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Date of Award


Document Type

Dissertation-ISU Access Only

Degree Name

Doctor of Philosophy (PhD)


Mennonite College of Nursing

First Advisor

Orin . Reitz


This dissertation is comprised of three manuscripts exploring the integration of simulation with system-based improvement strategies and specifically with gap analysis. The first manuscript presents a review of literature regarding the incorporation of simulation with system-based improvement strategies to identify safety risks that could lead to patient harm. Further research concentrating on simulation with these improvement strategies is warranted to build the body of literature in order to support its integration. This manuscript will be submitted to the Journal of Patient Safety and Quality Improvement.

The second manuscript is a report of the results of a descriptive qualitative study that explored integrating simulation with gap analysis to discover safety risks using falls as an exemplar. The Donabedian Model of Patient Safety, which depicts relationships that impact patient safety, guided the analysis. Five gaps between actual and desired practice were discovered along with five themes related to barriers in executing best practices. Findings of the study supported the use of simulation with the gap analysis strategy to discover latent risks that may not otherwise be found using conventional methods. This manuscript will be submitted to the Simulation in Healthcare Journal.

The third manuscript is a description of the process for integrating simulation with gap analysis. The manuscript is organized by three out of the four critical steps for conducting a gap analysis. Key actions and recommendations derived from previous studies are also described. Additionally, two lessons learned from this author’s study are also provided to help guide future research regarding integrating simulation with gap analysis.

KEYWORDS: Simulation; System-Based Improvement Strategies; Patient Safety; Gap Analysis; Hospital


Imported from ProQuest Farrow_ilstu_0092E_11581.pdf


Page Count


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