Translational simulation and systems thinking in emergency care: From crisis response to system catalyst

Abstract

The emergency department is a central node in the healthcare system, managing acute care while navigating high uncertainty, interdependence, and resource constraints. As a complex adaptive system, the emergency department exhibits emergent behaviours that challenge traditional, reductionist approaches to improvement. Many well-intentioned interventions fail by targeting isolated components without addressing systemic interactions and dynamics. This article advocates a shift in mindset toward embracing complexity and leveraging systems thinking to guide more effective, resilient emergency care strategies. Translational simulation is presented as a practical method for operationalising this approach. It enables safe, system-informed testing and refinement of interventions, revealing blind spots, mitigating risks, and fostering meaningful change. By viewing the emergency department as a site of crisis response and a driver of innovation, we can harness its adaptive potential to improve care delivery, inform policy, and build a more responsive, learning-oriented health system.