Transformative forms of simulation in health care – the seven simulation-based ‘I’s: a concept taxonomy review of the literature

Abstract

Simulation for non-pedagogical purposes has begun to emerge. Examples include quality improvement initiatives, testing and evaluating of new interventions, the co-designing of new models of care, the exploration of human and organizational behaviour, comparing of different sectors and the identification of latent safety threats. However, the literature related to these types of simulation is scattered across different disciplines and has many different associated terms, thus making it difficult to advance the field in both recognition and understanding. This paper, therefore, aims to enhance and formalize this growing field by generating a clear set of terms and definitions through a concept taxonomy of the literature. Due to the lack of alignment in terminology, a combination of pearl growing, snowballing and citation searching approach was taken. The search was conducted between November 2020 and March 2023. Data were extracted and coded from the included papers according to seven Simulation-Based I’s (SBIs; Innovation, Improvement, Intervention, Involvement, Identification, Inclusion and Influence). Eighty-three papers were identified from around the world, published from 2008 to 2023. Just over half were published in healthcare simulation journals. There were 68 different terms used to describe this form of simulation. Papers were categorized according to a primary and secondary Simulation-Based ‘I’. The most common primary SBI was Simulation-Based Identification. Selected categorized papers formed a descriptive narrative for each SBI. This review and taxonomy has revealed the breadth of an emerging and distinct field within healthcare simulation. It has identified the rate at which this field is growing, and how widespread it is geographically. It has highlighted confusion in terminology used to describe it, as well as a lack of consistency in how it is presented throughout the literature. This taxonomy has created a grounding and step change for this work which is embedded in the literature, providing a rich and varied resource of how it is being utilized globally.

Global consensus statement on simulation-based practice in healthcare

“…Within this context, simulation practice serves educational and non-pedagogical uses. It encompasses activities such as device, process, system testing, system integration, quality improvement, research and innovative approaches [2,3]. Contributions obtained during consultation have highlighted that simulation serves as an adjunct to therapeutic interventions.…”

“…Healthcare simulation is "a technique that creates a situation or environment to allow persons to experience a representation of a real event for the purpose of practice, learning, evaluation, testing, or to gain understanding of systems or human actions" [1]. Beyond education and training, it plays a pivotal role in optimizing healthcare systems, thereby enhancing healthcare delivery, promoting staff well-being and improving patient safety and outcomes [2,3].…”

Global consensus statement on simulation-based practice in healthcare

“…It encompasses activities such as device, process, system testing, system integration, quality improvement, research and innovative approaches. 2,3 Contributions ob-tained during consultation have highlighted that simulation serves as an adjunct to therapeutic interventions. It is employed in diverse situations, including complex case-by-case surgical planning, aiding pain management during labor, supporting cognitive behavioral therapy in mental health settings and facilitating the training of social skills for autistic patients.…”

“…1 Beyond education and training, it plays a pivotal role in optimizing healthcare systems, thereby enhancing healthcare delivery, promoting staff well-being and improving patient safety and outcomes. 2,3 The dynamics of knowledge sharing and interaction within healthcare communities have evolved significantly in recent years, driven by exponential access to virtual platforms. 4 This transformation has heightened awareness of the diverse landscape of simulation practices in healthcare worldwide.…”

Faculty development for translational simulation: a qualitative study of current practice

“…This approach "seeks to drive organizational learning by targeting simulation at the systems level as well as its components" [12]. Other terminologies and conceptual framings are offered for what we are referring to as 'translational simulation' , including in situ simulation (ISS) [13], systems integration simulation [14], simulation-based clinical systems testing (SBCST) [15], and transformative ('non-pedagogical') simulation [16]. Common to these conceptualisations is (1) a direct focus on healthcare safety, quality, and systems, as distinct from simulation for pedagogical purpose, and (2) simulation design and delivery methods that draw upon healthcare improvement, design thinking, systems science and other fields of practice that may be unfamiliar to educators [1,2,15,17].…”