Optimisation of systems, safety and efficiency using simulation: a qualitative exploration of the value proposition for healthcare leaders.

BACKGROUND: Simulation-based testing (SBT) is increasingly recognised as a strategic tool for enhancing healthcare safety, efficiency, and system readiness. Despite its growing use, the perspectives of healthcare leaders-key stakeholders in sustaining simulation services-remain underexplored. This study aimed to understand how healthcare leaders perceive the value of SBT, identify drivers for engagement, and explore how simulation activities can be aligned with leadership priorities to support quality improvement. METHODS: A qualitative, phenomenological approach was used, involving semi-structured interviews with nine healthcare leaders from executive, clinical, and infrastructure roles within a large Australian health service. Thematic analysis was conducted to identify key themes from the interview data. RESULTS: Three major themes emerged: Optimising operations-Leaders valued SBT for its ability to test real-world workflows, uncover latent safety threats, and ensure regulatory and licensing readiness. SBT was seen as a diagnostic tool that supports operational assurance and futureproofing. Collaborative design-Leaders emphasised the importance of engaging end users in simulation activities to ensure relevance, foster shared understanding, and support implementation. SBT was also valued for its role in experiential orientation and team cohesion. Reporting and recommendations-Timely, structured, and risk-stratified reporting was critical for decision-making. Leaders preferred concise executive summaries and actionable recommendations aligned with project goals and resource constraints. CONCLUSION: Healthcare leaders demonstrated a sophisticated understanding of SBT's strategic applications beyond education. They recognised its value in improving routine operations, supporting compliance, and informing high-stakes decisions. Simulation faculty can enhance the impact and sustainability of SBT by aligning activities with leadership priorities, ensuring timely communication, and delivering focused, actionable insights. These findings offer guidance for embedding SBT into broader quality improvement and organisational strategies. Future research should explore the generalisability of these findings across less mature simulation services and further investigate SBT's role in regulatory compliance.