By Doug Stephen, President, CGS Immersive
On a busy ward, a patient begins to deteriorate.
The team has the protocol; what wobbles though is the communication: who speaks, who acts, and how quickly the plan is confirmed.
In these moments, skills are more than clinical knowledge; they are behaviours under load.
We can train those behaviours the same way we train procedures: by practising the pressure before it reaches the bedside.
Healthcare safety organisations continue to remind us that the cost of miscommunication remains high.
Sentinel events are still reported in significant numbers, and recurring contributors include breakdowns in communication, gaps in teamwork and failure to follow policies.
In the U.S., the Joint Commission has long advocated for closed loop communication — clear directives, explicit acknowledgement, and confirmation — precisely because it reduces ambiguity when seconds matter.
That is where immersive roleplay — now increasingly AI-enabled — earns its place alongside simulation labs.
This isn’t about memorising polite phrases; it’s about deliberate practice of micro skills under realistic stress: tone and pacing when delivering bad news; escalation without blame; managing interruptions; and confirming actions using closed loop techniques.
With today’s tools, teams can rehearse these interactions anywhere, in short, frequent sessions that mirror the unpredictability of real clinical work.
The link to resilience is not soft science.
A recent meta-analysis found nurse burnout is associated with poorer patient safety, lower patient satisfaction, and diminished quality of care.
Doug Stephen
If we want safer care, we must design training that doesn’t just teach what to say but also builds the coping capacity to say it clearly when the stakes and stress are high.
High fidelity roleplay, paired with structured debrief, creates a safe space to explore emotional triggers, rehearse recovery strategies and normalise help seeking.
Critically, the evidence base for simulation and roleplay is mature.
Reviews covering hundreds of studies show that technology-enhanced simulation improves knowledge, behaviours, and team performance — and, importantly, patient outcomes in certain settings.
For organisations under pressure to demonstrate value, that shift from “engagement” metrics to clinical impact is not optional.
So, what does “good” look like when evaluating immersive roleplay for clinical teams?
1. Unscripted, two-way dialogue that adapts to the learner v. a fixed path of “expected answers.” Real life isn’t a multiple-choice test.
2. Scenario creation should be in your hands. You know the real situations your team faces — not the software vendor. Building new scenarios ought to take minutes, without having to wait on an outside provider.
3. Diverse range of personalities. The avatars you meet in the role play must match the diverse range of personalities you meet in the real world.
4. Closed loop by design. Systems should detect whether instructions were directed, acknowledged, and confirmed, and give feedback. Safety isn’t just what you know. It’s what the team hears.
5. Realtime scoring and analytics aligned to competencies (e.g., SBAR, de-escalation, shared decision making) to track progress at team and unit level.
6. Multilingual and context aware for diverse staff and patients, reflecting the populations we serve.
7. Guardrails and governance to prevent unsafe or biased outputs, with transparent audit trails for clinical education leads.
8. Workflow integration — with single sign-on, patient record context cards, and scheduled reminders on workplace platforms — so practice seamlessly fits into the working day.
9. Debrief culture: technology should guide quick reflection on what worked, what to adjust, and what to escalate.
10. Security: privacy and IP protection is critical. Only consider companies that follow industry security standards like ISO 27001 and the new AI standard ISO 42001
For ICBs and Trusts (note for non-UK readers: ICBs plan and pay for care in a region; Trusts run hospitals and services), a practical starting point is to focus on high-risk conversations where communication directly impacts outcomes — such as rapid deterioration, handovers, consent for complex procedures, care transitions, safeguarding, and difficult family conversations.
Create five to seven minute micro-scenarios that teams can run on a phone or workstation.
Track pre- and post-performance on closed-loop behaviours and escalation timing and add short wellbeing check-ins to monitor stress over time.
Regulatory expectations are moving in parallel.
As agencies tighten post-market surveillance and evidence requirements for digital and AI-enabled tools, training interventions that are measurable, governable, and auditable will be easier to defend.
Embedding roleplay inside existing quality and safety programmes also makes it straightforward to evidence competence assurance to boards and inspectors.
What about time and cost?
Traditional simulation can be resource-intensive, but a blended model works: reserve high-fidelity manikin or team drills for complex interprofessional scenarios, and use frequent, lightweight roleplay for the everyday conversations that drive most safety and experience outcomes.
Frequency and feedback are the real growth engines: every shift is an opportunity to practice one interaction better than yesterday.
The goal is a cultural shift from “train and hope” to “practise and measure.”
In aviation, teams rehearse the rare but critical events, so responses are automatic and coordinated.
Healthcare has the same imperative — and now, the tools to do it at scale.
If we want safer care and a workforce that can withstand the emotional load of modern practice, we should give teams something they rarely get: reps.
The next wave of health innovation won’t just be smarter algorithms.
It will be smarter teams: people who have rehearsed the hardest conversations, under pressure, until safety is their default.
