HealthManagement, Volume 18 - Issue 5, 2018


Simulation for building patient safety and quality leadership capacity

Simu-Leader is an interactive simulation designed to build the skills needed for today’s safety and quality leaders. This article provides an overview of its assets and role in leadership development.

Do healthcare leaders need simulation?

Leaders and managers at all levels of healthcare organisations play critical roles in patient safety and quality improvement efforts. This includes creating clear and compelling visions for the organisation, establishing and communicating goals, ensuring accountability, and engaging members of the organisation intellectually and emotionally in improvement work. This is complex work, and most leaders have few opportunities for formal development and mastery of these skill sets.

We know from decades of empirical research that practice and feedback within a simulation-based curriculum are more effective means of acquiring these types of competencies than more passive learning strategies. Simulation has become more commonplace for clinical care teams, but remains a relatively untapped strategy for developing organisational leadership and management skills. The Simu-Leader programme is designed to address this gap.

What is Simu-Leader?

Simu-Leader is an interactive, online, multi-player simulation designed to build skills in the areas of leadership, management, and implementation of patient safety and quality programmes. Leaders participate as a team, managing the implementation of a complex safety and quality improvement programme. Specifically, they go through three phases of interacting with a simulated hospital:

  1. Leaders assess their organisation. This includes reviewing clinical process and outcome data, interviewing key stakeholders, and participating in simulated unit leadership rounding. The team seeks information and collaborates to identify opportunities and challenges, prioritising their efforts moving forward.
  2. Leaders develop a plan for moving the organisation forward in improving safety and quality. They discuss and prioritise different tactics and develop their best plan based on time and cost constraints.
  3. Leaders implement this plan and receive feedback on the impact their plan has had on the safety and quality performance in their simulated hospital. They see changes in process and outcome data, and how different tactics played a role in those changes. Teams can then reflect, re-plan, and try to improve their performance.

Simu-Leader’s development

The development and initial evaluation of Simu-Leader was done via collaborative effort between patient safety experts at the Johns Hopkins University Armstrong Institute for Patient Safety and Quality and wargaming and organisational simulation experts at Johns Hopkins Applied Physics Lab. Simu-Leader was funded by the Agency for Healthcare Research and Quality to address gaps in patient safety and quality leadership development.

Who is Simu-Leader designed for?

Simu-Leader addresses learning needs for leaders across boundaries in the organisation, both hierarchical (ie, different levels of leadership) and horizontal (ie, different professional disciplines or departments). It targets leadership teams consisting of executive leaders, mid-level managers with quality and safety roles, and unit or departmental leaders. Patient safety and quality improvement work commonly happens in teams; therefore, we believed it was important to practise leadership of teamwork.

To date, approximately 1,000 learners have used a version of Simu-Leader. This includes Simu-Leader implemented as:

  1. A stand-alone learning activity within the Armstrong Institute’s Fundamentals of Leadership for Patient Safety and Quality Program, which targets practising safety and quality leaders
  2. Part of formal educational programmes in Johns Hopkins Schools of Public Health and Nursing; and
  3. A component of the Improving Surgical Care and Recovery (ISCR) programme, a national dissemination project for enhanced recovery pathways in the U.S.

What are the Simu-Leader objectives?

Simu-Leader can be adapted to different scenarios and learning objectives. Common learning objectives for Simu-Leader scenarios include:

  1. Identifying common misalignments in accountability across the organisation, including
         a. Role clarity, responsibility and feedback mechanisms
         b. Building capacity (formal and informal learning); and
         c. Time and resources (transparency of budgeting processes and alignment with organisational priorities).
     2. Implementing evidence-based management tactics for improving accountability in your organisation
     3. Applying transformational leadership and boundary spanning behaviours to accelerate the impact of                     management tactics.
     4. Developing new tactics for building accountability in your organisation.

The overarching goal is to provide an interactive environment for leaders to engage with a simulated hospital in a situation where there are no risks to failure. Learners are free to experiment and learn from one another while being exposed to evidence-based principles and practices for healthcare management.


The safety and quality improvement goals set out before the healthcare industry are challenging. Improvement requires change. Change requires leadership. And leadership requires skills that are not easily acquired, and not frequently formally developed in today’s healthcare leaders and managers. These leaders need more and more effective means to develop the fundamental knowledge, skills, and attitudes necessary for leading healthcare into the future. Simulation will no doubt be a significant component of the healthcare leadership development programmes of the future.

Key Points

  • Leading safety and quality improvement efforts requires a unique set of skills
  • Many people serving in leadership roles have few formal opportunities to build the skills they need to be effective in their roles
  • Simu-Leader is an interactive simulation designed to fill this gap—to provide healthcare leaders with a safe place to practise and learn