The Wrong Operation: Healthcare Simulation Isn’t Just for Training

The great Maimonides famously said that a Doctor should treat the patient, not the disease. But what happens when the real patient is the healthcare process itself, and the cause cannot be traced to trauma or disease or aging?

The healthcare community is constantly developing expensive new drugs, fantastic machines, and super-trained Drs/Rns. And to get to all this, the average patient undergoes a painful and lengthy and boring procedure that makes them nostalgic for the DMV. What’s more likely: that a patient complains about the skill of the health care provider or that she complains about wait-times, procedure, communication, etc. of the overall experience?

What are the biggest problems in healthcare? (Source: Forbes)

  1. A lot of unnecessary care. Somewhere between a third and one half of all health care costs stem from overuse and/or unnecessary care. This is a direct cost of hundreds of billions, not to mention an additional half-trillion attributed to lost productivity.
  2. Avoidable patient harm. The statistics are staggering: one in four admitted Medicare beneficiaries suffers from some form of hospital-related harm during their stay. Would you ride in a vehicle with a 1 in 4 chance of getting you hurt?
  3. Sheer waste. The Institute of Medicine Health reports that a third of all health costs are wasted.
  4. An epidemic of perverse incentives. Our system is based on paying providers for whatever they do, regardless of whether it benefits the patient or was even needed.
  5. Lack of transparency. How many tools are at the average person’s disposal to compare or evaluate, say, a new car purchase? These same consumers must realize that healthcare charges are high, variable, mysterious, and only revealed post hoc. That’s unacceptable now, and soon will be ludicrous.

And yet, when I look at the growing field of healthcare simulation I see a lot of grownups playing with expensive dolls. (Ok, really expensive, well-made dolls that simulate trauma, disease, and other healthcare procedures). Don’t get me wrong, I’m all in favor of teaching via simulation. It’s great. But why are we only teaching the hands-on part of healthcare this way?

Look at the above list. Only #2 has anything to do with medical skill; the rest are all about process improvement, Lean, and policy. And you could easily argue that even #2 is heavily influenced by process—the chances of hospital infection increase with the duration of the patient’s stay, and the chance of medication interaction is process related.

The whole hospital is sick, not just the patient.

Hasbro's Operation is like healthcare simulation

Simulating trauma or surgery is to focus on the holes yet miss the whole. We need to improve how the hospital operates, not how the surgeon does.

And yes, dammit! I am jealous of all the attention those rubber dummies get. I’ve been a process improvement guy all my life, and I currently work with FlexSim Healthcare to model, simulate, and optimize healthcare facilities. (Other top-shelf rival tools are Simio and ProModel). Customers typically see very fast paybacks on investment. More importantly, their patients see their providers faster!

The places to start, if you’re an HME or a hospital administrator, are the ER (where you lose all your money) and the OR (where you make it). Process improvements in these two areas alone are gold to hospitals.

Architects, process re-engineers, Six Sigma types—they’ll see immediate applications. Have you ever gone to a ward and suggested that they switch processes around six or seven times to try to find the best one? Now you can do that in your computer, eliminate the bad options, and provide a compelling case for your recommendation.

In summary, I’m not suggesting that medical training via simulation is akin to rearranging the deck chairs on the Titanic. I’m saying that the rest of the hospital can learn from the approach, leverage it to redesign their processes, and determine the optimal number of deck chairs in the first place.