Simulation is best known for helping individuals build skills. But when applied strategically, it becomes a powerful tool for identifying system failures, co-designing solutions, and embedding safer, more reliable care across entire healthcare systems. It quite literally translates simulation efforts into results that go beyond the individual and impact an organization’s performance overall.

“Translational simulation can be part of the diagnostics in health systems—identifying issues preventing excellent care and assessing outcomes achieved in response to interventions…. Appropriately targeted, translational simulation offers a range of interventions for individual, team and system level improvement, ideally embedded within an integrated ‘translational science’ model.”¹  

Dr. Victoria Brazil

Director, Bond Translational Simulation Collaborative; Professor of Emergency Medicine and Director of Simulation, Bond University

Why Training Alone Isn’t Enough

Healthcare has long relied on simulation to train clinicians. This is especially true for high-stakes or low-frequency events like the ones that providers see in Obstetrics, the Emergency Department, Neonatal Care, and Intensive Care. Simulation is an effective tool to build performance acumen like muscle memory, confidence, and critical thinking.

But increasingly, hospitals are discovering that performance failures often aren’t due to lack of skill or knowledge. They’re due to system-level breakdowns:

These issues can’t be fixed by training harder. They require a method that lets you see the system in action—and simulation provides exactly that.

Enter Simulation as a Diagnostic and Design Tool

“It’s a way to crash test the system just like you would crash test a car to make sure it’s as safe and effective as possible. This allowed us to iron out the kinks so that by the time real trauma patients were involved, the only impact they were more likely to see was better outcomes.”² 

- Dr. Andrew Petrosoniak MSc (Med Ed), FRCPC, 
Emergency Physician and Trauma Team Leader at St. Michael’s Hospital in Toronto, Canada

In short, simulation can be used not just to practice within the system, but to fix the system itself.

This approach—often called translational simulation—focuses on using simulation to:

Unlike traditional training, these efforts focus on learning about the system, not just the individual.

Real-World Examples Where Simulation Exposed System-Level Failures

1. Pediatric Emergency Response – “1 Safety Threat per 1.2 Simulations”

A pediatric ED at a large U.S. hospital ran in situ simulations to evaluate emergency readiness. Their simulations uncovered safety threats in:

These were not issues of knowledge or skill, but of process and system design. As a result, the team updated layout, communication protocols, and resource access—contributing to over 1,000 consecutive safety event-free days.³

2. St. Michael’s Hospital – Trauma Bay Redesign

Before finalizing construction of a new trauma bay, Dr. Andrew Petrosoniak and his team used simulation to test layout and team flow.

“We believe that we should simulate scenarios as a means to test the equipment and the space, ensuring that it works as we imagine it will. We do this so that by the time we open for patient care, we’ll know that all systems are a go,”⁴ said Dr. Petrosoniak.

As a result, over 150 latent safety threats were addressed—before a single patient entered the room.

“St. Michael’s is really ahead of the curve for integrating the clinical team in the design of the space the way they did. We’re grateful for the Operational Readiness team’s safety-minded approach and that we have a simulation program that can support this type of work,”⁵ says Dr. Petrosoniak.

3. Rural Nebraska Hospitals – OB Hemorrhage Response

A simulation-based QI initiative across 12 rural hospitals helped identify gaps in postpartum hemorrhage protocols. Simulations revealed delays in transfusion, inconsistent use of hemorrhage carts, and unclear roles during escalation.

One OB physician shared:

“A week after our OB team completed the training, we [had a real postpartum hemorrhage]… the simulation was invaluable.”⁶

What System Problems Can Simulation Help Fix?

How to Use Simulation to Fix System Problems

Here’s a practical pathway for simulation leaders, quality managers, and clinical teams:

System failure isn’t always obvious on paper. But simulation can make it visible—and fixable. Start using it to redesign care that works better for patients and the teams who serve them.

Ready to rethink your next QI initiative? Contact us to explore further how you can start with simulation.