title: Simulation in the Executive Suite: Lessons Learned for Building Patient Safety Leadership.
abstract: BACKGROUND
  Simulation is a powerful learning tool for building individual and team competencies of frontline health care providers with demonstrable impact on performance. This article examines the impact of simulation in building strategic leadership competencies for patient safety and quality among executive leaders in health care organizations.
  
  
  METHODS
  We designed, implemented, and evaluated a simulation as part of a larger safety leadership network meeting for executive leaders. This simulation targeted knowledge competencies of governance priority, culture of continuous improvement, and internal transparency and feedback. Eight teams of leaders in health care organizations-a total of 55 participants-participated in a 4-hour session. Each team performed collectively as a new chief executive officer (CEO) tasked with a goal of rescuing a hospital with a failing safety record. Teams worked on a modifiable simulation board reflecting the current dysfunctional organizational structure of the simulated hospital. They assessed and redesigned accountability structures based on information acquired in encounter sessions with confederates playing the role of internal staff and external consultants.
  
  
  RESULTS
  Data were analyzed, and results are presented as qualitative themes arising from the simulation exercise, participant reaction data, and performance during the simulation. Key findings include high degrees of variability in solutions developed for the dysfunctional hospital system and generally positive learner reactions to the simulation experience.
  
  
  CONCLUSIONS
  This study illustrates the potential value of simulation as a mechanism for learning and strategy development for executive leaders grappling with patient safety issues. Future research should explore the cognitive or functional fidelity of organizational simulations and the use of custom scenarios for strategic planning.
authors.affiliation: From the Armstrong Institute for Patient Safety and Quality (M.A.R., X-X.C., J.O.F., D.R., P.J.P., S.J.W.); Department of Anesthesiology and Critical Care Medicine (M.A.R., P.J.P., S.J.W.), The Johns Hopkins University School of Medicine; Johns Hopkins Bloomberg School of Public Health (M.A.R, P.J.P., S.J.W.); Johns Hopkins School of Nursing (M.A.R., P.J.P., S.J.W.); Carey School of Business, Johns Hopkins University (S.J.W.); and MedSTAR Health (C.A.G.), Baltimore, MD; Department of Psychology (X-X.C.), Florida Institute of Technology; VHA, Inc (R.C., L.G., J.N.M., K.C.K.), Irving, TX.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Rosen
authors.forename: Christine A
authors.initials: CA
authors.lastname: Goeschel
authors.forename: Xin-Xuan
authors.initials: XX
authors.lastname: Che
authors.forename: Joseph Oluyinka
authors.initials: JO
authors.lastname: Fawole
authors.forename: Dianne
authors.initials: D
authors.lastname: Rees
authors.forename: Rosemary
authors.initials: R
authors.lastname: Curran
authors.forename: Lillee
authors.initials: L
authors.lastname: Gelinas
authors.forename: Jessica N
authors.initials: JN
authors.lastname: Martin
authors.forename: Keith C
authors.initials: KC
authors.lastname: Kosel
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Pronovost
authors.forename: Sallie J
authors.initials: SJ
authors.lastname: Weaver