Weldon SM, Mardon J, Tallentire V, et al. BMJ Leader Published Online First: [please include Day Month Year]. doi:10.1136/ leader-2025-001408.

Transformative Simulation is a structured framework for using simulation not to educate, but to illuminate, test and improve complex health and care systems. While simulation has traditionally focused on clinical skill development, Transformative Simulation positions simulation as a vehicle for collective inquiry, shared sense-making and system redesign. Patient safety is one of the core domains in which this approach is actively applied.

Why Transformative Simulation matters for patient safety

Healthcare harm rarely arises from a single error; it emerges from interactions between people, processes, cultures, technologies and organisational pressures. Transformative Simulation addresses this complexity directly. It enables organisations to move beyond retrospective incident review toward embodied system inquiry and practical redesign.

Through Transformative Simulation, organisations can:

• Explore how governance, hierarchy and context influence safety behaviours.
• Test potential changes in a psychologically safe environment before implementation.
• Engage patients, families and staff in co-produced learning.
• Translate investigation findings into system-level reform.

What makes Transformative Simulation distinct

Transformative Simulation is structured around seven simulation-based intentions (SBIs), which clarify the purpose of each simulation activity, and the 4D process: Design, Delivery, Data and Debrief. Each stage is deliberately aligned with the chosen intention, ensuring learning is architected rather than incidental.

Central to the framework is the principle of reciprocal illumination: simulation informs practice, and practice reshapes simulation design. This creates an adaptive learning loop that supports system-level change.

Transformative Simulation in patient safety contexts

Transformative Simulation has been applied in safety-critical settings, including Never Events prevention, organisational learning after serious incidents, leadership and governance review, and human factors integration. The aim is not performance rehearsal alone, but structured exploration of system conditions that shape safety outcomes.

Working with the hub community

Through collaboration with Patient Safety Learning, in this topic area we will share case examples, host structured discussions and explore how simulation can strengthen shared learning and system redesign. The intention is to complement existing safety approaches by offering a structured method for working with complexity in practice.

Invitation

hub members are invited to share experiences, questions and case examples. Where do patient safety investigations most often stop short of system redesign? How might simulation help teams test and refine safer ways of working?

The Transformative Simulation Special Interest Group (ASPiH)

The Transformative Simulation Special Interest Group (TfS SIG), hosted by ASPiH (Association for Simulated Practice in Healthcare), brings together clinicians, patient safety professionals, human factors experts, patients and system leaders committed to advancing simulation as a vehicle for system-wide change.

The SIG works across sectors and national contexts to develop theory, practice and evidence in Transformative Simulation, including applications in patient safety, human factors, leadership and digital innovation.

Further resources, publications and events can be found via ASPiH and the TfS SIG: https://aspih.org.uk

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