Using simulation to strengthen workforce participation, belonging and wellbeing: The Inclusion Intention

Summary

Transformative Simulation considers how simulation can be intentionally used beyond education to understand and contribute to change within healthcare systems.

The Inclusion Simulation-Based Intention focuses on using simulation to strengthen workforce participation, belonging, empowerment and wellbeing, creating conditions in which people feel able to contribute meaningfully to healthcare systems and change.

This resource from hub topic lead Sharon Weldon brings togethers a short Transformative Simulation thought piece, visual explainer and selected examples from the literature demonstrating how simulation can contribute to more inclusive, connected and psychologically safe healthcare workplaces.

Further resources from Sharon on Transformative Simulation:

• Using simulation to improve patient safety and healthcare systems: The Improvement Intention

• Using simulation to involve patients and communities in shaping safer care: The Involvement Intention

• Using simulation to identify patient safety challenges: The Identification Intention

Content

What is the Inclusion Intention?

Healthcare organisations increasingly recognise that workforce wellbeing, engagement and psychological safety are closely connected to how effectively people can participate in and contribute to healthcare systems. Yet staff are frequently asked to adapt to change without being meaningfully included in shaping it. In complex and pressured systems, this can contribute to disconnection, disengagement, change fatigue and reduced psychological safety.

Within Transformative Simulation, the Inclusion Simulation-Based Intention describes the purposeful use of simulation to strengthen participation, belonging, empowerment and workforce wellbeing within healthcare systems.

The emphasis shifts away from individual performance towards how people experience participation within the system itself. Simulation can create a shared space in which relationships, communication, collaboration and organisational dynamics become visible and can be collectively explored.

Inclusion, therefore, asks not simply whether people are present, but whether they feel valued, heard, connected, supported, psychologically safe and able to influence what happens around them.

Explore the idea

Simulation-Based Inclusion: Participation, Belonging and Workforce WellBeing is a thought piece exploring the Inclusion Intention and how simulation can be designed to support participation, belonging and workforce well-being.

It considers how theories and approaches from organisational psychology, employee engagement, participatory design, relational coordination, psychological safety and workplace well-being can shape simulation differently. Rather than asking only whether staff can perform correctly, an Inclusion lens considers how systems enable people to communicate, collaborate, contribute, adapt, connect and sustain themselves through change.

The accompanying short video provides a visual introduction to the Inclusion Intention and its place within the wider Transformative Simulation framework.

Inclusion in practice

Research and practice across healthcare simulation demonstrate different ways in which simulation can contribute to an Inclusion intention.

Examples include using simulation to:

• Create psychologically safer spaces for staff to contribute perspectives and concerns.

• Strengthen relationships, communication and collaboration across professional or organisational boundaries.

• Enable staff to participate meaningfully in organisational and system change.

• Explore workplace experiences that influence belonging, connection and wellbeing.

• Understand how organisational conditions enable or constrain staff participation.

• Support collective sense-making during periods of uncertainty or change.

• Contribute to cultural development by creating opportunities for staff to shape the systems in which they work.

Importantly, Inclusion and Involvement are related but distinct intentions.

Involvement asks: Whose voices need to be brought into the conversation?

Inclusion asks: How do we create conditions in which people within systems feel able to participate, contribute and remain?

They may overlap in practice, but distinguishing them helps clarify who simulation is for, what form of participation is being sought and what outcomes the simulation is intended to generate.

Good examples from the literature include:

• Validation of behavioral simulations: a case study on enhancing collaboration between partnership organizations
  Shows how behavioural simulation can bring partner organisations together to explore how they work collectively, creating a shared space to strengthen collaboration and participation across organisational boundaries.

• Sequential Simulation aimed at GP receptionists and their role in integrated care via a patient journey
  Demonstrates how simulation can recognise and empower an often-overlooked part of the healthcare workforce, helping GP receptionists understand their contribution to integrated care and participate more confidently in shaping patient care.

• Simulation Safety Club – NHS Forth Valley NHS Trust

  Shows how a regular, risk-informed Simulation Safety Club can create a structured space for frontline staff and leaders to explore live system challenges together, supporting participation, shared understanding and psychologically safer conversations about organisational change.

• Exposure to incivility does not hinder speaking up: a randomised controlled high-fidelity simulation-based study
  Uses simulation to explore how interpersonal responses and incivility shape staff willingness to speak up, illuminating the relational conditions that influence voice and participation in patient safety.

From inclusion to action

Simulation-Based Inclusion requires attention not only to who participates, but to how participation is experienced. Transformative Simulation therefore encourages teams to consider how the Inclusion intention shapes each of the 4Ds: Design, Delivery, Data and Debrief.

For Inclusion, this means designing simulation around the relational and organisational conditions that influence participation and belonging; delivering it in ways that support psychological safety and meaningful contribution; capturing data that helps us understand experiences of connection, engagement and wellbeing; and creating approaches to debriefing that enable collective sense-making and give participants genuine influence over what happens next.

Questions for practice

When designing simulation for Inclusion, consider:

• Who needs to feel able to participate and contribute?

• What might currently prevent people from speaking, participating or influencing change?

• How psychologically safe is the simulation environment for different participants?

• What relationships, hierarchies or organisational conditions might affect participation?

• How can the simulation strengthen connection, belonging and collaboration?

• What data could help us understand participants’ experiences of engagement, inclusion and well-being?

• How will participants have meaningful influence over what happens as a result?

Further Transformative Simulation resources on the hub:

Transformative Simulation resources

About the author

Professor Sharon Weldon is Professor of Healthcare Simulation and Workforce Development at the University of Greenwich and President of the Association for Simulated Practice in Healthcare (ASPiH). She co-developed the Transformative Simulation framework, which brings together different ways in which simulation can be intentionally used to contribute to healthcare cultural and systems-level change. Her work focuses on healthcare simulation, patient safety, workforce development and participatory approaches to understanding and transforming healthcare systems.