Table 2.

Themes and elements identified in phase 1 exploratory interviews and focus groups

Theme	Elements
Simulation	Implementing a broad range of simulation practices following best practice Simulated patient’s quality questioned with practice uninformed by theory Development of alternate modalities of simulation
Collaboration	Variability in collaboration and sharing resources Lack of collaboration between different stakeholders, hospital specialties and departments and hospital simulation centres Develop networking opportunities through communities of practice Regular networking between government, educators, trainers and hospitals (e.g. conferences, meetings, communication networks)
Recognition and incentives	Simulation not recognised as adding value to support backfill of staff off the ward and conducive rostering Infrastructure, leadership and executive support required to grow simulation programmes Promote opportunities of simulation to policymakers, educators, students and clinicians Promote certification, accreditation, benchmarking and minimum standards to enable recognition of staff and the work being done Professionalise education and training related to simulated learning environments to enable recognition of the specialised skill set
Teaching and learning	Evolvement of the educational pedagogy surrounding simulation Clinical skill development and assessment, and critical incident training well addressed but difficulties encountered in more complex areas such as behavioural and cultural change and interprofessional training Lack of understanding regarding surrounding design for learning to maximise learning from simulation experience Lack of standardisation in simulations used for assessments
Sustainability	Inadequate or unreliable funding sources Inequitable distribution of resources and spaces /funding across metropolitan and rural areas Purchase of equipment without conducting appropriate needs analysis Maintenance of equipment World-class simulation resources that need coordination and support Staff roles in simulation do not have definitive boundaries, many have multiple roles Lack of dedicated simulation staff including technical support Large turnover of simulation staff and excessive workloads
Professional development	Centralised training developed clarity in different roles in simulation Using a train-the-trainer model to build capacity in simulation in hospitals, across different disciplines Strategies to prevent skill decay and ongoing support and mentorship for simulation staff Availability of mentorship, education and training in regional areas Education and training for specific simulation modalities including in situ, simulated patients, high technology, immersive simulations, scenario design, hybrid simulation
Research	Need to improve research, publication and dissemination of activities and innovations from simulation in different settings Need to understand research priorities related to simulation and champion the outcomes achieved from simulation Form research collaboratives to develop research skills in clinical staff Sharing research being conducted in centres, organisations and groups
Patient safety	Supports strong operational teams: experience and initiative Using simulation to assess job design and workforce safety issues and usability testing of systems and equipment Apply simulation from a risk and harm minimization perspective Collaborate with quality and safety departments to manage risk
Technical	Clarify roles of simulation technicians Have dedicated technical support, so that educators can focus on training and not fixing equipment Audiovisual equipment knowledge Pressures of running a simulation supported by AV at the same time More technical training for all staff Develop the recognised role of simulation specialist
New adopters	Lack of understanding and experience regarding simulation and what it means Reluctance of some clinical communities to use simulation Lack of skills of staff in some work contexts to design scenarios for assessment