2023 VA Immersive Summit: Creating VA and Staff-Specific Training Panel
So I want to invite to the stage two of our members of the simLEARN team who've been here demoing in the exhibitor space as well as Dr. Brian Kaufman, who was a game changer before we even knew anything was going on in New York Harbor, he was doing simulation with virtual reality there. So great amount of experience with him and then Dr. Divya Singhal, who is a wonderful testimony of the story of success of the entire program. She and I connected in 2021. Do you remember this? Via email going back and forth about the potential virtual reality, and then last year she joined the summit, and she's become one of our greatest champions and providers.
The chief of spinal cord injury there in San Antonio also joined us for the Congress day, spent her clinical time and joined us here in D. C. to demo for Congress.
Really grateful for the work that you've done and the way you've championed. I'll hand you the mic as the moderator, and if you guys want to join us as well, that'd be great. Good morning, everyone. And thank you so much for that wonderful introduction, Dr. Bailey.
Thank you all for an energizing morning. I think we are already on a great high from hearing some amazing speakers and all the things that we can do within the VA and within the world of innovation. So for this next session here, we have three wonderful speakers whom we'll be hearing from. They bring from different backgrounds a lot of great skill sets, ranging from having worked in academia to the simLEARN, to the Slice Network.
We'll do a round of introductions real quick. First of all, Dr. Brian Kaufman, who is a professor of internal medicine, anesthesiology, neurosurgery, and an anesthesiologist by background was actually the founder for the VNU Harbor SimLab 15 years ago. And over the last several years has been involved with virtual reality and training for ACLS, tracheostomy complications, airway management, and more; if you'd like to add anything to that, Dr.
Kaufman, a little bit about your background. Yes , I've been involved in critical care education for probably 40 years. Became involved in simulation based education about 15 years ago, opened up and developed a simulation lab at our Manhattan campus, and there's a simLEARN lab at our Brooklyn campus where we're considered one institution.
We were lucky enough to get an educational enhancement grant from the VA, so we could have a simulation fellow every year. Who's a senior critical care fellow, and they have to be involved in developing a research project in addition to their education efforts. I had a very forward thinking fellow from about four years ago, Dr. Ali Hafiz, who was into virtual reality, which I had really never heard of. And that's how he got us interested in developing some research projects, which I hope we'll get a chance to share with you in a little while.
Thank you, Dr. Kaufman. Please hold on to that thought of being a virtual reality. We'll come back to that in a few. And then I'd like to introduce Mr. Jon Borgwing.
He comes to us as an associate director for the SLICE Network, which stands for the simLEARN Innovation Centers for Education. So if you'd like to share a little bit more about yourself. Yeah, good afternoon. So the SLICE Network really came about at the tail end of COVID, where simLEARN was trying to distribute content throughout the VA. We realized that we did have a challenge and that was that distribution model. And so the SLICE Network, came to be in order to solve that challenge.
And we went from about 14 sites earlier this year to now we're at over 70 sites. Very excited about that. With the goal of distributing nationally accredited training, that can be locally contextualized and providing resources and also the discovery of simLEARN and traditional products and services. So we've really been focused on that distribution model to provide value for both our clinical training as well as supporting veteran care in that population group. Thank you so glad to have you join. Also on our panel complimenting the skill set is Mr.
Devin Harrison. He is the associate director for simLEARN and has a very interesting journey having worn many hats, including from being a project management engineer to CBOT manager to now being the associate director for simLEARN. As part of that, I liked how he explained to me his role, which is bridging the gap in design and understanding of everything related to simLEARN for both technicians as well as clinicians. Thank you.
I'm the associate director for the assessment collaboration and outreach team within simLEARN. Our job and my portfolio focuses on conducting process simulation for pre design activities and post construction activities during the entire project life cycle where we look for latent safety threats and workflow inefficiencies. I just want to say on behalf of simLEARN, we appreciate Caitlin for giving us the platform to talk about what we're going to talk about today. And we're just excited to be here. Thank you all. So starting off, Dr.
Kaufman, you had alluded to being new to virtual reality. So very curious to know how were you first introduced to immersive technology? And what was your reaction to it? When my young fellow said, we have to do this, I had been teaching out of operating room area management at simLEARN...... the trainer courses there under Dr.
Jessica finally, and for the American College of Chest Physicians, which is a international organization of lung doctors, thoracic surgeons, anesthesiologists, respiratory therapists, and acute care nurse practitioners and physician assistants. The courses we used to teach in person were three day simulation based courses and with COVID that kind of stopped and they said, "can we teach the same material in a different way with virtual reality?" And I had already reached out to them and say, "Hey, if you ever have any interest in that, I have a young guy who really can teach us and work with us." So they reached out to us and along with the medical school I work at, which was NYU Grossman, Mayo Clinic, and I believe it was Bowman Gray school of medicine. They partner with a company which was called Dark Slope.
It's now called Lometo. And we helped them develop an operating room experience and then pilot tested it at the three institutions with our critical care fellows, some of our faculty. And what we found with that is that there was a significant learner growth, particularly in the less experienced individual. That's how I got turned on to virtual reality as a way of teaching.
And what was exciting about it is that with headsets, people could join us from anywhere in the country. Even if you didn't have a advanced faculty member who could debrief, we could provide that, for institutions that lack that. Thank you for sharing that and it's really fascinating to hear how from the world of academics you were able to weave together connections between all of these different academic centers and bring that into the VA as well and building on one of the speakers said earlier, Dr. Reisweber, how the VA has all these endless opportunities.
So I'm curious to know, Mr. Borgwing, building on what Dr. Kaufman said, how has immersive technology really changed the way we have different offerings for learners within the VA healthcare system? It's a great question. I think I heard also in the previous panels as well, it's all about finding the right tool at the right time for the right learner. It is, this innovative technology has really changed the way that we can view some of the solutions we have for training challenges.
As we look at... critical tasks as we look at competency, as we look at empathy training, that it's another tool in our belt that we can really use to help build some of those competencies, some of those training interventions. And so we're really excited about what that looks like for the future. At the same time, we're looking at how do we distribute that content as well. We want to make sure that it's available across the enterprise, and that we can do it at scale. So virtual reality is unique.
Where we can do it once and we can distribute that across the enterprise as well. I think it's really transformational in that aspect as well. Thanks for sharing that. And it's really neat to hear how virtual reality is bringing us all together. And as you alluded to, it's happened in times of COVID and be has been leading the forefront since way before code and doing that.
So just another shout out to Anne and Caitlin for being visionaries in this field starting, I think, in 2017 or earlier. So really leading the way. and helping shape it, not just for the VA, but for all of us nationally as well as internationally.
So building on what Mr. Borgwing has shared, Mr. Harrison, if you could please share with us, immersive technology and trainee learning.
As we know, all of our trainees, especially health professional trainees, at some point or another, 70 percent of them get to work and experience the wonderful VA healthcare system, myself included. So specifically for all of those trainees. What role does immersive technology have in shaping their training experiences? Two words come to mind, and thank you for the question, better communication and perspective.
And when it comes to the type of work that we do in assessment collaboration and outreach, a lot of the pre designed activities that we do needs to collaborate a bunch of different people from a bunch of different fields. Specifically, when it comes to clinicians understanding the architectural blueprints that we're trying to replicate and create the intermentional models of. Most times, our clinicians are not able to understand those blueprints in a two dimensional format.
We have to be able to provide a platform for them to be able to understand and take a view of what that plan is supposed to look like before construction is completed. So they can give sound input or what changes need to be made to the technicians and that both the technicians and the clinicians are speaking the same language, if you will. So the immersive technology allows us to do that because now you can see that different perspective three dimensionally and say, "no, that shouldn't go there. I should go here. This should change here.
We should be widening this. We should be decreasing this as well." the ability to be able to provide that level of communication where everybody is speaking the same thing and also the ability to provide that different perspective so that everybody can work in a collective way to provide the best care and the best environment possible for the veteran is how immersive technology allows us to do that. That's a great summary of how it unifies all of us while also offering diverse perspectives and allows that to be spread and that for it to grow like a wave of an ocean, if you will.
So my question was more focused on trainees. So coming back to you, Dr. Kauffman, how would you say immersive technology is helping offering new learning and training opportunities for all of our staff, irrespective of whether or not they trained at the VA before? As you mentioned, 70 percent of all trainees get some exposure at the VA. And I'd say at our institution, it's much more than that. We do lots of simulation, mannequin based simulation, but there are a lot of limitations with that.
You can't do a good neurologic exam. You can't change the skin tone or expressions and we recognized based on a large paper that came out about 10 years ago related to airway emergencies. They looked at every hospital in the United Kingdom over one year and looked at all the complications that occurred in terms of airway management. And it was shocking to find that half of them had nothing to do with putting the breathing tube in, but rather were tracheostomy complications. And we spent 99 percent of our time teaching our fellows, our faculty had to deal with intubation and less than 1 percent of our time talking about tracheostomy complications. So we had this knowledge gap that we recognized and we decided we're going to develop a virtual reality experience to have our learners go through the process of recognizing and managing that and it really didn't exist.
So that's what we focused on and we got a grant from the American College of Chess Physicians, and working with a medical VR company, we've developed cases that are very realistic, and we just started utilizing this for education, it's a prospective randomized study comparing two different ways of teaching a material, and then we're going to assess them on a high end task trainer, so we're really excited . Hopefully this will show that they will learn better with VR, and they'll retain it better, but we need this kind of data. Thank you. That is really exciting to hear because airway management can be very scary in the moment and there is very little or no margin for any kind of error and there's only so much we can learn from simulations and mannequins. So having VR technology being able to replicate it and train is amazing.
Building on what we're teaching anesthesiologists, I'm sure that would be helpful to nurses and other clinicians as well. How would you say, Mr. Borgwing, this is VR, or immersive technology, is expanding opportunities for all of our VA staff in terms of the quality of training and what we can offer them? It is a great equalizer, right? Because we have the ability to distribute across the entire enterprise and there are several different platforms that, you gain access to for some of these scenarios. But there's also the ability to do things through the web on even on the mobile phone.
So if we look at our learners and we look at our population on where we can reach them, it's gonna be about identifying where they're at and meeting the learners where they are. The standardization of content is incredibly important. Sometimes we hear the term one VA is one VA, but we're obviously fighting that in, in every capacity so that we have that standardization for best practices. And I think this technology is transform, is transforming that conversation as well.
Because as we do nationalize these initiatives and we put them in VR, for example, we're able to push out those efficiencies and those best practices. Thank you for sharing that. That's a really great thing to hear from the SLICE network, how all of these things will be available to everyone nationally.
Mr. Harrison, what would you add to that from your assessment, collaboration, and outreach perspective on what other opportunities for high quality training are available because of immersive technology? Yeah, I think that, like I mentioned before, it kind of levels. The playing field in terms of what we're providing and what can be expected.
So within my group, a lot of different groups we work with involves engineers, architects, planners, doctors, nurses, veteran experience staff. And we need to be able to create a platform for everybody to be able to see exactly what's supposed to be built and provide sound input on what's going to be designed. So having immersive technology and being able to navigate through spaces and be able to understand exactly what's going to be there allows us to truly be able to provide the same type of information, it just provides another opportunity for all parties to be actively involved in what is expected to be created, designed, and produced out in the field.
So building on the theme of collaboration, Dr. Kaufman, you've worked both in academic non VA settings and VA settings. From your perspective and experience, do you feel that immersive technologies has helped increase collaboration as well as communication within VA health care systems? The answer is for sure, and Dr. Bailey, in particular has been very helpful here. If somebody's reaching out and says, do you know any physician that's using it for education, she'll give them my name and I'll get phone calls and we'll interact.
And I think that's always a great method. I think the simulation community in general, including VR is very collaborative. Something as simple as: I'll read an article about a new approach to teach CPR in patients following cardiac surgery, which is a whole different way of doing it than the traditional. And I just reached out to the author said, "Hey, we're interested in virtual reality and we like to teach ACLS and special techniques." Before I knew it, they sent it to us and we were collaborating with them.
So I think it's just a great community. That's really exciting to hear. Hearing those specific stories, I think, always builds hope and energizes all of us. And I would like to echo what you said about Dr. Bailey as well, of just being that great connector.
So there seems to be no distance anywhere. If you need anyone for anything related to be immersive, she always has the answer or knows where to find the answer. Borgwing, about how you have observed from your SLICE or simLEARN hat of how the healthcare system's communication and collaboration has changed with immersive technology. Thank you, that's a great question.
The SLICE Network is definitely a living and breathing network. It's bi directional, it's not just the stuff coming from simLEARN in and out to our SLICE sites. So we're actually collaborating with our SLICE sites on their offerings that they have in order to nationalize those opportunities. Great example of that is our SLOPE course, our simLEARN opioid program for educators. We actually had three different national programs happening at the same time. We were able to actually consolidate that and offer one solidified program with those best practices.
We see that same model applying to VR as well. We look at VR as an additional tool that we give our educators and we, in a different way that we can present this information; in a standardized manner through some of our platforms like the simLEARN virtual academy. And so we're looking to partner with our SLICE centers so that we can see what virtual reality things they need. And in fact, we made a connection just here a few moments ago on working with someone in order to try to see how we can leverage some of their challenges and leveraging that in a virtual reality environment.
So this is a great example of that. Yeah, I'll just add to that. So before I came to simLEARN, when I came to simLEARN, I learned that a lot of the simulations and immersive things that we was doing was more clinical based. Then when I was able to go into the position that I was in now, it opened the door for us to bring in more of those planners and engineers and that technical side. So now what I see is opportunities coming from that space, specifically when it comes to immersive technology. Even though I may not be able to provide that service, I know that we have partners and Caitlin and Anne that could two instances, for example, one was from the Office of Construction and Facilities Management, where they was trying to do a design for a museum that involved immersive technology.
Although I was able to provide something, I know someone who could. So I reached out to that group to see if there was something that they can do on it, or at least it got us in the right direction. Another example dealt with women's health, where I'm a part of a IPT that deals with facility standardization for all construction and design moving forward.
One of our strongest partners is women's health. There was an opportunity to have an immersive component involved in the type of work that they're doing within immersive health. And again, I'm not able to provide that, but because of the space that I'm in, in my level of influence, in my circle of influence expanding, I'm able to at least be able to say, "I can't do it, but I know somebody who can." Let's have your people meet my people kind of thing. And that's what we're doing.
I think that this opportunity just opens the door for endless possibilities. I think it provides better collaboration so that people are not working in silos. I think I heard somebody say that in the previous discussion and I'm just excited to be a part of it. Thank you for sharing that.
It's really neat to hear the theme of community and collaboration and how thinking outside the box is part of immersive technology, and so is collaborating in ways we never knew was possible engineers to it, to thinking outside, web designer, clinicians, everyone. So immersive technology is bringing us all together in ways we never thought was possible and creating new possibilities. A couple of questions for each of you. For our audience in the room as well as those who are joining us virtually, if there is one thing you'd want them to take away from this session, what would that be, Dr.
Kaufman? I think there's no limitation with what you can do with the immersive environment, which is extremely exciting. It can solve problems you can't do with education, with mannequin base or task trainers. And to explore that is just an incredible thing to do. And I'm actually now without compensation, basically retired, but I'm staying involved in doing educational research and things like this because I just love it and I think it's so important.
Congratulations on your retirement and thank you for continuing to give back and help the community all that you've learned with your 15 years plus of experience. What about you, Mr. Borgwing? What would you like the audience to...
I think it's an incredibly exciting time to be in this space, as we are looking at how we can add virtual reality as a tool to the tool belt and finding the right time to leverage it. I think there's gonna be a vast amount of opportunity and we can really be innovative in this area. So let your imagination run wild. That could become a hashtag as well, Imagination Run Wild, heads in headsets and ask for it from the veterans. Thank you.
How about you, Mr. Harrison? Yeah, I think that, to add on to it, what Dr. Borgwing said was when we talk about moving forward, one of the things that you to ask is why not? Why can't we do this? Why not try this? I think we're just at the tip of the iceberg of what the VA is capable of doing. I just like the fact that I'm excited about the VA creating things that are considered cool and it's not outside of that, right? Because why is it that everybody else can create cool stuff, but the VA can't? So I like this platform, I like where we're going and I'm just ready to see what else is going to be created out of this collaboration in this group.
It's exciting to see the endless possibilities in collaboration. So as we speak to a group that has vast amounts of experience with immersive technology, some of us may be new to it. Some of us may have been believers or even those who've been trailblazers. I wonder if each of you could please share with the audience, what are things you'd want them to know if they ever hit a roadblock or if they're talking to someone who they need the buy in from, how do they convince them that immersive technology has a huge role in VA training? If they had to have a punchline, or way of explaining, what would that be? I think I've heard this a few times, put them in a headset, and they'll understand. Heads in headsets. You don't have to pay me for that's a...
Yeah, no it's incredible. I put my grandson into a headset, he's a geography whiz, and when he started visiting places all over the world and he took the headset off, just the biggest smile on his face. And you see that with all the, not a hundred percent, but most of the learners, when they come out of the headset, they go, wow, that's incredible, when can I do it again? I would echo that completely. heads in headsets. I would actually echo that.
Can see it on a 2D screen, and we have the ability to show some of what it looks like in that 2D environment, but having the heads in headsets is incredibly important, and that's how you get stakeholder buy in is showing them, rather than just telling them. We can do return on investment analysis, we can do return on effort for learners analysis, and I think there is a huge role to play there on both of those aspects. But I think also having them experience what that difference is, that delineation from, say, e learning, or that delineation from doing a scenario, for example, in person, and showing where the value is there is huge. My answer's a little different, two part. For my clinicians, I know you may not have time to necessarily look at plans in a two dimensional format, but if you put yourself in a headset, you'll be able to see what you're expected to get, and then you can provide that input. To be able to say, things should change or we should be going into this direction.
Our designs and construction moving forward should be clinically driven and not necessarily driven by the technicians on what should be in here, what not should be in here. So for time sake, just put yourself in a headset, take a look at what we're going to get, let us know what we need to change and then we can move forward. For my technicians, what we do in terms of immersive technology, when it comes to design reviews, we're not trying to eliminate the design review process from redlining two dimensional plans, and for my engineers and planners. But, we're just providing an extra level of enhancement to make sure that we get it right the first time.
Because the last thing we want to do is be going to a facility that's already done, and you're doing your walkthrough, and then you realize things should be changed. What that does is it causes delays for the opening of a building, potential funding increases, and then you're delaying the care and safe environments for our veterans. And we don't want that.
And as we continue to get this influx of funds coming in from the PACT Act, and we're able to, and we're designing these new facilities and building these new facilities moving forward, we want to make sure that we have the mindset of better collaboration and the use of emergent technologies. And immersive technologies so we can get it right. So what I'm hearing in there is an invitation to the audience and leaders and others not only to put their heads in headsets, also be a part of the change, the development, the innovation, and truly be the community that helps co create and design this.
What a unique opportunity, makes me feel very proud to be at the VA as other speakers have said as well. I've always felt proud being at the VA and I think that's only grown with VA Immersive and so many other unique opportunities. And this aligns perfectly with our Undersecretary of Health, Dr. Elnahal, you heard him speak earlier this morning, his priority of best and soonest care for veterans. It's incredible how we're hearing about these different threads, how it helps veterans, our women veterans, our staff, our trainees, as well as helping with burnout. So at this point, I'll open it up to our audience and see what questions, thoughts, or comments we might have from the audience.
.....verbal and visual cues. The closest thing I can think to a cue that is not verbal or visual is when I was first in training, the first time I was really dealing with someone with alcohol dependence and I was like, Oh, that's what that smells like. And that became a tool in my toolbox that now the next time I smell it and the time after that, I know with my eyes closed the disorder at play. But I imagine that in the world of surgery, or, you had mentioned intubation, I believe, and only having a second, there are things that you feel. Doing that, you know when you've cut right, or is that a place where you guys feel like investing more in the immersion and adding other sensory features are worth it? Or is there a point at which it's like, you prep, you prep, you prep, and now you got to go in and do it on a person, for lack of a better way to say that. I can tell you from do it as a person perspective, not from the VR.
But, we did for years, in the first month, like in July, with our new psychiatry residents. We would have the entire team call to a mental health crisis event, including the hospital police, and I would be the patient. I'm not a great actor.
I'm okay. Then we get to the point, depending on my mood, they would restrain me. At one point, if they didn't do my feet hard enough, I would kick out. And at one point, they wanted to kick everybody out and get the mace out for me. I was glad they left the guns outside the room. So I think it'd be less stressful to me and people like me to do it in virtual reality.
From looking at an educational perspective, I think that it's about choosing the right tool at the right time. So if we are looking at a tactile feel, for example, I think you're gonna want a task trainer, right? Or you're gonna want something, to feel that, because you want to know what it feels like to push an IV, for example, in the vein. You don't necessarily right now get that feedback.
There are some solutions out there, but then there's a question is what is the return on investment? What is the return on effort? So I think VR is amazing and there's tremendous applications and it's only gonna get better with time. Especially if we look at augmented reality, for example, and the ability to overlay things on items. I think that's an area of growth and innovation that's still happening, and so being able to combine that task trainer with that augmented reality also may have some huge benefits and outcomes, but that's where you have to play the game, including the smells, right? You don't have those smells inside ...... they have some things that they've
introduced, but by and large it's not something that happens, so I think mixing the two sometimes can pay huge dividends. In terms of airway training, what we do is : these people are unstable, their oxygen level is low, their blood pressure is low, it's totally different than the operating room for a stable patient. So we want to make sure it's an airway team with an airway team leader that they know their roles and what they can do to stabilize the patient, bring the blood pressure up, get the oxygen level up, and the actual physical skill of putting the tube in as Jon's mentioning, they can't do that right now and maybe never in the future, but in terms of the teamwork , that's exactly what's great in our virtual reality experience.
The same thing with ACLS, you can have a multiplayer experience to make sure everyone works together. Creating a learning scar as we call it. Thank you for that awesome question. Hello, Mike Weaver from Orlando VA.
My background's in recreation and I'm involved in adaptive sports. What an incredible opportunity for us to look at this as a way of integrating the veterans into adaptive sports individually as well as at a sport, whether it's crewing or if it's in archery or it's in shooting. And I'm hopeful that we take this into a level of sports that goes into the next level for these veterans. Any comments? No, I appreciate it.
Thank you. First, hello neighbor from simLEARN. Hi, how you doing? I think that what you're talking about is a perfect opportunity to look into that, especially at the simVET center. I know that's something that we don't do there now, but I think that all options are on the table and I think that there is an opportunity for us to discuss that and see how we can utilize that into our facility. I can't be specific, but my memory jogs me that we did have at one point inside the Sim Center, supporting of something similar to that.
Not in the VR capacity obviously, but in IRL as somebody said in the past panel. I think th's, there's huge promise there, especially as we look at the multiplayer environments that are possible. And even if we look at, rural environments and pulling people together in a unified space there.
That's a great question as well, and I would echo that from the physician perspective. I think there is a great opportunity. I've had the fortune of working with veterans who are part of adaptive sports, and as I've been part of their acute rehab journey and used the virtual reality, I think there is a lot of potential, and I guess this is the start of another conversation we can continue of how to help build that out.
I have some ideas as well, so thank you for that great question. I love how engaged your audience is. What other questions do we have? Has any work been done to integrate immersive technology into our existing talent management system to move away from this environment in which all of our mandatory education is done at a computer screen that we just click through every year just to check off a box to change what we're getting out of our mandatory training.
I don't know what you're talking about as far as clicking through things. So as far as compliance training, we have really taken a focus on competency. So I know we do a lot of things with confidence, right now with TMS. But I'd like to say I want a brain surgeon who is competent as well as confident, not just, confident.
As we look at how we can build some of those, pieces, some of the mandatory training, in fact some of those compliance training is actually being looked at on how we can potentially make those immersive. And having that immersive experience for that actually leads to better outcomes because if we're trying to, for example, empathy, or we're trying to show scenario based development of right and wrong decision making. We've seen the TMS e learning being put together, which they did a great job creating scenarios in which you use your analysis of that scenario to come up with outcomes.
But being actually in that scenario then is a hugely different, and more immersive experience. And you can't click next because you have to listen to everybody talking to you as well. That's something that's a huge opportunity, I think. Thank you for sharing these ideas and opportunities for future collaboration and projects. Any other thoughts, questions, or feedback from this wonderful audience? Hi, Sue Woods, also retired from the VA, former digital, Director of Digital Patient Experience.
It's a big enterprise, and this technology touches a lot of different silos. You've got connected care, mobile health, you've got simulation labs, now you have innovation. I'm really interested in finding where the natural collisions are to drive adoption and implementation.
My question is really around what are the factors that are really going to be needed that are absolutely essential to really drive that, in your experience. Because adoption doesn't happen without staff. What is very frustrating and hard is to get staff time, particularly nursing time, to come join us. It's easier for me to have the physicians have scheduled time to have the nurses because they have, it's hard for them to get out of the ICU, for example. So I think if we do get them out, then they'll have my in, but that's my major limitation right now. I think there is one of the things, one of the ways you can do it is finding common ground.
And in the work that I'm doing, the common ground is bringing facilities and designs faster to market. So when we talk about the design of a construction project and how do we speed up the design process and how do we speed up the construction of a building? We bring in all of those parties involved from technicians to clinicians. And one of the areas that we're trying to incorporate into this pathway is pre designed activities, doing simulations during the design process to make sure that the design is correct. And a part of that is immersive technology.
So for us, what we're doing is we're saying, "okay, we're going to incorporate these pre design simulation activities into the design process," but what it also involves is immersive technology and the people who are within these groups talking about how we can bring designs and construction faster to market are people at the top levels, undersecretaries and other executive leaderships who can really make a decision and say, "this is the direction things should go." So when it comes to trying to get that buy in, finding that common ground is really important and I think that's what we're doing on the design and construction side.