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2/14/2019 8:00 AM

#SuperSHIFTER Tim Willett is the President and CEO of SIM-one, the Canadian Network for Simulation in Healthcare (CNSH), the member-based network that supports and unites simulation programs across the country. Tim sees simulation as both an educational tool and a change agent to advance healthcare education, patient safety and care quality.

What can you tell us about SIM-one/CNSH?

We are the non-profit network of healthcare simulation centers and personnel across Canada and beyond.  I would estimate there are 200 to 250 simulation centers and programs in Canada, found at university faculties, colleges, hospitals, and other care agencies. Our membership is currently comprised of 52 organizations and close to 300 individuals. Our subscriber base currently sits at 1,950, with 25 per cent of that being international.

Our network's vision is exceptional healthcare through simulation. Our mission is to advocate and advance simulation for healthcare education, patient safety and care quality.  Our role is to support and expand the scope and quality of simulation, and to help improve the sustainability of simulation programs. We bring people together for knowledge exchange and collaboration, resource sharing, and offer a suite of education programs that teaches people how to use simulation as an educational tool. It requires special skills to facilitate simulations; it is not the same as a traditional teaching paradigm.

What makes simulation unique and innovative?

Simulation does not just deliver knowledge for individual learning. It has evolved far beyond that.

At the team and system level, it provides experience that helps people to understand current practices, challenges to the current culture, ways to make things better, and opportunities to practice new ways so that improvements can be more easily implemented.

People working in simulation are powerful change agents. When you are looking to change educational paradigms, improve quality, change an organization's culture, or change the way processes and spaces are designed, you will find that simulationists are very passionate, forward-thinking, open to change and skilled at facilitating change.

What opportunities do you see for simulation?

There is incredible potential for simulation to improve care in hospitals and other care settings.

An important part of our mandate is our advocacy role. We work with other groups, like the Canadian Patient Safety Institute, to help them understand the role that simulation can play to advance their mission. Increasingly, we are seeing that implementation and culture change are bottlenecks to improvement in healthcare. Simulation is a powerful tool for implementation, and can help to change behaviours, improve teamwork and transform a culture. We want to ensure that our stakeholders understand the role simulation can play and find ways through collaboration that we can help to advance their work.

In the education world, the evidence of simulation is well-established, and Canada is a world leader in the use of simulation within healthcare education curricula. Simulation is improving how healthcare students learn and develop as professionals. From a patient safety and education perspective, practicing on mannequins and actors is far more desirable than practicing on patients or other healthcare professionals.

While simulation has a strong foothold in education, there is a tremendous untapped potential for simulation on the healthcare delivery side. There are only a handful of hospitals and healthcare agencies in Canada who are really embracing simulation to improve safety and quality at the point of care delivery. That is where the opportunity lies and Canada is just at the beginning of taking advantage of the possibilities. This includes using simulation to design healthcare spaces, refining healthcare processes, identifying safety threats before they occur, just-in-time training to ensure staff are refreshed on the skills needed before going into a critical healthcare procedure, improving the quality of continuing professional development, assisting in the implementation of a quality improvement plan, improving teamwork in interprofessional care, and improving safety cultures. Traditionally, simulation has been thought of as an education tool and we are advocating that the use simulation for these system-level opportunities can improve healthcare.

How has simulation evolved and what is needed today to advance simulation?

Twenty years ago, when simulation was just taking off, the focus was on equipment. After five or 10 years, it became quite apparent that having the human resources to design and implement simulation was paramount. The focus shifted from equipment to personnel and training people to become simulation experts.   

The next steps to advance simulation in Canada are twofold:  one is a broader awareness of the opportunities and evidence, especially in the healthcare delivery setting, and the other is to increase the human capacity to implement simulation throughout education and healthcare delivery.

In your work in simulation, what have been your major learnings and takeaways?

The first is that simulation does not have to be expensive. More thought is needed around simulation programs, rather than simulation laboratories. Creation of a simulation program is not expensive if you invest in people before you invest in equipment. I would be very cautious about treading into simulation without that investment in human resources. Simulation by its nature is immersive and you want to deeply engage people in doing simulations. There is a specific skill set for creating and facilitating simulations. Again, that focus on creating the resource capacity and skill set to implement simulation is both critical and more feasible than many may realize.

The other thing that I have learned over the past six years is that as large as Canada is, the simulation community at a national level is not that big.  It is a niche area. Collaboration among organizations and professionals is becoming increasingly essential to improve the quality and sustainability of simulation across the country.

Finally, there are a lot of aspects of simulation that can be shared – everything from policies within a simulation lab, organizational structures, staffing models, simulation scenarios, and validation tools for assessing simulation.

What challenges are you seeing?

There is continued skepticism about the value for investment in simulation. The perception of leaders and decision-makers is that it is a nice-to-have program that is expensive. We need to better understand the barriers to overcome this perception, and help our leaders to recognize that it is an investment with demonstrated returns and an essential tool for quality and safety improvement. There is also a perception around the necessary expense of equipment over resources. We need to improve buy-in and investment in simulation at the leadership level.

Can others adopt or replicate what SIM-one/CNSH has to offer?

I absolutely want to see more engagement across the country in simulation and more organizations involved is this network because the more people contributing to the shared knowledge, resources and insight, the more all benefit and the stronger our collective voice on simulation.

There is a lot of value in regional simulation networks as it is not always feasible to travel to national conferences and there is power in establishing regional collaborations. I would encourage groups across Canada to look in their area and build those relationships within their cities and provinces, and build bridges with the national network.

I hesitate to say that the model we have developed could be replicated. The history of any group like this is going to be unique. In our case, we grew out of two prior networks: SIM-one, which had the luxury of government funding for a number of years to establish programs and an infrastructure. About a year ago, SIM-one integrated with the Canadian Network for Simulation in Healthcare, which had developed national level relationships. Our backgrounds are unique and have provided the foundation to where we are now.

What is needed to start the conversation and create a ripple effect to advance simulation?

I would like to see two related and parallel conversations at a national level. The first would be a conversation with organizations like the Canadian Patient Safety Institute, the Healthcare Insurance Reciprocal of Canada, the Canadian Foundation for Healthcare Improvement, and other national stakeholders on how to better inform decision makers in government and healthcare delivery settings about the opportunity and value, and to advance the scope and quality of simulation in that setting.

The parallel conversation would be among decision-makers and leaders in the educational sphere for healthcare professions. Again, what are the issues that they are grappling with currently and where do they see those issues in five or 10 years from now, and looking at what ways will expanding simulation help to address those issues.  Are those issues human resource shortages, education quality, patient safety, and/or increased expectations from the public and employers around highly trained healthcare professionals?

Where can I go to learn more?

Anyone can look at our website, to get more information and access resources, but I would like people to contact me. My virtual door is always open! Our success will come from community relations and collaboration -- and the best way to establish that is in how we connect with people.  Send me an email or give me a call so that we can learn more about your context and discuss how we might support your vision. 

Tim Willett, President and CEO
Mobile: 647-448-7119

Learn more about hospital-based simulation at the 2019 National Forum on Simulation for Quality & Safety, May 28, 2019 in Vancouver, BC.  Visit  for more information.