Making Sense of Simulation as a Complex Intervention in Health Care Systems.

Statement: Simulation is increasingly used not only to train clinicians but also to explore how clinical systems function in practice. As simulation becomes embedded in everyday health care settings, it is shaped by the conditions of clinical work. This raises questions about how simulation should be understood once it becomes part of the systems it is intended to influence. Drawing on concepts from complexity science and implementation research, this article examines simulation as a complex intervention introduced into complex health care systems. Rather than focusing on how simulation is designed or implemented, it offers a conceptual perspective for interpreting how simulation changes after becoming embedded in clinical practice. From this viewpoint, differences in how simulation sessions unfold are not necessarily signs of poor implementation but may instead reveal how simulation interacts with local clinical conditions.