Enacting Translational Simulation: A 24-hour Human Biocontainment Simulation Incorporating Patient Participation and Video-Reflexive Ethnography

Abstract Translational simulation is increasingly used to examine and improve healthcare systems in real-world contexts. This approach is particularly relevant in human biocontainment settings, where opportunities to learn from managing high-consequence infectious diseases (HCIDs) are rare. The aim of this paper is to describe the application of the translational simulation conceptual framing to the design and implementation of a continuous 24-hour in situ simulation in an operational human HCID biocontainment centre, incorporating video-reflexive ethnography (VRE) and a real infectious disease inpatient. The simulation was conducted in a tertiary biocontainment centre using a scenario involving the admission and management of a patient with suspected Ebola disease. A real infectious diseases inpatient (who did not have an HCID), receiving routine care in the hospital, participated in the simulation. The conceptual foundations of the study were grounded in safety and quality improvement within a complex adaptive system, and person-centred care. VRE was used to generate and analyse data. Video data collected during the simulation were used in nine group video-reflexive sessions involving healthcare workers, and a separate reflexive session with the patient. The audio-recorded reflexive sessions were analysed using the Special Pathogen Operational Readiness Self-Assessment (SPORSA) framework. The simulation demonstrated the feasibility of a continuous, time-extended translational simulation embedded within routine healthcare delivery. Implementation required substantial organisational preparation, including governance approvals, workforce coordination, identification of a suitable inpatient participant, and operational support. Inclusion of a real inpatient enabled exploration of both system functioning and lived experience of care. VRE supported collaborative examination of healthcare practices and enabled patient perspectives to inform staff reflexive discussions. The approach generated system-level insights relating to workflow, communication, infection prevention and control, staffing, patient experience, and healthcare worker experience. This paper provides the methodology and a practical example of how translational simulation can be operationalised through explicit consideration of purpose, process, and conceptual foundations. By integrating a continuous 24-hour design, patient participation and VRE, the study extends current methodological approaches to translational simulation. Importantly, it demonstrates how patients can contribute not only to care delivery, but also to the understanding, evaluation, and improvement of healthcare systems.