February 17, 2021By Lindsey Nolen

Simterviews: Medical Simulation Experts Discuss Ways to Maximize ROI

Healthcare simulation is an extremely useful education and training resource, and investment in this learning method can result in improved patient safety outcomes. Clinical simulation educators are often tasked with ensuring that these outcomes are met through high-fidelity simulation experiences, but can be left wondering how best to maximize their return on investment. However, there are a number of ways these healthcare simulation leaders can work to set themselves up for the best possible outcomes to maximize their return on investment. HealthySimulation.com spoke to a number of healthcare simulation experts inquiring about their greatest advice for those already engaged in simulation, who want to continue to maximize their outcomes and ROI moving forward? Throughout this new Simterviews series, these experts shared that the key to this success involves setting goals, defining intended outcomes and making sure they are aligned with program missions. They also suggest tracking metrics to better define where to allocate resources.

Dr. Paul Phrampus, MD, Director of the Peter M. Winter Institute for Simulation, Education and Research (WISER), and professor in the Departments of Emergency Medicine and Anesthesiology at the University Of Pittsburgh School Of Medicine.

Dr. Paul Phrampus: One would be to make sure you’re collecting data. Everybody thinks that the hardest thing to do is to launch the course or launch the simulation program, and it is a phenomenal amount of work. What happens is that people often think it’s too much work to then collect data on users and user satisfaction, or the impact and competency levels that you might be impacting with simulation. That data that you’re gathering along the way is going to be something that can contribute mightily to the eventual ROI calculations — whether we’re talking about primary users on the school side or primary users on the health system side.


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One of the hardest things for us to do, myself included, is to go back and reflect on, “Why did we do this? Why did we design the simulation like this? Is it still meeting our goals? How can we do it more efficiently? How could we perhaps increase the effectiveness? How is my simulation program solving somebody else’s problem?”

That’s a critical question that people in mid-career and leadership need to ask. They need to be solving the problems of the people who are funding them to operate. Make sure your objective goals, work and outcomes are aligned with the missions that support your program.

Kim Leighton, PhD, RN, CHSOS, CHSE, ANEF, FAAN. Executive Director, ITQAN Clinical Simulation & Innovation Center in Doja, Qatar. She is the founder of the Evaluating Healthcare Simulation website, and is respected as a simulation educator, researcher, and mentor.

Dr. Kim Leighton: My best suggestion is to saturate yourself. By that I mean read every manuscript that’s remotely similar to what your interests are. Read the books, join the organizations, follow the listservs, go to the conferences, and network tirelessly. This is how you can identify where your gaps are and learn how to fill those gaps because you’re doing this homework.


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When I first went to work for Meti, I was starting work on my PhD. I was going to do it on clinical simulation, and at that point there were only about 71 published articles about healthcare simulation. There was practically nothing. Now, there’s so much it’s hard to keep up with. Be an abstract reader, because then when the question comes up later you’ll be like, “Oh, I read something about that.” Keep the papers and create a database. You can always come back to this information. That’s my best advice, saturate yourself in the literature and the conferences.

Janice C. Palaganas, PhD, RN, NP, ANEF, FNAP, FAAN, FSSH is the Associate Director of Health Professions Education at MGH Institute of Health Professions and Principal Faculty at the Center for Medical Simulation (CMS). She develops health professions educators in an Integrated Programming Environment setting.

Dr. Janice C. Palaganas: I think my biggest advice to Simulationists that have been around the block and are experienced is to disseminate your knowledge in a way where other people can replicate it. I think many people publish and talk about what they do, but not in a way where, where someone can just take it, use it and see if it works for their environment to rebuild what they’ve created.

Dr. Haru Okuda, MD, FACEP, FSSH, is the executive director of University of South Florida Health’s Center for Advanced Medical Learning and Simulation (CAMLS). In this role, he has oversight of a 90,000-foot, state of the art, advanced training facility, with the mission of creating and providing experiential learning that improves clinical skills and patient care in the community and around the globe.

Dr. Okuda: If you are a simulation operator, some of your outcomes might be more focused on improving efficiency, effectiveness and fidelity. Outcomes can be very specific, such as improving your moulage skills or training others. Outcomes are very different depending on who you ask. I think for a clinician, outcomes may include saving lives and reducing infections. Outcomes of an emergency physician may be improving resuscitation and airway management. It’s important to define your outcome at the beginning to know how to define both short- and long-term outcomes. This will also help identify how to focus yourself so that you’re not getting distracted too much, and that you’re heading towards your endpoint from a return on investment (ROI) standpoint.

Lynn Welch is the vice president of business development and marketing at Education Management Solutions, now SimulationIQ. She has also served as a Board of Director At Large Member and corporate roundtable chair at the Society for Simulation in Healthcare (SSH) since January 2020. Her unique background includes federal defense, global marketing, business development, sales leadership, and volunteer efforts.

Lynn Welch: I think one of the critical pieces is to understand where you are. If you’re not doing really intensive high-quality debriefing, if you’re not tracking your evaluations, if you’re not doing surveys of your learners to understand what their impressions are before they went into a SIM training encounter versus after, it’s hard for you to understand where you are to see where you need to improve. Once you start tracking those metrics, that’s going to guide you on where you need to allocate your resources and where you need to grow your programs. It also helps you scale because you become more efficient with utilizing both your time, your human capital and your high-value assets, like high-fidelity mannequins.

I think it’s all about tracking the analytics across your operations and your learner performance. That will really guide where and how to grow your programs. The other thing tracking your analytics will do is let you carefully forecast what you’re going to need. We rarely hear of a center that opens and gets utilized less. They tend to grow organically and very quickly, but that creates its own chaos. So tracking your analytics helps you plan not just how to build and open a center, but how to maintain it and where you want the center to be in five years. How am I going to get there? And what tools do I need to make that happen?

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