{
  "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.",
  "authors": [
    {
      "affiliations": [
        "Health Sciences, University of Greenwich, London, UK",
        "Imperial College London, London, UK",
        "Barts Health NHS Trust, London, UK"
      ],
      "name": "Sharon Marie Weldon"
    },
    {
      "affiliations": [
        "Scottish Centre for Simulation and Clinical Human Factors, Forth Valley, Scotland, UK",
        "NHS Forth Valley, Stirling, Scotland, UK"
      ],
      "name": "Julie Mardon"
    },
    {
      "affiliations": [
        "NHS Lothian, Edinburgh, Scotland, UK",
        "NHS Education for Scotland, Edinburgh, Scotland, UK"
      ],
      "name": "Vicky Tallentire"
    },
    {
      "affiliations": [
        "Scottish Centre for Simulation and Clinical Human Factors, Forth Valley, Scotland, UK",
        "NHS Forth Valley, Stirling, Scotland, UK"
      ],
      "name": "Daniel Hufton"
    },
    {
      "affiliations": [
        "Scottish Centre for Simulation and Clinical Human Factors, Forth Valley, Scotland, UK"
      ],
      "name": "Andrew Galbraith"
    },
    {
      "affiliations": [
        "NHS Education for Scotland, Edinburgh, Scotland, UK",
        "University of Staffordshire, Stoke-on-Trent, England, UK"
      ],
      "name": "Paul Bowie"
    },
    {
      "affiliations": [
        "Guy's and St Thomas’ NHS Foundation Trust, London, England, UK"
      ],
      "name": "Colette Laws-Chapman"
    },
    {
      "affiliations": [
        "Laerdal Medical AS, Stavanger, Rogaland, Norway"
      ],
      "name": "Marco Grit"
    },
    {
      "affiliations": [
        "Health Sciences, University of Greenwich, London, UK",
        "King’s College London, London, England, UK"
      ],
      "name": "Paul McCrone"
    },
    {
      "affiliations": [
        "University of Dundee, Dundee, Scotland, UK"
      ],
      "name": "Samantha Smith"
    },
    {
      "affiliations": [
        "Health Sciences, University of Greenwich, London, UK",
        "Canterbury Christ Church University, Canterbury, England, UK"
      ],
      "name": "Andy Buttery"
    },
    {
      "affiliations": [
        "University of Hertfordshire, Hatfield, England, UK"
      ],
      "name": "Kenneth Spearpoint"
    },
    {
      "affiliations": [
        "Health Sciences, University of Greenwich, London, UK",
        "King’s College Hospital NHS Foundation Trust, London, UK"
      ],
      "name": "Philip Gurnett"
    },
    {
      "affiliations": [
        "Nottingham University Hospitals NHS Trust, Nottingham, England, UK"
      ],
      "name": "Bryn Baxendale"
    }
  ],
  "title": "From escalation to emergence: NHS Forth Valley and the quiet power of Transformative Simulation",
  "uid": "9fe8ca0a-f81c-515e-83a5-23082a26a702"
}