Transformative forms of simulation in health care – the seven simulation-based ‘I’s: a concept taxonomy review of the literature

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Introduction: Simulation for non-pedagogical purposes has begun to emerge. Examples include quality improvement initiatives, testing and evaluating of new interventions, the co-designing of new models of care, the exploration of human and organisational behaviour, comparing of different sectors, and the identification of latent safety threats. However, the literature related to these types of simulation is scattered across different disciplines and has many different associated terms, thus making it difficult to advance the field in both recognition and understanding. This paper therefore aims to enhance and formalise this growing field by generating a clear set of terms and definitions through a concept taxonomy of the literature. \n \nMethods: Due to the lack of alignment in terminology, a combination of pearl growing, snowballing, and citation searching approach was taken. The search was conducted between November 2020 – March 2023. Data was extracted and coded from the included papers according to seven Simulation-Based I’s (Innovation, Improvement, Intervention, Involvement, Identification, Inclusion and Influence). \nResults: 83 papers were identified from around the world, published from 2008 to 2023. Just over half were published in healthcare simulation journals. There were 68 different terms used to describe this form of simulation. Papers were categorised according to a primary and secondary Simulation-Based ‘I’. The most common primary Simulation-Based ‘I’ was Simulation-Based Identification. Selected categorised papers formed a descriptive narrative for each SBI. \nDiscussion: This review and taxonomy has revealed the breadth of an emerging and distinct field within healthcare simulation. It has identified the rate at which this field is growing, and how widespread it is geographically. It has highlighted confusion in terminology used to describe it, as well as a lack of consistency in how it is presented throughout the literature. This taxonomy has created a grounding and step-change for this work which is embedded in the literature, providing a rich and varied resource of how it is being utilised globally.

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