Over the past two decades, simulation has moved into the forefront of medical education. Top healthcare systems and schools are seeking simulation center managers for their expertise in simulation, not only for the training of staff within the walls of the simulation lab, but for the identification of latent safety threats within the health system (in situ simulations), testing preparedness for rarely used equipment and protocols, translational outcomes improving patient care, improving patient safety, decreasing medicolegal risk, improving recruitment and retention of staff, and the development of novel educational methods. 

There are many different roles and responsibilities of a simulation center manager.  These leaders provide leadership to carry out the overall institution’s strategic mission, and goals focused on improving the knowledge, skills, and abilities of healthcare professional learners and, ultimately, patient care. They must maintain simulation best practices such as the International Nursing Association for Clinical Simulation in Learning (INACSL) standards.[1] Simulation center managers are qualified to be the leader of the simulation center from their academic preparation, clinical experience, leadership experience, educational experience, simulation related training, and experience. These experiences vary, but the manager must show evidence of the skills and experience needed to meet the needs of the program.

Create and/or uphold the center's mission and vision

A mission is a present-based statement of purpose for the program or its reason for existing. The mission guides the program's actions and decision making. A vision statement is a future-based statement that declares the program's long-term goals. Both the simulation center's mission and vision statements should align with the organization's mission and vision statements. 

Build and/or carry out the center's strategic plan 

A simulation center's strategic goals are written to carry out the simulation center's mission and vision. They are independent of the larger organization's strategic plan but assist with meeting those goals.  A formalized strategic planning process takes place to create a strategic plan to assure to accommodate the growth of the organization and center. Usually, the team writes a plan for 3-5 years and presents it to an advisory board, stakeholders, and/or administration. The goals are written, specific, measurable, relevant, and include a time frame.  Typically, a good plan will include goals that are both short term and long term.  This plan includes what tools will be utilized to measure the goals. The plan provides a vibrant picture of the department's primary focus to guide in making decisions.

Create and/or maintain a simulation advisory committee

This is a core group of stakeholders who the simulation center manager reports to and is charged to ensure that the learners' and organization's simulation needs are met.[2] This committee comprises of departments or individuals who use simulation often within the organization, other institutional leaders, students, and sometimes simulation educators from the community. This group usually meets at least twice a year to oversee the activities, review/approve policy and procedures, and advise/approve future purchases.

Create a well-balanced and realistic budget to ensure the sustainability of the program

The manager is responsible for preparing, implementing, and monitoring the center's budget. Budgets may look different at each simulation center; however, they should all align with the mission, vision, and strategic plan of the center.  Sometimes budgets are supported by the hospital, university, specific divisions, revenue-generating courses, research, patronage, and trade groups.[3] Some centers develop fee-for-service activities supported by other departments. Simulation center managers should collaborate with senior administrators to have a clear, documented process that includes how the budget is drafted, reviewed, approved, and funded. 

Creating, editing, and upholding policies and procedures

The center's policy and procedures (electronic or in print) should describe how the program will operationalize its mission and vision. It provides specific steps to be implemented for various matters that involve the center. The policies should be organized, indexed, complete, coherent, approved, and finalized.  

We recommend the following policies, at a minimum, for the manager to develop and uphold:

• Confidentiality
• Protection (physical and psychological safety)
• Separation of simulation and patient care resources
• Storage and maintenance of equipment and supplies
• Video and data security
• Prioritization of simulation resources

Uphold ethical standards

The manager has a responsibility to ensure the principles which promote values, including trust, good behavior, fairness, and/or kindness throughout the program. Examples may include protecting patient's privacy by adhering to Health Insurance Portability, and Accountability Act (HIPAA) standards, requiring research be Institutional Review Board (IRB) approved, following Family Educational Rights and Privacy Act (FERPA) guidelines, and upholding the Society for Simulation in Healthcare (SSH) Code of Ethics.

Provide oversight and leadership   

Managers are responsible to strategically embed simulation into a curriculum to meet program outcomes by conducting a needs assessment and developing a curriculum map for integration of simulation into a unit or course's curriculum. This should include incorporating simulation standards of practice in the design, implementation, and evaluation of simulation-based experiences. A storyboard or a standardized simulation template for each scenario should be used in addition to conducting a dry run before the event.[4] Additionally, the manager should be able to identify prospects of enhancement, innovation, implementation, and integration of simulation into existing healthcare programs.

Maintain effective staff and faculty members

The simulation center manager is responsible for hiring, creating, and implementing effective simulation staff. During the onboarding process, the manager should provide a unit-based orientation for their staff members. This may include providing new employees with an onboarding checklist, job-specific manuals, and/or common processes that the employee would be responsible for implementing. A detailed list should be given to each employee that identifies roles, tasks, and expectations of daily, weekly, and annual responsibilities. All faculty and staff that are responsible for debriefing should also be oriented to the department's chosen theory-based simulation debriefing model.  All debriefers' qualifications should match the learning objectives of the simulation. The manager is also responsible for maintaining the competency and proficiency of staff and faculty. This may be in annual evaluations of performance and debriefing, if applicable.  Some tools that have been identified as being helpful for these evaluations are Objective Structured Assessment of Debriefing (OSAD), Debriefing Assessment for Simulation in Healthcare (DASH), and Peer Assessment Debriefing Instrument (PADI).[5] The manager should set the required ratings the staff/faculty need to achieve to meet center expectations, how often the evaluations and feedback sessions are conducted, and what the remediation plan is if a staff/faculty do not meet expectations. 

Communicate clearly with simulation staff and faculty

The manager should ensure staff and faculty are made aware of program changes and process improvements promptly. This may be by conducting regular staff meetings, special training sessions, emails, newsletters, department website, or a message board. Meeting minutes should be kept, including information on who is responsible for tasks and timeframes.   

Provide opportunities for training simulation staff/faculty

Not only does the simulation center manager have to be trained in simulation best practices, but they also must provide their simulation staff and faculty formalized simulation training and ongoing development.[6] Some of this training may be met by attending conferences or completing online courses.  However, funding is limited for these offerings, and often the simulation center manager must create training to be conducted within the organization. Benner's Novice to Expert Model offers the required conceptual structure to guide the manager in developing the simulation facilitator.[7] Simulation center managers should ensure attendance records are kept of these professional development activities. If the manager's program utilizes simulated patients (SPs), the manager should also ensure there is initial and continual SP training in role portrayal, student rating, and giving student feedback.[8]

Quality Improvement 

Simulation center managers should have a process in place to evaluate the simulation, center, and staff (see above) to improve future learning outcomes. Many times, student surveys help to indicate if the learning objectives are met and if any improvements are needed to improve learning outcomes. A plan should be in place to review feedback to make improvements.  Specific process improvement theories such as Plan Do Study Act (PDSA) cycle or Six Sigma may be used. Additionally, the manager must maintain evidence of utilizing reliable assessment tools with evidence of validity. 

Reporting metrics 

The manager should maintain an annual report of the following:

• Name of event
• Date(s) of event
• Number of event dates
• Number of learners
• Types of learners
• Hours of instruction per learner
• Total hours (Learner contact hours are defined as the number of learners times the number of hours of simulation.)
• Type of event (Assessment, Teaching/Learning, Research, and Systems Integration)

The manager should be able to demonstrate high-quality indications of effectiveness and value to the organization.[9]  

Creating links outside of the organization 

The manager is responsible for increasing the users of the simulation center through the promotion of services of internal and external associations that may create new business or funding. Opportunities include partnering with industry partners looking to test devices for patient care and local philanthropic organizations looking to see their investment dollars help the community. To develop these relationships, a strong internet presence may be required. The manager should ensure the center's website is up to date and markets the center's capabilities. The manager may be involved with generating proposals, negotiating contracts, managing funding, and monitoring return-on-investment with outside organizations.

Additionally, the simulation manager should be a part of the local simulation alliance if available.