Table 1

Driving forces and implementation mechanisms for full integration of simulation into health care

Entity*	Driving forces	Implementation mechanisms
*Entities are listed from top to bottom roughly in descending order of current interest in implementing the simulation vision, and roughly in ascending order of the ultimate power of their driving forces.
Simulation societies and researchers	• Promulgate simulation	• Research, position papers, standards, guidelines
Simulation societies and researchers	• Improve care and patient safety	• Research, position papers, standards, guidelines

Professional schools	• Improve learning	• Curricula
	• Competition with other schools	• Instructor training

Professional societies	• Improve performance	• Guidelines/standards
	• Avoid government regulation	• Curricula, research

Professional or subspecialty licensing or accrediting organisation	• Improve performance	• Required curricula
	• Assure maintenance of competency	• Simulation based testing
	• Respond to public pressure	• Guidelines/standards

Health care organisations	• Improve care and patient safety	• Required curricula
	• Improve efficiency, reduce cost	• Internal testing
	• Competition with other organisations

Funders of medical care	• Reduce costs	• Required curricula
	• Reduce errors	• Guidelines/standards

Liability insurers	• Reduce claims payout	• Discounts on premiums
	• Reduce claims	• Required curricula to receive coverage

Accrediting organisations	• Improve and ensure uniformity of care and patient safety	• Voluntary programs
	• Improve and ensure uniformity of care and patient safety	• Standards

Government	• Same as funders	• Laws and regulations
	• Respond to pressure from public	• Oversight of voluntary programmes

Public	• Improve care and patient safety	• Media attention
	• Reduce “training” on patients	• Acceptance of voluntary programs
	• Ensure uniform competence and proficiency of clinicians	• Pressure for government action