Simulation-based team training and patient safety culture: A controlled multi-site study in pediatric departments

Background: Research examining whether sustained simulation, embedded in everyday clinical routines, can shift staff perceptions of patient safety culture remains limited.Methods: We conducted a controlled multi-site study across eight pediatric departments in Denmark (four intervention, four control;2023-2024).Departments in the intervention region integrated simulation-based team training into their duty rosters.Patient safety culture was measured pre-and post-intervention using the Safety Attitudes Questionnaire-Danish version.The primary analysis applied a difference-in-differences approach.Results: Of 2,440 distributed questionnaires, 1,412 were returned (58%), and 1,220 were eligible (947 unique respondents).Intervention sites conducted 244 simulation sessions compared with 84 in control sites (a 2.9-fold difference).Relative to controls, intervention departments reported higher scores for perceptions of management ( + 5.1 points, 95% CI: 0.8-9.5)and working conditions ( + 6.1 points, 95% CI: 2.0-10.2);changes in other dimensions were smaller and not statistically significant.Conclusions: A sustained, locally facilitated simulation program was associated with improved perceptions of management and working conditions-domains closely linked to patient safety culture.These findings suggest that, under supportive conditions, simulation may operate not only as a pedagogical method but also as an organizational practice that can influence how staff perceive the culture of their clinical environment.