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“Simulation moves the sharp and dangerous edge of the learning curve away from patient care and services.”

-Ian Curran, MD


  • Discuss the various opportunities for using simulation in a hospital or healthcare system.

  • Describe how to identify a champion for the simulation program.

  • Describe the initial planning for implementation of a simulation program.

  • Identify the types of simulators used with different learners and courses.

  • Describe the challenges of implementing a simulation program and potential solutions.

Simulation programs in clinical settings such as hospitals and healthcare systems are both similar to and different from those in academic settings. As with simulation programs in academic settings, those situated in clinical settings typically have a significant educational component focused on individuals. Some uses for simulation in clinical settings include (Agency for Healthcare Research and Quality [AHRQ], 2013; Ulrich, 2013):

  • Onboarding new employees

  • Assessing the competency of new or newly employed healthcare providers

  • Assessing and maintaining individual competency

  • Building and sustaining high-performing teams

  • Testing new equipment for usability prior to implementation

  • Testing new clinical services and patient care units

  • Assessing processes for latent errors

  • Other quality improvement or risk management activities

Page, Fairbanks, and Gaba (2018) identified priorities for improving healthcare safety through simulation. These include:

  • Designing simulation-based activities to promote high reliability and cultural change in healthcare

  • Creating and maintaining a strong culture of safety

  • Testing for and using optimal processes and procedures

  • Providing intensive and continuing training for individuals, teams, and larger units

  • Conducting thorough prospective and retrospective organizational learning and safety management

  • Building and maintaining resilience in healthcare systems

  • Evaluating the impact of adverse events in healthcare and how simulation-based activities can be used to determine and potentially prevent their cause

The location in which simulation activities occur may differentiate clinically based simulation programs from those in academic settings. Simulation programs serving hospitals and healthcare systems may be based in a freestanding educational building, within the walls of the clinical setting, or even in a mobile van that travels from site to site. Within a hospital or healthcare system, simulation programs can also exist outside of an actual physical location. They can involve in-situ simulations occurring in the actual clinical environment—for example, in an operating room, patient care unit, or emergency department.

Simulation programs based in a hospital or healthcare system support efforts toward improving patient safety, enhancing the educational experiences of staff, and creating a new system to assist in improving overall system performance. Chapter 12 offers details on using simulation for these purposes.


Engaged and active leadership is critical to the success of a simulation program. Healthcare and educational organizations must identify a high-level champion who embraces the value of simulation—for example, a board member or hospital executive—to support the simulation program. This level of leader can ...

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