The number of healthcare simulation centers (HSCs) in mainland China has increased exponentially. However, the performance of these centers varies significantly between hospitals.

The aim of a study was to address two research questions:

(1) what are the critical factors for implementing high-performance HSCs, and (2) how are these critical factors used in the development of implementation strategies to achieve satisfactory performance?

Following a literature review on information technology (IT) implementation, Yan et al. identified a framework comprising four key dimensions for HSCs implementation: technology, organization, environment, and individuals. This TOEI Technology-Organization-Environment framework was then used as a basis for a multi-center case study through which data collection and analysis proceeded. They collected 12 one-to-one in-depth interviews alongside secondary data from six high-performance HSCs in mainland China.

The study identifies critical TOEI factors that collectively influence HSC implementation performance and major activities at the six high-performance HSCs. Three strategies for implementing high-performance HSCs are also identified: facility management platform, education and training center, and innovation center.

HSC implementation is a holistic approach. The critical TOEI factors collectively build a foundation for center activities. An HSC's implementation strategy highly relies on organizational strategic goals. Additionally, HSCs in mainland China face some common challenges such as faculty retention and future opportunities such as expanding the research scope. This study also provides insights for hospital leadership, medical associations, and policymakers ¹⁾