Article Text

40 “You didn’t follow the policy?!” using simulation to evaluate new policies
  1. N Woodier1,
  2. T Blanks1,
  3. L Fullerton2,
  4. A Al-Rifai2,
  5. M Fores1
  1. 1Trent Simulation, UK
  2. 2Nottingham University Hospitals, UK


Background When incidents occur, a common finding is that “staff did not follow policy.” As part of the investigation it is essential that investigators explore “why” the staff didn’t follow policy. This may be because the policy is inappropriately written and impossible to put into practice on the frontline. A disconnect can exist between the authors of a policy and those who actually put it into practice; work as done versus work as imagined.1

To address this we have developed the use of simulation to support the evaluation of draft policies before publication. This abstract uses a local case study to exemplify.

Method Whilst drafting the new, local, intravenous administration policy we utilised simulation with clinical staff to evaluate its usability- ease of following and committing to memory. Using a simulated-patient actor we developed two simulations to which the policy could be applied- direct injection and infusion.

Participants were recruited from frontline nursing staff (those putting the policy into practice) and faculty drawn from Pharmacy, Nursing and staff with training in Human Factors. Participants were given the opportunity to read the draft policy and then undertake the simulations. All simulations were video-recorded and participants were interviewed using a semi-standardised structure.

Results 10 staff attended the simulation. A full evaluation was developed that highlighted issues associated with:

  • Ease of access to and visibility of key information

  • Clarity surrounding the process

  • Consistent language

  • Difficulties with application to the “real world”

  • Training requirements

  • Potential impact

Simulation, using simple scenarios, allows the safe-evaluation of new policies and guidelines before publication to ensure they are appropriate for frontline use. It engages staff in user-centred design in their own healthcare system. All clinical policies should be evaluated using simulation before publication.


  1. E Hollnagel. The Functional Resonance Analysis Method.

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