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Research Results: Can Simulation Improve Healthcare System Performance?

[This is cross-posted from the original entry on the Z Shift corporate blog.]

Using simulation to improve medical training is a fairly well researched and understood phenomenon at this point. Many articles point to the effectiveness of using simulator-based systems to improve the results of clinician training. (I'm planning on providing an overview of this in a future blog post.) But can simulation be used to improve the systemic performance of clinical care? In other words, can we use simulation to model clinical healthcare systems and then improve their real-world performance based on the results of the simulation? This is one of our focus areas at Z Shift and so it's of great importance to us. Together with my co-author Dr. Robert Szczerba of Lockheed Martin, I hypothesized about this in a paper that won the Best Paper award at I/ITSEC (Interservice/Industry Training, Simulation, and Education Conference) in 2010, "Simulated clinical environments and virtual system-of-systems engineering for health care". (Full text (PDF). Slides (PDF).) But what about results from actual clinical trials?

As it turns out, a number of papers have been written on various aspects of this subject, over a period of decades, and the results have been positive. A brief survey of the available literature revealed the following:

  • A 1989 article published in Annals of Emergency Medicine described a "computer simulation model of emergency department [ED] operations". The authors concluded that "simulation is a potentially useful tool that can help predict the results of changes in the ED system without actually altering it and may have implications for planning, optimizing resources, and improving the efficiency and quality of care". (1)

  • A 2007 study published in Pediatric Emergency Care found that a model of patient flow within a pediatric emergency department based on discrete event simulation "accurately represents patient flow through the department and can provide simulated patient flow information on a variety of scenarios. It can effectively simulate changes to the model and its effects on patient flow". (2)

  • A 2008 article from AORN Journal [Association of periOperative Registered Nurses] described a simulation project "performed to assist with redesign of the surgery department of a large tertiary hospital and to help administrators make the best decisions about relocating, staffing, and equipping the central sterilization department". The authors found that "simulation can facilitate the design of a central sterilization department and improve surgical sterilization operations". (3)

  • An article published in the Journal of Healthcare Management in 2011 discussed the use of discrete event simulation as a "cost-effective way to diagnose inefficiency and create and test strategies for improvement". The authors concluded that while discrete event simulation "is not a cure-all for clinic throughput problems," it can nevertheless "be a strong to provide evidentiary guidance for clinic operational redesign". (4)

  • A 2011 article in the Journal of Healthcare Quality described the use of discrete event simulation to "model the operations and forecast future results for four orthopedic surgery practices". The authors concluded that simulation "was found to be a useful tool for process redesign and decision making even prior to building occupancy". (5)
As stated, this was from a relatively brief survey. I suspect that a more thorough search of the available literature would reveal additional similar articles. I should also point out that I haven't cherry-picked these results; all the relevant articles I found had positive conclusions on the question of using simulation to systemically improve healthcare. It's highly encouraging.


1. Saunders CE, Makens PK, Leblanc LJ. Modeling emergency department operations using advanced computer simulation systems. Annals of Emergency Medicine. 1989 Feb;18(2):134-40. Abstract.

2. Hung GR, Whitehouse SR, O'Neill C, Gray AP, et al. Computer modeling of patient flow in a pediatric emergency department using discrete event simulation. Pediatric Emergency Care. 2007 Jan;23(1):5-10. Abstract.

3. Lin F, Lawley M, Spry C, McCarthy K, et al. Using simulation to design a central sterilization department. AORN Journal. 2008 Oct;88(4):555-67. Abstract.

4. Parks JK, Engblom P, Hamrock E, Satjapot S, et al. Designed to fail: how computer simulation can detect fundamental flaws in clinic flow. Journal of Healthcare Management. 2011 Mar-Apr;56(2):135-44; discussion 145-6. Abstract.

5. Montgomery JB, Linville BA, Slonim AD. Desktop microsimulation: a tool to improve efficiency in the medical office practice. Journal of Healthcare Quality. 2011 Sep 13. doi: 10.1111/j.1945-1474.2011.00166.x. Abstract.


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