Healthcare professional and patient smiling at each other
HealthOctober 26, 2020

Improving the patient experience through simulation

By: Sarah Handzel, BSN, RN
In 2012, the Centers for Medicare and Medicaid Services tied a portion of acute care hospital reimbursement directly to patient satisfaction surveys known as the HCAHPS or CAHPS Hospital Survey.1 Since then, this incentive has driven many efforts to improve the patient experience throughout the continuum of care.

While the patient experience is important on all hospital units, the emergency department (ED) presents a unique challenge to achieving satisfaction goals. EDs may be loud and crowded, and long wait times may increase frustration and dissatisfaction with the care provided.

In the United States alone, as many as 139 million people visit the ED each year.2 As such, it’s wise for hospital leadership to invest in efforts to improve the patient experience within this unit. The Journal for Nurses in Professional Development details a recent case study involving ED simulations to improve staff behaviors and, ultimately, the experience of each patient.

The advantages of clinical simulations

Unlike other forms of learning, clinical simulations provide hands-on experience to help healthcare staff develop their skills for more effective practice.3 This learning method can be customized to the participants, who all have the freedom to make mistakes and learn from them. Additionally, simulations offer an opportunity to receive feedback in real-time, which can help an individual better understand how their actions directly impact patients.

Using simulation to improve the patient experience

The article in the Journal for Nurses in Professional Development4 describes a simulation curriculum in one hospital. The program was developed by the ED Nursing Director, the hospital’s Chief Nursing Officer, ED staff nurses, and others concerned with improving the patient experience throughout the healthcare organization.

Entitled the “Patient Experience Boot Camp”, the program took place in a wing of the hospital’s ED usually used for overflow patients. Each attendee worked through a series of events intended to help them experience firsthand what a typical ED patient might experience. This included all the sights, sounds, and interactions with various staff members that usually occur in the ED.

The simulation curriculum combined immersive experiences, activities promoting self-reflection, and skills stations to help participants understand how their actions influence the overall patient experience.

During the first immersive simulation, attendees were given a gown and socks to wear over their clothes and placed in a stretcher or a wheelchair. Then, they selected between different medical devices, such as a bedpan or cervical collar, that an ED patient might use. Vision distorting goggles and recordings of various ED sounds, like a machine alarm, were used to simulate the typical ED environment. Finally, each “patient” was wheeled into the hallway and left by themselves for five minutes.

The simulation concluded with a debriefing; participants noted that the wait time in the hallway was long, staff walked by them without interacting with them, and they felt they were ignored or forgotten. The exercise highlighted the importance of communicating estimated wait times and next steps in care, while also emphasizing how each patient should be checked on and given updates on their progress regularly.

Each staff member then proceeded through a series of skills stations designed to:

  • Enhance communication skills
  • Help diffuse difficult situations
  • Improve the perception of the ED environment and care provided
  • Develop a better “on-stage presence”

The exercise ended with another immersive simulation, this time with staff members treating a “patient” in the ED. Each person was evaluated using a performance checklist to help ensure they achieved the program’s intended goals.

115 ED team members participated in the simulation curriculum, which represented approximately 95% of the unit’s staff. All participants successfully completed the final simulation, and many immediately implemented changes within the ED environment, such as smiling more and quieting hallway conversations.

The authors of this case study note that the leaders of the program decided that similar simulations should be offered throughout the hospital to help improve the patient experience systemically. Like other nursing skills competency training techniques, simulations to improve the patient experience can help educate staff members and drive positive change.

Sarah Handzel, BSN, RN
Freelance Health and Medical Content Writer, Wolters Kluwer Health
Sarah has over nine years’ experience in various clinical areas, including surgery, endocrinology, family practice, and pharmaceuticals. She began writing professionally in 2016 as a way to use her medical knowledge beyond the bedside to help educate and inform healthcare consumers and providers.
  1. “HCAHPS: Patients’ Perspectives of Care Survey.” CMS, 2020,
  2. “FastStats - Emergency Department Visits.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 21 Feb. 2020,
  3. “About SSH.” The Society for Simulation in Healthcare, 2020,
  4. Medland, Jacqueline PhD, RN, NEA-BC, et al. “Raising the Bar: Using Simulation to Advance Staff Competency Regarding the Patient Experience.” NursingCenter, 2020,
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