Comparing barriers and facilitators to healthcare simulation across educational and clinical contexts

Background Healthcare simulation is increasingly delivered across both education/training organisations and clinical sites. While previous research has identified barriers and facilitators to simulation implementation, little is known about how these factors differ across contexts. This study examined and compared determinants influencing simulation delivery in education/training and clinical contexts in the Republic of Ireland using the Capability, Opportunity, Motivation-Behaviour (COM-B) model and Theoretical Domains Framework (TDF). Methods An exploratory qualitative study was conducted using semi-structured interviews and open-ended survey responses. Thirty simulationists participated in interviews (15 from education/training organisations and 15 from clinical sites), and 120 survey respondents provided qualitative data on barriers and facilitators to simulation delivery. Directed content analysis informed by the COM-B model and TDF was used to categorise determinants across 14 behavioural domains. Results Determinants of simulation delivery spanned all COM-B dimensions. Capability-related factors included simulation knowledge, pedagogic understanding, technical expertise, and facilitation skills, although the specific capabilities emphasised differed between educational and clinical contexts. Across both datasets, opportunity-related determinants- particularly environmental context and resources- were the dominant influences on simulation delivery. Protected time, staffing, facilities, funding, and leadership support were consistently identified as critical to sustainable simulation delivery. Motivation-related factors reflected a strong commitment to simulation, but participants also described challenges relating to burnout, recognition, and sustaining programmes over time. While many determinants were shared across contexts, important differences existed in how these factors were experienced and prioritised. Conclusions While simulation delivery requires skilled and motivated faculty, the principal determinants of sustainability are organisational rather than individual. Protected time, staffing, infrastructure, funding, and leadership support emerged as the dominant influences across both educational and clinical contexts. Efforts to expand healthcare simulation should therefore move beyond faculty development alone and prioritise the organisational investment and implementation strategies needed to embed simulation as a routine and sustainable component of healthcare education and improvement.