The tide is turning: organizational structures to embed simulation in the fabric of healthcare.

In this issue of Simulation in Healthcare, there are two papers discussing important issues facing the simulation community at a critical juncture in the development of simulation in healthcare. A full manuscript1 describes an independent organization—Advanced Initiatives in Medical Simulation (AIMS)—that can be considered a “cousin” to the SSH, whereas a meeting report2 describes the 2006 Simulation Summit that the leadership of the Society for Simulation in Healthcare (SSH) convened in November 2006. We must disclose that SSH is the professional society that publishes this Journal. One author of this editorial is the founding and current President of SSH; the other author is a founding member of the SSH Board of Directors and currently an ex officio member of the SSH board. Furthermore, are both current or former board members of AIMS. Still, even looking beyond our biases, it is fair to say that the recent activities of these two organizations represent important milestones in the evolution of simulation as a core component in the revolutionary effect that simulation is having on healthcare education and safety in the United States. Although SSH is an international society, the focus of its SUMMIT was on North American stakeholders. AIMS is specifically focused on US policymakers, although AIMS activities have participants from other countries. The SSH Summit was a chance to take stock of where the field of simulation in healthcare is today and where SSH wants to be in the future, in the context of where we have been. Twenty years ago, there was frequent use of simple part-task trainers (eg, cardiopulmonary resuscitation mannequins, intravenous arms). Standardized patient (actors) exercises, although started in the early 1960s and developed extensively in the 1980s, did not themselves become widespread until the 1990s. In 1990, there were only a few pockets of technological simulation in a narrow spectrum healthcare domain. Today, technological simulation is in widespread use and growing rapidly in many different fields and in locations throughout the world. Part-task trainers and standardized patient simulations are also commonly used, sometimes in various combinations with each other or with technological simulators. When some of us first started our mannequin-based simulation work in the midto late 1980s, we believed that simulation would become important to healthcare over the following decade. Now as we are into our third decade of simulation work, we realize that we are still in the early phases of the decades-long process of embedding simulation into the fabric of healthcare. A number of observers—mostly those with a technological or entrepreneurial bent—have asked: “What is the next big invention in simulation?” With a broader view they might ask: “What is the next big step for simulation?” We would contend that while there is abundant need for technology development to make simulation devices of greater veracity and for more applications, the biggest step for simulation going forwards will not be technological, but will be organizational. That is, even with today’s technologies there is an enormous amount that can be accomplished with simulation that is not being done because the institutional mechanisms for providing it are immature.