When healthcare quality falters, our first instinct is often to retrain staff, revise a protocol, or issue a new policy. But these passive approaches rarely result in meaningful change. To improve outcomes and reduce risk, healthcare organizations need methods that actively examine, test, and improve the systems themselves. Simulation provides that method. 

Good Intentions, Limited Impact

A near-miss in the ICU. A hemorrhage case that didn’t go according to plan in Labor & Delivery. Miscommunication during an emergency handoff in the ED. In the wake of these types of events, hospitals often reach for well-worn quality improvement (QI) responses:

Are these the types of solutions you are familiar with? If so, you are not alone. And you have likely been disappointed by the results. That stands to reason. The above are all passive methods—interventions that assume the problem lies in individual knowledge or motivation, rather than in the system itself.

And they often fail.

Why Passive Methods Fall Short

1. Re-education Doesn’t Solve Systemic Problems

An analysis of safety reports by the Agency for Healthcare Research and Quality (AHRQ) and related studies consistently indicates that breakdowns in communication and systemic process failures are the root causes of most adverse events—not knowledge deficits. Yet training is often the go-to fix, often assigning “blame or liability” in the process.²

2. New Protocols Often Go Untested

Protocols are valuable, but if they’re never rehearsed in context—under real pressure, with actual teams—they risk failure when it counts. Policies alone don't ensure behavior change.

“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.”³ 

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

3. Memos and Mandates Don’t Change Behavior

Written communication may raise awareness, but it doesn’t embed new workflows or habits. Without practice and feedback, performance gaps persist.

"Designing a great organization, process, or system is only the beginning. It’s up to leadership to create an environment in which employees embrace and adopt new behaviors, relieved of the frictions that too often impede adoption and ultimately thwart change efforts.”⁴

 

- Tracy Thurkow and Adélaïde Hubert,
Bain & Company

4. Punitive Action Silences Learning

Disciplinary responses send the message that individuals—not systems—are the problem. They damage morale, create fear, and discourage open reporting, all while the root cause remains untouched.

"Healthcare professionals are [often] punished for being human. This drives fear, suppresses error reporting, and ultimately puts patients at risk. ... The focus must shift from determining who is at fault when errors happen, to determining what went wrong, what we can learn, and how to improve the system overall."⁵

 

- Marcus Schabacker,
President and CEO of ECRI

Simulation as a Better Way Forward

Simulation offers a powerful alternative—an active, system-focused approach to quality improvement that enables hospitals to move from reactive fixes to proactive learning.

“Simulation provides a crystal ball into the future for how processes, systems, spaces and personnel will function during rare but high-stakes events. This allows for decision making with greater certainty and also mitigating predictable system level issues.”⁶  

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

 

Why Simulation Works

• ✓Tests systems, not just people
• ✓Reveals latent safety threats
• ✓Engages frontline staff in problem-solving
• ✓Enables rapid-cycle testing and refinement
• ✓Builds confidence and shared mental models

Some Examples Where Simulation Did What Passive Methods Could Not

Simulation Success: North Middlesex Hospital, UK

29 pediatric emergency sessions involving 98 participants were conducted in situ to improve acute pediatric care.  This was part of a critical incident analysis of an adverse event that happened in the paediatric accident and emergency department. Errors identified included three key drugs continually out of stock, consumables out of stock, staff unfamiliarity with location and use of key equipment.

Result: Systems changes were put in place to include Pharmacy as part of the accountability process, Rx check sheets for the emergency staff, regular inventory protocol, and remedial training. ⁷

Simulation Success: St. Michael’s Hospital, Toronto—Latent Safety Threats

In 12 trauma simulations, the hospital’s teams uncovered over 150 critical latent safety threats. The simulations led to improved trauma bay design, workflow changes, and faster, more coordinated care.

Result: Real-world trauma cases showed more consistent team performance and reduced errors.⁸

Simulation Success: Bryan Health, Nebraska—Obstetric Hemorrhage Response

At Bryan Health in Nebraska, rural hospitals conducted postpartum hemorrhage simulations that revealed gaps in emergency protocols and resource locations.

Result: Hemorrhage carts were repositioned, blood delivery protocols revised, and communication workflows clarified. One physician said, “A week after our OB team completed the simulation training program, we put our training to work in a postpartum hemorrhage requiring a massive transfusion protocol. The simulation was invaluable.”⁹

From Passive to Proactive with Simulation

Here’s how to shift your QI response from reactive and passive to simulation-informed and proactive: