In-situ simulation has the potential to improve patient safety through the identification of previously unidentified or unresolved threats to patient safety, but only if actions are subsequently taken to resolve those threats. In their recent research, the investigators reported on patient safety threats identified during in-situ simulations across 21 hospitals in New Zealand and any actions taken to resolve the threat. It was found that many of the identified latent safety threats (LSTs) remained unresolved, and thus lie dormant with potential to contribute to patient harm in the future. This lack of resolution is also apparent in the literature arising from patient incident reporting systems.
While there have been many studies reporting patient safety threats identified by staff incident reporting systems or following in-situ simulations, less is known about how these identified threats can be resolved. This research is novel in that it is a prospective study of identified patient safety threats, it is large, involving half the public hospital system in New Zealand, and it focusses on outcomes – what happens to these identified threats.
NetworkZ is a national in-situ simulation team-training programme for operating and emergency department teams. The research proposed here is enabled by this unique initiative. The ability to identify safety threats from these NetworkZ simulation sessions provides a unique opportunity to identify potential ways to resolve LSTs, share learning between hospital departments, inform interdepartmental policies and initiatives and thus improve patient safety.
To understand how and why these identified threats are resolved or not, the investigators will develop and introduce a rigorous reporting process for patient safety threats identified during in situ patient simulations, collect data identified during NetworkZ courses and follow up on actions taken to resolve the threats. Key staff involved in the identifying and reporting of these threats and staff responsible for hospital quality improvement programs will also be interviewed.
The findings of this study are likely to be applicable to the general issue of actually implementing change in response to evidence of LSTs. Thus, this study is likely to be highly competitive internationally, and to have relevance beyond anaesthesia. The research will contribute to international knowledge about the facilitators and barriers to collating and resolving threats to patient safety identified during in-situ simulation.
Professor Jennifer Weller, Dr Jennifer Long, The University of Auckland, New Zealand.
The project was awarded $A55,314 through the ANZCA research grants program for 2022.
Hospitals use in situ simulation, practice scenarios run in real clinical environments, to uncover hidden problems that could threaten patient safety. These problems, known as latent safety threats, can include issues with equipment, the physical environment, processes, teamwork or organisational systems.
While in situ simulation is well recognised as a way to identify these risks, far less attention has been paid to what happens after the problems are found. In many cases, it is unclear whether the identified safety threats are actually fixed, who is responsible for addressing them, or what helps or hinders their resolution.
The problem we sought to address was this gap between identifying safety risks and resolving them. Specifically, we wanted to understand how often safety threats identified through in situ simulation in Aotearoa New Zealand hospitals were resolved, and what factors influenced whether those threats were successfully addressed.
We studied safety threats identified during in situ simulation courses run across hospitals of different sizes throughout Aotearoa New Zealand. Three months after each simulation course, we reviewed whether the identified safety threats had been resolved. We also spoke directly with clinicians who coordinated simulation programmes to better understand their experiences and perspectives.
This research shows that identifying safety risks through in situ simulation is only the first step in improving patient safety. Without clear systems to support action, many important risks remain unaddressed.
To make better use of in situ simulation, healthcare organisations need to move beyond simply finding problems and focus on helping clinicians resolve them. This includes creating clear processes for reporting and tracking safety threats, supporting collaboration across departments, and ensuring accountability for follow-up. Importantly, organisations should recognise and value frontline clinicians’ insights and give them the authority and resources needed to make meaningful change.
By aligning organisational structures with the realities of clinical work, healthcare systems can better translate simulation findings into real improvements in safety, resilience, and patient care.
We found that, although a large number of safety threats were identified, fewer than one in three had been resolved within three months. Problems related to equipment, physical spaces, or specific clinical tasks were more likely to be fixed, particularly when solutions were straightforward and within clinicians’ control. In contrast, issues related to teamwork, communication, or organisational systems were much less likely to be resolved.
Hospital size mattered. Smaller hospitals were more successful at resolving safety threats than larger hospitals. Clinicians explained that this was often due to clearer communication pathways, fewer layers of decision-making, and greater ability to act locally. Across all hospitals, clinicians were more motivated and able to resolve problems when they felt a sense of ownership, had authority to make changes, and could clearly communicate the issue to the right people.
However, when safety threats required involvement from multiple departments, senior management, or structural change, they often remained unresolved due to limited time, lack of authority, and absence of clear organisational processes to support follow-up.
Weller J, Fahey-Williams K, Henderson K, Torrie J, Hamill J, Moore J, Campos C, MacCormick A. Resolving latent safety threats identified through in situ simulation: a multicentre mixed-methods study. Advances in Simulation. 2025 Dec 8.
Conference presentations
Accepted for oral presentation at SESAM Conference, Lyon, June 2026
Invited presentation at ANZCA ASM in Foundation Grants session, Auckland May 2026.
Webinar
Presented at NZ Association for Simulation in Healthcare Webinar, Nov 2025.