Simulation demystified and reimagined-using simulation to transform clinical practices.

Simulation has traditionally been used for paedagogical purposes. More recently, simulation has been advocated for use in transformational ways - leveraging simulation to test and improve clinical systems and service delivery. This article presents a narrative account of transformational simulation in stroke care. We describe three simulation-based initiatives: a review of simulation on door-to-needle times, development of a telethrombolysis protocol and implementation of a thrombectomy pathway. This article demonstrates how simulation can be used to transform healthcare. Our examples have focussed on stroke presentations; however, the 'seven I's model' outlines how simulation can be used to identify, improve and innovate across the care spectrum.