Sharing our Work on Systems Safety Simulation

22 Feb 2022, 5:12 p.m.

Emma Broughton, our Operational Lead for Simulation at GOSH, represented the Clinical Simulation Centre at the Association for Simulated Practice in Healthcare (AHPiH) conference in November 2021.

Emma presented the following: 'Embracing a Systems Based Approach to Simulation - The Experience of a Paediatric Hospital during a Global Pandemic'.

Emma shared how the new and unfamiliar working practices introduced by the COVID-19 global pandemic has accelerated the simulation team’s focus towards systems safety simulations and adoption of a prospective, safety II approach to simulation delivery.

A systems safety simulation is one designed to help a team understand and interrogate the system they are working in; from the physical environments they work within to processes and protocols they work to.

Emma explained how the simulation team and had already started to use in-situ simulation to evaluate clinical systems and processes ahead of the pandemic, giving the example of a simulated patient transfer between the neonatal intensive care unit and the cardiac catheter suite. This was a new process when the cardiac catheter suite started to perform a new neonatal procedure, but both teams knew the importance of carrying it out safety from the very first patient.

By rehearsing new ways of working like this, clinical teams can be proactive in identifying latent safety threats and make changes to ensure that things go right as often as possible from the very start. This is an example of working to the safety II model and differs from the safety I approach of reacting to safety threats after an incident has occurred. In the neonatal transfer example, the practice-run allowed the teams to anticipate challenges in the process which informed guidance for the procedure for example changing the way theatre was set up for this specific operation.

Neonatal transfer
Simulated Neonate arrives in cardiac catheter suite

The onset of the COVID-19 pandemic in March 2020 led to many changes including staff redeployment, new processes, protocols, and ways of working which had not previously been tested. Understandably, teams were feeling concerned and unprepared.

Emma explained how the simulation team worked with staff groups to identify which parts of their new systems they wanted to interrogate. Simulation exercises were designed to focus on rehearsal and refinement of processes and systems, and towards uncovering latent safety threats or gaps in practice. They worked closely with the quality and safety teams and a reporting tool was developed to capture risks, identify mitigating actions, and share learning.

Over the course of three months, the team ran 10 exercises which helped to develop five new clinical guidelines relating to COVID-19 specific practices. Examples included rehearsing how to prone older children in intensive care and transferring a simulated COVID positive patient to the radiology department. This single simulation identified 11 latent safety threats which could be mitigated before the first COVID positive patient arrived in the department one week later.

Beyond COVID, the simulation team have continued to adopt a prospective, safety II approach to simulation delivery. Key successes have included an exercise in our new iMRI hybrid theatre which helped to determine where to position emergency equipment, and a simulated fire evacuation in a new clinical building which has informed their evacuation process.

Fire evacuation simulation

More than 10 protocols within the organisation have now been influenced by systems safety simulations, a great success for patient safety and the simulation team. Proactively anticipating the next steps, Emma ended her presentation by sharing an aspiration for the future: to offer simulation at pre-construction level to aid design teams to test future clinical environments before they are even built.

Congratulations Emma on an excellent presentation and thank you for sharing the team’s work with the wider simulation community.

If you would like more information on the work we do at the Clinical Simulation Centre, or are interested in evaluating a system you work in, please get in touch at We look forward to hearing from you!

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