The time for advocacy is now!

Our editor-in-chief Pier Luigi Ingrassia reflects on why now is the time for the healthcare simulation community to turn evidence into advocacy.

Simulation community has spent decades building its scientific foundations. The evidence base is now solid, the methodologies are mature, and the community of practice has grown into a global network of educators, researchers and technicians. Yet, in most healthcare systems, simulation remains a marginal activity, funded through goodwill, included in curricula almost as an afterthought, and evaluated using metrics that fail to capture its true value.

Frankly, I am increasingly convinced that the question our community must ask today is no longer whether simulation works, but whether we are doing enough to make decision-makers (and the public!) understand that it works.

Advocacy is the answer to that question, and the moment to act is urgent.

Let’s start with the basic concept of advocacy. The World Health Organization defines advocacy as “a combination of individual and social actions designed to gain political commitment, policy support, social acceptance and systems support for a particular health goal or programme”.⁽¹⁾ In practice, this involves adjusting the simulation parameters at every level of the system, from institutional policies to national strategy.

But what does it take for advocacy to be effective? I’m certainly not the first to say this: we need to strike the right balance between science and art. Let me explain.

It is certainly necessary to translate evidence (science) into arguments that resonate with policymakers, to show that investing in simulation delivers returns in resource efficiency, as well as to highlight its educational effectiveness and clinical impact, and to navigate the policy environments where decisions about health education and patient safety are actually made. In this regard, I think the simulation community is already off to a good start. We produce rigorous research, we are accustomed to discussing outcomes, efficiency, and risk reduction. We just need to make these concepts understandable to decision-makers and policymakers at various levels.

At the same time, however, we need a set of skills that are often less developed in clinical and academic settings: the art of influence. Building relationships with journalists, ministry officials, hospital executives, and professional associations. Creating narratives that connect simulation to problems decision-makers already care about, such as workforce shortages, preventable errors, system process efficiency and the cost of inadequate training.

Neither set of competencies is sufficient alone: data without relationships stays in journals; relationships without data become lobbying without credibility.

Effective advocacy requires a strategic vision and a clear agenda for action, not just a critique of the status quo. It requires coalitions that extend beyond the simulation community itself, reaching into medical, nursing, pharmacy, primary care, and patient safety organizations. It requires media engagement that raises public and professional awareness.

For our community, this means working simultaneously across several fronts. At the global level, international societies and networks must present a unified position on simulation as an essential infrastructure for safe healthcare. At the national level, national societies need to engage directly with health ministries, licensing authorities, and accreditation bodies to embed simulation into standards that carry regulatory weight. At the institutional level, every simulation centre director must be willing to make the case in the rooms where resource decisions happen.

Health systems worldwide are under extraordinary pressure. The accelerating complexity of clinical environments. due to the ongoing challenges facing healthcare systems, has created a window in which arguments for better, safer, more scalable training, as well as for rigorous simulation-based testing of systems and processes, are unusually persuasive. Policymakers are looking for solutions. Simulation offers them, and the evidence is there to prove it.

The risk is that this window closes while our community debates internally rather than acting externally. SIMZINE exists, in part, to support that external action: to inform, to connect, and to equip professionals with the arguments and the confidence to advocate effectively. This issue continues that mission.

The work, however, happens beyond these pages.

PLI

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