By: Victoria Brazil (@SocraticEM)
If you work in simulation, you’ve probably been asked: “What’s the value?” or ‘’Does it really work?”
We reach for familiar frameworks, pull out a pyramid, and hope the arrows point neatly from training to outcomes to dollars saved. But real work is never quite that tidy. A new paper from Lisa Barker and colleagues reframes how we talk about—and measure—value in simulation. It’s pragmatic, service-level, and unapologetically contextual.
On the companion Simulcast/Advances podcast, I sat down with Lisa, Ben Symon and Katie Walker. We traced the 25-year arc of “value” in sim – from early Kirkpatrick levels, through ROI fever, to today’s translational simulation mindset. The conversation was frank: our measurement habits can be wasteful, our hierarchies misleading, and our stories to execs… occasionally incoherent. Their antidote is the Value-Based Simulation in Healthcare (VBSH) model – a taxonomy (not a hierarchy) that helps services co-create relevant metrics with their organisations.
A pie, not a pyramid
The VBSH model has six freestanding but interdependent slices. No one slice sits “above” another; the mix you report should suit your purpose and stakeholders. That simple design move – pie over pyramid – nudges us from chasing “higher levels” to selecting the right levels. Here’s the quick tour:
- Service Products – the operational “what, who, and how”. Courses delivered, participants, time, space, consumables. Easy to collect, often what sponsors actually want to know, and powerful for accreditation and planning. In the podcast we laughed (a little) about times we’ve over-promised bedside outcomes when the funder only needed to know we trained 85% of staff by June. Match your evidence to their question.
- Program Perceptions – not just “smile sheets”. Purposeful perception data from learners, supervisors, executives, consumers. Confidence and self-efficacy can predict behaviour when you’re adopting new processes, and negative sentiment is an early-warning signal. The key is to value subjectivity without pretending it proves learning.
- Acquired Expertise – verified knowledge and skills. Think defensible assessment with validity evidence, not self-ratings. If you’re teaching rapid cycle teamwork for maternity emergencies, show that team performance scores actually improved. This is the place for your checklists, scales, and mastery learning outcomes.
- Workplace Performance – whether learning is implemented, and what simulation uncovers about “work as done.” This is translational simulation territory: testing processes, surfacing latent safety threats, shaping pathways. Debriefs become data for system learning, not just education.
- System Benefit – tangible and intangible organisational impacts mapped to the quintuple aim. Patient experience, staff wellbeing, equity, cost. Not every quality improvement saves money, and sometimes costs rise with better care. Name that complexity and measure what matters.
- Value Analyses – bring cost into the conversation when it’s the right question: “Was it worth it for the spend?” ROI is one method, but not the only one. Use it when decisions genuinely turn on financial trade-offs; don’t force it when your organisation already budgets for simulation because of strategic benefits captured in the other slices.
Why this matters (and to whom)
The model helps three conversations land better:
- With executives: It translates sim-speak to service value. Instead of “We hit Level 4,” you can say, “Here are the outputs we delivered (Service Products), how it was received by clinical leads (Program Perceptions), what teams demonstrably got better at (Acquired Expertise), and the workflow changes adopted on the floor (Workplace Performance). We’ll fold cost into a Value Analysis once we’ve stabilised the new process.” That’s a coherent, decision-ready story.
- Within sim teams: It curbs our reflex to measure everything, every time. Collecting tenuous outcome data can burn staff time and goodwill. The VBSH taxonomy legitimises selecting a few high-yield measures aligned with this intervention and these stakeholders.
- Across the organisation: It reframes simulation as a strategy for insight and system improvement, not only training delivery. When your debrief data routinely flows into quality forums, you begin to build organisational memory and responsiveness—exactly what complex systems need.
From theory to Tuesday morning
On the podcast, Lisa, Ben and Katie shared pragmatic moves you can adopt this week: co-design measures with sponsors up front; label each metric to a VBSH slice; and be explicit about what each slice can and cannot conclude. For example, don’t “prove” learning from satisfaction scores (that’s Program Perceptions); do show a credible improvement in a teamwork scale (Acquired Expertise) and how that translated to a standardised checklist actually used in theatre (Workplace Performance).
A favourite vignette: an exec demanded “more speaking-up training” after near-misses in theatre. The sim team brought the VBSH pie to the table and negotiated a smarter plan—use translational sims to diagnose the barriers (Workplace Performance), iterate checklist prototypes with staff feedback (Program Perceptions), then watch for improvements in psychological safety and checklist integration (System Benefit). No performative ROI spreadsheet required—at least, not yet.
Mind the traps
Three traps we called out in the episode:
- Hierarchy worship: Stop treating some data as intrinsically superior. Relevance beats rank.
- ROI or bust: Financial analysis is important in the right contexts—but can distort incentives and miss intangible wins. Use it judiciously.
- Self-report alchemy: Confidence is useful as confidence, not as proof of competence. Keep your slices straight.
Bottom line: Value in simulation isn’t a race to the top of a pyramid. It’s a negotiated, context-rich story told with the right slices of data for the job. Barker and colleagues give us a shared language and a service-level lens to tell that story better – and to steer our time and measurement toward what matters.
Read the article here: Barker, L.T., Meguerdichian, M., Walker, K. et al. Value-based simulation in healthcare: a new model for metrics reporting. Adv Simul 10, 41 (2025)
Listen to the episode here: Advances in Simulation: Value-Based Simulation in Healthcare with Lisa Barker and Katie Walker. 2025 Simulcast
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