“In light of the government’s push to curb healthcare costs and expand the availability of healthcare to a wider population, efficiency may well take the lead. When it does, healthcare planners will need a tool that can handle every aspect of healthcare management, not individually, but as a unified and integrated field”
-Lou Keller, Flexsim Software Products, Inc.
There are two ways of answering the question, "Why Bother with Healthcare Simulation?" That is, after all, what the assigned title to this editorial is really asking. The first way is fairly esoteric, meaning that it addresses the question in what I refer to as, "quant-speak," a language that management engineers and methods analysts use when they think others are eaves dropping. Think I'm kidding? Okay, try this.
Answer number 1: Because of the variance inherent in human activity, the number of different considerations required in any related analytical effort, and the ramifications associated with the implementation of most solutions to healthcare management problems, even problems that can seem small often demand evaluative solutions that are intractable. In other words, the generation of a workable solution to an existing problem can take longer to derive than the need for a solution can wait.
Answer number 2 is far simpler. We bother with simulation because healthcare problems are hard to solve using any other method. Moreover, the variety of solutions to healthcare management problems are usually far too numerous or complex for the human mind to comprehend, much less adopt without lengthy consideration and, most importantly, some means of validation.
In either case, the routine non-simulation based analytical and evaluative methods that we use to off-set the incredible complexity healthcare problems represent, don't generally work as well as we'd like. We still use them but we don't usually trust their results.
Know why that's the case? Well, it's partially because hospitals aren't factories. They don't manufacture anything; there is no product that leaves the front door when a patient checks out. Accordingly, it's relatively impossible to account for all of the resources, in every form, that were consumed in producing a given outcome. In fact, thinking of a hospital that way, or of a patient as a product, not only does a massive disservice to the patient who will eventually begin to feel like box moving along a conveyor, but it robs the provider of the individuality we depend on to achieve quality care. And yet, to simplify analytical efforts, more often than not we do exactly that. We treat, speak of, and deal with patients as entities, not as the highly sophisticated beings who come equipped with their own behaviors, preferences, cares and concerns. Oh, and by the way, the provider community isn't exempt from the same thinking. If a patient is a product, then a provider is a factor of production. Too bad they're not. Their predictability would make analytical evaluation and planning so much easier.
The truth of the matter is that Hospitals have but one single goal, to change a patient's state of health ... hopefully for the better. And, to do that, hospitals rely on the availability of a wide spectrum of resources, all of which come with a price tag. But, even that doesn't tell the whole story. They also rely on patient involvement, compliance, and cooperation, three things that, although difficult to quantify, have to be considered. My point is that sometimes the two work well together but more often they don't. What's even more important though, is that methods of evaluation and planning that either don't deal with or account for the complexity and variances that exist within the healthcare realm, can't adequately predict the impact that those characteristics might have on performance.
So, what's the point? Just this. Prior to 1980, the efficiency and effectiveness of healthcare systems were essentially independent characteristics of the same process. That said, because there wasn't any way to quantify efficiency, effectiveness was the more attended to component. Today, literally twenty-five years after the implementation of prospective reimbursement and DRGs, they're on equal footing. In fact, in light of the government's recent enthusiastic push to curb healthcare costs and pending legislation that could expand the availability of healthcare to an even wider slice of the population, efficiency may well take the lead. When it does, healthcare planners will need an evaluative tool that can handle staffing, resource allocation, systems design and every other aspect of healthcare management, not individually, but as a unified and integrated field.
I suspect that simulation is the answer and here's why.
There are six ways to, "skirt," the difficulties associated with analyzing complex problems and the time it takes to reach meaningful, believable solutions. Without a lengthy explanation of what they are suffice it to say that simulation handles five of them well. More to the point, simulation can be used to accurately and comprehensively model anything from a nursing unit to a shared services environment, from a single clinic to a network of hospitals.
Within the model, planners can include anything that's germane either to the operation of the system under study or to its evaluation. There are no restrictions. Financial controls, human performance factors, patient activities, staffing variances, and even constraints that have yet to be realized, can be added, edited and expanded with ease. And, as far as output reports are concerned, the simulation world is the planner's oyster. Anything that's manifest in the real world, can be measured, calculated, and reported in almost any quantity imaginable.
But, there's more; two things that really make simulation valuable. First, nothing has to be assumed away; not variance, unexpected events, extremes in behavior, or any aspect of real life that may cause a healthcare system to perform in unexpected ways. Then, there's animation. It's the one tool that simulation brings to the planner's table that no other evaluative method can compete with. As such, It serves not only as a means of validating the performance of the model but as both a research and teaching tool as well. More often than not, it even enables a manager to see not only what's going on, but often why, without opening a single report.
As the healthcare world becomes more demanding and complex, wouldn't it be nice to have an evaluative tool that can meet the challenge?