Category Archives: return on investment

Fire Alarm Systems and Simulation Programs in Hospitals – What is the ROI?

shutterstock_278643779How do you respond to your financial administrator or controller of the purse strings when they ask you what the return on investment is for your hospital-based simulation program? It’s quite complicated.

Return on investment in today’s vernacular implies that there is a financial spreadsheet that can show a positive bottom line after revenue (or direct cost savings) and expenses are accounted for. This is really difficult to do with simulation.

I have seen business plan after business plan of simulation centers that have promised their administration that they will become financially positive and start bringing in big bucks for the institution in some given period of time. Usually it’s part of the business plan that justifies the standing up of the simulation center. I think I can count on one hand the simulation programs that have actually achieved this status. Why is this?

The answer is because calculating discrete return on investment from the simulation alone is extraordinarily difficult to do. While there are some examples in the literature that attempt to quantify in dollar terms a return on investment, they are however few and far between. It is largely confined to some low hanging fruit with the most common example and published in the literature focusing on central line training.

Successfully integrated hospital focused simulation programs likely have found a way to quantify part of their offerings in a dollars and cents accounting scheme, but likely are providing tremendous value to their organizations that are extraordinarily difficult, if not impossible to demonstrate on spreadsheet.

What is the value the simulation center may bring to the ability of a hospital to recruit more patients because the community is aware of patient safety efforts and advanced training to improve care? What is the value of a simulation center in its ability to create exciting training opportunities that allow the staff to feel like the system is investing in them and ultimately helping with recruiting of new staff, along with retention of existing staff members?

What is the value or potential in the ability to avoid causing harm to patients such as mismanaged difficult airway because of simulation training of physicians and other providers who provide such care? What is the value of litigation avoidance for the same topic?

Also, the value proposition of the successfully implemented simulation program for patient safety extinguishes itself over time if it significantly reduces or eliminates the underlying problem. This is the so-called phenomenon of safety being a dynamic, nonevent. Going back to the more concrete example of airway if your airway management mishap rates have been essentially zero over several years, the institutional memory may become fuzzy on why you invest so much money and difficult airway training….. A conundrum to be sure.

I think of fire alarm systems in the hospital as similar situation Let’s compare the two. Fire alarm systems detect or “discover” fires, began to put the fire out, and disseminate the news. Simulation programs have the ability to “detect” or discover potential patient safety problems for the identification of latent threats, poor systems design or staffing for example. Once identified, the simulation program develops training that helps “put out” the patient safety threat. One could argue that the training itself is the dissemination of information that a patient safety “fire” exists.

Fire alarm systems and hospitals cost hundreds of thousands, possibly millions of dollars to install and run on the annual basis. But the chief financial officer never asks what’s the return on investment? Why is that?

Well, perhaps it is a non-issue because fire alarm systems have successfully been written into law, regulations of building codes and so on. Regulation is an interesting idea for simulation to be sure but probably not for a long time.

However, if you think about it beyond a regulatory requirement, the likelihood of a given fire alarm system actually saving a life is probably significantly less probable then a well-integrated simulation program that is providing patient safety programs designed around the needs of the institution it serves. Admittedly the image of hundreds of people being trapped in a burning building is probably more compelling to the finance guy then one patient at a time dying from hypoxia from a mismanaged difficult airway.

Do you really know what to do when the fire alarm system goes off in your hospital? I mean we have little rituals like close the doors etc. But what next? Do we run? If we run, do we run toward the fire? Or away from the fire?  Do we evacuate all the patients? Do we individually call the fire department? Do we find hoses and start squirting out the fire?

When we conduct simulation-based training in hospitals that are aligned with the patient safety needs of the given institution we are extinguishing or minimizing the situation that patients will undergo or suffer from unintended patient harm. The existence of simulation programs and attention to patient safety education are a critical need for the infrastructure of any hospital caring for patients.

The more we can expand upon this concept and allow our expertise in simulation to contribute to the overall mission of the institution in reducing potential harm to patients and hospital staff, the more likely we will receive continuing support and be recognized as important infrastructure to providing the highest quality and safety to our patients.

Just like the fire alarm systems.

 

 

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Value and Learning Propositions for Safety through Simulation – Don’t Sell Your Efforts Short

shutterstock_561835375aAll too often it is easy to be stuck in a mindset which can create tunnel vision. One of those time frames in the simulation world can come from an overall short-sightedness, into the usefulness, power, wisdom and change that can result from well-run simulation efforts. Many people have heard the adage “with simulation is within the debriefing that all the learning occurs.”  While phrases like this are meant to underscore the importance of the debriefing following a simulation if they are taken too literally they can result in a lack of recognition of total value of the simulation program investments and contributions.

This phenomenon is prevalent when evaluating the impact of simulation programs as part of patient safety efforts in healthcare systems in hospitals. In-situ simulation programs, or mock code evaluation programs are of unquestionable value to those of us who are in leadership in patient safety roles. Undoubtedly learning can occur during the simulation itself as I discussed in a previous blog post. Further, we all recognize the value of learning that can occur during well-run debriefing sessions. Lastly and perhaps most importantly great value can come from the information obtained during the simulation.

Scenario and debriefing sessions involved in in situ and other simulation programs that occur with practicing professional’s as participants have their limitations. First, and most practically is the operational recognition that healthcare professionals can only be kept “off-line” for a certain period of time to accomplish the simulation and debriefing. Secondly, some topics may be more sensitive than others and are not appropriate to be addressed directly with individuals during a debriefing that involves peers, as well as other healthcare colleagues. This point may be considered when evaluating the political and perceptions of your in-situ programs as received by the staff. Lastly, when you execute such a simulation there is only so much that can be absorbed at one point in time before cognitive overload becomes a significantly limiting factor.

Thinking traditionally from a “simulationist” point of view, is easy to think that all of the learning that will be recognized comes from the performance of the simulation combined with debriefing. With structure, planning and a systems-based approach to the simulation efforts, data can be gathered and analyzed to help a given hospital, or health system, understand the capabilities and limitation of their various clinical delivery systems. This can be invaluable learning for the system itself, which can then be incorporated into a plan of change to improve safety or in other cases efficiency in the delivery of care.

The given plan of change may incorporate additional educational efforts, policy, procedure or process changes that will be made in a more informed way than if the data from the simulation was not available. To garner such useful information at a systems-based level it is important that the curriculum integration be developed with consistent measurement strategies, objectives and tools that will allow meaning information to accrue.

A well planned, needs based targeted implementation strategy will create larger value than the simulation efforts occurring in a silo not connected to a larger strategic plan of improvement. If you think about a simulation event it is easy to picture small groups of people learning a great deal from the participation in the scenario or program. Simulation has the unique capability to abstract information to help provide insight into aspects of the patient care that both go smoothly as well as identify opportunities for improvement simultaneous with deployment of useful learning.

Once these opportunities are catalogued and recognized, a transformation of greater scale can take place through careful planning and implementation of further patient safety efforts with defined targets. Partnering with your risk management or patient safety colleagues to work on the integration plan can be valuable for increasing leadership buy-in for supporting your simulation efforts.

So I challenge you! If you are running relations in situ make sure that you keep in mind that your educational efforts during the simulation scenario are part of a bigger picture of increasing the safety and/or efficiency for providing care to patients, thus bringing a higher return on investment for the simulation efforts that you are conducting.

Until next time…… Happy Simulating!

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