From escalation to emergence: NHS Forth Valley and the quiet power of Transformative Simulation

TY - JOUR

T1 - From escalation to emergence

T2 - NHS Forth Valley and the quiet power of Transformative Simulation

AU - Weldon, Sharon Marie

AU - Mardon, Julie

AU - Tallentire, Vicky

AU - Hufton, Daniel

AU - Galbraith, Andrew

AU - Bowie, Paul

AU - Laws-Chapman, Colette

AU - Grit, Marco

AU - McCrone, Paul

AU - Smith, Samantha

AU - Buttery, Andy

AU - Spearpoint, Kenneth

AU - Gurnett, Philip

AU - Baxendale, Bryn

N1 - Publisher Copyright: © Author(s) (or their employer(s)) 2026. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ Group.

PY - 2026/1/31

Y1 - 2026/1/31

N2 - 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.

AB - 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.

KW - care redesign

KW - engagement

KW - health system

KW - learning organisation

KW - multi-professional

UR - https://www.scopus.com/pages/publications/105029433344

U2 - 10.1136/leader-2025-001408

DO - 10.1136/leader-2025-001408

M3 - Article

C2 - 41620215

AN - SCOPUS:105029433344

SN - 2398-631X

SP - 1

EP - 5

JO - BMJ Leader

JF - BMJ Leader

ER -