September 8, 2020By Lance Baily

COVID-19 Response: Healthcare Simulation Champions Create Manifesto for Practice

Responding to COVID-19, a team of Healthcare Simulation Champions from around the world have crafted a manifesto for action, incorporating a more comprehensive understanding of healthcare simulation, beyond tool, technique or experience, to understanding it now as a professional practice. Acknowledging that the global crisis has been “disruptive, even a threat, to healthcare simulation, affecting all aspects of operations from education to employment”, the group has created this “call to action for all simulationists is to adopt a commitment to comprehensive safety, to advocate collaboratively and to lead ethically”. Perfectly suited to share with administrators of your healthcare organization, here we dive deeper into the document and add our own thoughts!

The article “Manifesto for healthcare simulation practice” (http://dx.doi.org/10.1136/bmjstel-2020-000712) is made freely available for use in accordance with BMJ’s website terms and conditions for the duration of the covid-19 pandemic or until otherwise determined by BMJ. The research journal BMJ Simulation & Technology Enhanced Learning (BMJ STEL) provides a forum to share scholarly practices to advance the use of simulation and technology enhanced learning in the context of health and social care. This includes knowledge translation to improve clinical outcomes, health systems, patient experience and safety. BMJ STEL is the official journal of ASPiH (Association for Simulated Practice in Healthcare) and the Irish Association for Simulation (IAS), which is currently managed by Editor-in-Chief Professor Debra Nestel, Monash University. Those is Healthcare Simulation Practice (HSP) that helped to author this manifesto include: Christine S Park, Louise Clark, Grace Gephardt, Jamie M Robertson, Jane Miller, Dayna K Downing, Bee Leng Sabrina Koh, Kellie D Bryant, David Grant, Dinker R Pai, Jesika S Gavilanes, Edgar Israel Herrera Bastida, Keith Littlewood, Eliana Escudero, Michelle Ann Kelly, Debra Nestel, and Jan-Joost Rethans.

“Informed by this critical need, this group collaborated to produce this manifesto for action that is rooted in simulation in healthcare as an evolving practice. A manifesto has been defined as ‘a published declaration of the intentions, motives or views of the issuer, be it an individual, group, political party or government’. While COVID-19 is the catalyst, even cataclysm, that sparked this document, the principles outlined here are relevant for other pervasive and deadly challenges impacting and impacted by healthcare simulation, including those of healthcare disparities, human rights and social justice, and for the future of healthcare simulation.


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The Manifesto states that healthcare simulation as a practice forms the foundation for three key tenets: safety, advocacy and leadership. Using these three tenets, the group argues that we can powerfully shape the resilience of healthcare simulation practice for now and for the future.

Safety: The safety of patients and learners is a core value for HSP. However, the safety of the medical simulation providers themselves is often overlooked in the understanding of this core value. The safety of clinical simulationists must be embedded in this core value in order to achieve comprehensive safety for HSP [as] some healthcare simulationists, such as operation specialists and SPs, have been categorized as ‘essential’, and have been working in simulation centers (aka simulation centres), and even in clinical environments.

Advocacy: Healthcare simulationists may work in settings where they feel they must accommodate the decisions of others rather than honoring their own expertise. Too often, clinical simulation professionals are disempowered and under-resourced, and expected to accommodate to make clinical education work—causing overwork, straining operations and compromising the well-being of medical simulation team members. In addition to expertise and service, we must also develop improved autonomy, as autonomy is needed for continual improvement of quality in a profession. Therefore, we must shift our practice from one that tolerates inequitable distribution of power and resources to one that thrives on collaborative mutual respect. The HSP must work together in collective advocacy.

Leadership: As a practice, we have an obligation to fairly represent our needs and the benefits we offer to all our stakeholders. This is especially important in a time of constrained resources when sustainability is called into question in all endeavours. As systems progress through crisis response toward recovery, even essential functions are vulnerable. We must all engage in understanding the costs and benefits of our choices. Safety, advocacy and leadership policies, and practices that cannot be sustained are unethical. Leadership decisions for simulation operations that do not advocate for equity and safety on behalf of the simulation workforce are unethical. Developing more creative, more inclusive and more transparent models for educational and financial sustainability will make our simulation programmes more resilient in the face of ongoing transformation in every sector.


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During the COVID-19 pandemic and indeed throughout history, simulationists have delivered innovation and maintained personal resilience. In sharing this creativity and knowledge to advance innovations for patient safety, this pandemic has heightened the necessity of cultivating equity throughout HSP. Most importantly, our community must champion those simulationists whose calls for safety are overlooked or even disregarded by their own institutions. By leveraging the disruptions to the status quo catalysed by this pandemic, HSP will be poised to successfully rise in response to future crises.

Their call to action is for all simulationists to adopt a commitment to comprehensive safety, to advocate collaboratively and to lead ethically. Using the three tenets described, one can powerfully shape the resilience of HSP for now and for the future.”

Our Support

HealthySimulation.com supports the Healthcare Simulation Manifesto, recognizing that while the COVID-19 pandemic has had negative consequences for the world’s population, its healthcare systems, governments, and the economy, that the crisis has created a catalyst towards the use of simulated healthcare practices in countless institutions.

During a webinar entitled “Creative Ways to Implement Virtual Simulation During a Pandemic” from Dr. Kellie Bryant and her team at the University of Columbia’s School of Nursing, we learned that many of the new technological innovations brought to the sim labs to combat COVID-19 will have a “permanent place” within their institution even after the pandemic ends.

As such, we believe strongly that COVID-19 has forced some “laggards” to adopt simulation based education and related technologies in a way nothing ever has before. We may indeed be seeing the beginning of our industry’s evolution from early-adopter to early-majority (in developed countries).

HealthySimulation.com has answered the call to further support the global healthcare simulation community with the launch of a healthcare simulation webinar platform — so check it out. You can also view our complete COVID-19 Healthcare Simulation Resources Page for even more help.

Read the Full Manifesto on BMJ’s STEL Website Today!


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