table?

HealthySim: What is your greatest advice for those already engaged in clinical simulation, who want to continue to maximize their outcomes and ROI moving forward?

Lynn Welch: I think one of the critical pieces is to understand where you are. If you’re not doing really intensive high-quality debriefing, if you’re not tracking your evaluations, if you’re not doing surveys of your learners to understand what their impressions are before they went into a SIM training encounter versus after, it’s hard for you to understand where you are to see where you need to improve. Once you start tracking those metrics, that’s going to guide you on where you need to allocate your resources and where you need to grow your programs. It also helps you scale because you become more efficient with utilizing both your time, your human capital and your high-value assets, like high-fidelity mannequins.

I think it’s all about tracking the analytics across your operations and your learner performance. That will really guide where and how to grow your programs. The other thing tracking your analytics will do is let you carefully forecast what you’re going to need. We rarely hear of a center that opens and gets utilized less. They tend to grow organically and very quickly, but that creates its own chaos. So tracking your analytics helps you plan not just how to build and open a center, but how to maintain it and where you want the center to be in five years. How am I going to get there? And what tools do I need to make that happen?

HealthySim: What is something that is currently exciting you about the healthcare simulation industry right now? (A book, a website, a product, a service, research, conference, etc.)

Lynn Welch: I really think what’s most exciting to me is how the walls of the classroom have disappeared. The walls of the clinical simulation center have disappeared because we’ve all had to get outside the walls. For example, we have a healthcare client with several hospital systems, and they run medical simulations before they open the floor of a hospital.

When they’re building a new hospital, each department has to run healthcare simulations of their standard operating procedures before they’re allowed to open and have live patients. When COVID-19 came in, that all had to stop because that staff could no longer travel to that hospital to run those healthcare simulations. They utilize one of our mobile audio recording, bookmarking and debriefing solutions now to do that virtually. So they dial in and they’re in a live video conference. They can see everything happening as that medical simulation happens across a hospital department.

It’s going room-to-room as a virtual participant as the clinical simulation unfolds. They have a Bluetooth speaker along with the mobile AV solution. They’re seeing everything and giving live feedback. They can stop and pause the medical simulation, do a partial debriefing and restart it; but they’re right there embedded, even though they’re not physically there. When you start removing walls and taking geography away from the limitations of healthcare simulations, and allow it to flow outside of brick-and-mortar centers, you’re really changing how you can deliver simulation overall.

Again, it’s about access and scalability, and you’re just opening that up because they can have anyone attend across their healthcare system. Anyone who wants to watch those live healthcare simulations can, and get constant reinforcement of these key patient safety training elements.

HealthySim: How has your company responded to COVID-19? What industry trends are you seeing from the pandemic? What tools has your company been selling most during the pandemic that you think will have a lasting impact on the community?

Lynn Welch: We have done a lot of innovation around again serving the need for healthcare simulation training without brick and mortar centers, focusing on (the question of) how do you deliver clinical simulation by proxy? We came out with a product called DistanceSIM, which allows an instructor to go into a brick and mortar sim room even if their students can’t be there. The student can remotely be right in that room with the instructor, seeing through the cameras, seeing everything happening in the room and directing a proxy to take actions on a hands-on physical exam using a mannequin or other tools, removing that wall. That was one of the pieces we worked on.

We also looked at the patient exam, and we built a full turnkey, virtualized (objective structured clinical examination) format. We had an online platform that would facilitate all the requirements for a high intensity OSCE exam and allow for that fully virtual telemedicine-enabled, virtual exam. Live, standardized patient instructors and observers can log in, watch live and evaluate – and it’s all scored — just like it would be in their healthcare simulation center, but 100% virtual.

We deployed that inside of two weeks. We had a client this summer who engaged with our Virtual OSCE platform, right before the Fourth of July. Our development team stood it up for them over the holiday weekend. We trained all of their instructors over the next three days, and in the beginning of August they ran a giant day of clinical simulation where they conducted 1,243 OSCE encounters across their four medical school locations.

They were all training together, keeping everything moving forward, and were able to have it happen inside of two weeks. If you think about the timelines for an initiative like this in the past, you’re talking months, and this is now happening in the matter of weeks. When you can accelerate these timelines and get these products fully developed, fielded and deployed, then there’s no limit on what we can do in the future.

HealthySim: Tell us about the recent acquisition of EMS by Collegis. How will that impact current customers and future customers of EMS?

Lynn Welch: That was another exciting piece that happened during COVID-19. For being locked in our houses, we had a lot happening at Education Management Solutions! During the earlier part of the summer, we were engaged with a potential client. As we began talking with that client, they brought in some of their outsourced services that were provided by a company called Collegis Education that works with a lot of higher education institutes.

They provide a wide variety of services to support the growth of Higher Education programs. Schools looking to move towards online courses and online curriculum, plus grow their student base, will engage with Collegis Education. The company will come in and provide the marketing recruiting to grow enrollment, plus the technology requirements and the workflows to enable and optimize online programs.

They support them in the curriculum development and the measurement of outcomes to make sure they’re building these high flex environments that are combining an online cohort of students with an in-classroom group. For example, that may have a large cohort that is online only in addition to the cohort that comes on campus. How do you manage that curriculum across both modalities of learning and fuse it together? Collegis Education comes in and provides those service solutions.

They provide a lot of CIO services and all of the ancillary IT support services. They have this huge skill set and they offer a wide variety of high value services, but they were not a technology company. As we began talking with Collegis, and holding ongoing discussions with a mutual client, the two companies really began to realize the potential for combining both the high quality service and the software technologies. Collegis was already providing all of these other turnkey wraparound services, and the two companies just fit hand in glove.

We quickly saw the compatibility between the two companies and the value of a merger. So we merged the companies and until late October, none of the executive team, or even the two company owners had ever met face to face. It’s an interesting, interesting dynamic. It happened over the course of about four months, and we liked each other even better in person when we finally did get to meet face to face. What this means for EMS is that we now have a great partner who we can help our current customers expand and accelerate their programs.

Our clients need the curriculum designers. A lot of them are really struggling with taking their clinical simulation curriculum and their regular curriculum and moving it all online because they haven’t had to do this before. We now have this great partner, Collegis Education, who can help them figure all those pieces out. Our Collegis colleagues can help our clients really solve their entire education challenges, whereas before, we were more primarily focused on the healthcare simulation technology workflows.

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