Healthcare Simulation Accreditation provides an external, peer-reviewed evaluation of a clinical simulation program. The Society for Simulation in Healthcare (SSH) has an accreditation program that examines a healthcare simulation program’s processes and outcomes in the core standards, assessment, research, teaching / education, and systems integration. A clinical simulation program can achieve accreditation in core standards plus at least one other area. The healthcare simulation program can obtain full or provisional accreditation. The article by Nina Marcellus, MSN-Ed, RN, CHSE, CNEcl, will offer personal experience with the SSH Accreditation process and some helpful insights. Disclaimer: The experiences and strategies shared in this article reflect the author’s personal journey toward accreditation with SSH and are intended for informational purposes only. This article should not be interpreted as a guarantee of accreditation. Each program will have unique requirements, processes, and outcomes based on individual context and resources.
The Journey to Accreditation Begins
In 2021, I assumed the role of Director of Simulation for the BSN program at Nevada State University. This coincided with the relocation of the lab courses into a newly built simulation facility. This transition was both a change of location and an opportunity to better align the clinical simulation program with the rigorous standards of the International Nursing Association for Clinical Simulation and Learning (INACSL) and the Society for Simulation in Healthcare (SSH). With the support of faculty, staff, and leadership, the program began to navigate the maze of preparation to apply for accreditation. In 2024, these efforts were recognized with SSH International Provisional Accreditation, with full accreditation anticipated in 2026. This article will share the journey here to support and encourage other healthcare simulation programs with similar accreditation goals.
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Establishing a Foundation of Excellence
One of the first priorities in elevating program standards was formalizing policies and procedures. Previously, many practices were informal or passed down verbally and lost in translation. We developed clear guidelines for simulation design, debriefing frameworks, scenario development, evaluation standards, scheduling, accountability, and lab safety to ensure consistency and equitable experiences. Training and onboarding processes for staff were also standardized, including scheduled courses and refresher seminars for educators and facilitators.
Effective onboarding includes the opportunity to shadow more experienced team members, the review of departmental policies, and engagement in simulation-specific continuing education. Clearly defined professional development and certification goals are essential for SSH accreditation and to foster a culture of quality improvement. Encouragement for professional growth in healthcare simulation can be achieved through conferences, webinars, and online courses to support team members to earn credentials such as CHSE and CHSOS.
Driving Programmatic Innovation
Alignment of initiatives with accreditation standards and the purposeful implementation of changes amplifies the impact of clinical simulation. At Nevada State, a new curriculum launched in Fall 2020 featured three leveled, stand-alone skills lab courses, replacing the traditional single foundational lab. These labs reinforce psychomotor skills through repetition and scaffolding, strengthen clinical judgment through progressive complexity, and promote team-based learning. After ongoing evaluation, the mid-level lab transitioned to a hybrid format, and peer-to-peer evaluations were introduced in mid- and upper-level courses, which replaced the 1:1 testing model used in foundational labs.
All changes undergo rigorous review based on outcomes, space utilization, and program needs before implementation. Each modification is clearly documented, detailing benefits for teaching and learning, operational impact, and plans for continued evaluation. Many programs make changes without considering their effect on overall quality; however, this healthcare simulation program’s approach ensures every adjustment is evidence-based and aligned with long-term goals.
In the preparation for the accreditation application, the team must highlight meaningful improvements in evaluation processes, feedback training, and revisions to teaching and learning materials. These initiatives enhance transparency, strengthen student trust, and support faculty development. A healthcare simulation program should demonstrate a culture of continuous improvement and professional growth, with psychological safety and feedback mechanisms embedded throughout program operations.
How to Create a Culture of Continuous Improvement
To remain responsive and adaptive, the team implemented a structured system for ongoing evaluation. After each clinical simulation, students, faculty, and staff complete standardized assessments of the experience, clinical relevance, and operational effectiveness. Feedback was reviewed each semester to guide revisions to scenarios, progressions, and processes. To strengthen debriefing quality, the DASH tool was used to provide consistent feedback on facilitation and learner engagement. The evaluation tools used should be based on the best fit for each healthcare simulation program. Regardless of the tool(s) used, the goal is a layered feedback system that drives continuous improvement and aligns with best practices.
The team also maintained a regular review cycle for teaching materials, policies, and workflow processes. Major revisions followed a clear timeline to ensure accountability. This feedback loop keeps the program dynamic, data-informed, and aligned with evolving standards in simulation-based education.
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A Deliberate Model for Simulation Facilitation
Deliberate planning and intentional, structured processes move a program beyond on-the-fly facilitation into a systematic and framework-based model. Every position on the team should have a dedicated and well-articulated role and clearly delineated responsibilities. Our program employs a three-role facilitation model:
- Simulation Operations Specialist (SOS): Manages technical setup, facilitates the team huddle, orients learners to the space, calibrates equipment, voices the manikin using a standardized script, and ensures scenarios follow standardized progressions.
- Trained Simulation Facilitator: Leads the prebrief and sets confidentiality expectations, observes and annotates the simulation, guides student-driven debrief sessions using a structured framework, maintains psychological safety throughout the experience, and ensures end-of-experience evaluations are completed.
- Content Expert (Clinical Faculty): Offers clinical insights during the post-debrief Q&A, helping students connect the simulation to real-world practice, while maintaining a psychologically safe learning space.
Although not required for accreditation, this model promotes consistency, equity, and formal training for all involved. The adoption of a model that fits the individual program’s resources and needs is essential for the delivery of effective, evidence-based simulation experiences. Understanding the pedagogical foundations of simulation (e.g. experiential learning, psychological safety, and structured debriefing) is as critical as mastering the technical and clinical components.
Collaboration and Commitment
Achieving SSH International Provisional Accreditation required eight months of dedicated time, focused effort, and close collaboration between the Program Director, Lab Coordinator, Dean of Nursing, and a consultant from an SSH-accredited program. The combined effort and diverse perspectives led to a stronger, more comprehensive approach, clarified key requirements, and enhanced the quality of our application.
The collection and organization of the required documentation was intensive and time-consuming but reinforced our commitment to quality and innovation. The process revealed areas for growth and laid the foundation for full accreditation in 2026. For programs considering this journey, early engagement with leadership and stakeholders is essential. Seek trusted resources, such as consultants if the budget allows, and use the SSH companion document as a guide.
Once eligibility for the application is confirmed, establish an organizational strategy that works for your team. This may include files with teaching resources, evaluation forms, photos of simulation spaces and equipment, and accountability structures. If an item or process exists, document the process and explain the purpose. Every detail tells your program’s story.
Reflection on the Journey
This journey has been one of transformation, collaboration, and continuous learning. With the alignment of international standards, development of a culture of innovation, and prioritization of psychological safety, we have built a simulation program that prepares students for real-world practice. If your healthcare simulation program is considering SSH Accreditation or INACSL Endorsement, the process may seem daunting, but is deeply rewarding. As more institutions pursue simulation excellence, the experience and practical applications in this HealthySimulation.com article provide guidance and inspiration for your own journey.
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