Weldon, Sharon Marie ORCID: https://orcid.org/0000-0001-5487-5265, Mardon, Julie, Tallentire, Vicky, Hufton, Daniel, Galbraith, Andrew, Bowie, Paul, Laws-Chapman, Colette, Grit, Marco, Mccrone, Paul ORCID: https://orcid.org/0000-0001-7001-4502, Smith, Samantha, Buttery, Andy, Spearpoint, Kenneth, Gurnett, Philip ORCID: https://orcid.org/0000-0003-0445-0255 and Baxendale, Bryn (2025) From escalation to emergence: NHS Forth Valley and the quiet power of Transformative Simulation. British Medical Journal (The BMJ). pp. 1-5. ISSN 1759-2151 (Print), 0959-8138 (Online) (In Press) (doi:10.1136/leader-2025-001408)

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Abstract

Background: In 2022, National Health Service (NHS) Forth Valley, Scotland was escalated to Level 4 under the NHS Scotland Support and Intervention Framework - triggering the highest level of oversight and engagement from the Scottish Government prior to statutory intervention. While many systems under such pressure default to compliance-driven responses, NHS Forth Valley took a different path: embracing a whole-system approach focused on leadership, culture, integration and governance. Within this, Transformative Simulation was embedded as a leadership method to support cultural and systemic renewal.
Approach: A multi-professional, multi-sector delegation from the Association for Simulated Practice in Healthcare (ASPiH) visited NHS Forth Valley in early 2025 to observe simulation in practice as a leadership tool. Over two immersive days, we witnessed how simulation was used not only for education and training but also for engaging with emotionally charged challenges, enabling system-wide reflection and co-designing new models of care.
Reflections: Leadership behaviours observed during the visit were marked by humility, openness and courage. Senior leaders did not simply oversee change - they participated in simulations, listened deeply and responded actively. Simulation served as both a mirror and a mechanism: surfacing cultural dynamics, enabling cross-boundary collaboration and supporting healing after organisational trauma. Transformative Simulation emerged not as a short-term intervention but as a long-term leadership framework.
Implications: NHS Forth Valley’s response demonstrates that simulation, when embedded intentionally, can be a powerful lever for leadership, trust-building and transformation. Their story offers a hopeful vision of what becomes possible when leadership chooses connection over control.

Item Type:	Article
Uncontrolled Keywords:	Transformative Simulation, leadership, complex systems, human factors, quality improvement, patient safety
Subjects:	H Social Sciences > HD Industries. Land use. Labor > HD61 Risk Management L Education > LC Special aspects of education R Medicine > R Medicine (General)
Faculty / School / Research Centre / Research Group:	Faculty of Education, Health & Human Sciences Faculty of Education, Health & Human Sciences > Institute for Lifecourse Development Faculty of Education, Health & Human Sciences > Institute for Lifecourse Development > Centre for Professional Workforce Development Faculty of Education, Health & Human Sciences > School of Health Sciences (HEA)
Last Modified:	26 Jan 2026 12:36
URI:	https://gala.gre.ac.uk/id/eprint/52330

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