By: Victoria Brazil (@SocraticEM)
Healthcare performance and patient outcomes can suffer because of poor physical design, and design flaws can also cost money. A lot of money.
Describing how ‘the future is simulated’ in this blog post, Chris Hicks illustrates how simulation enabled the redesign of an emergency room resuscitation bay, and outlines principles for applying simulation enabled redesign in other contexts. Clearly, simulation can be a powerful tool for testing new or renovated healthcare spaces before they’re used for patient care. But is it worth it?
Clinician educators may be asked to support simulation-based testing of physical environments because of their familiarity with simulation based educational practice. While there are some overlaps, there are also some important differences in approach if the objective is systems testing, rather than individual learning. The methods and techniques used to do this draw upon methodologies from Human Factors, ergonomics and design thinking. This can’t just be a ‘let’s do a sim to test it’ approach.
In a previous ICEnet post we highlighted work from Nora Colman, Alysha Kaba and others that provided us with comprehensive guidance on the ‘how’ of simulation-based hospital design testing (SbHDT). More recently, a team from New Zealand show us how simple this can be; they took less than a day of inexpensive simulation to evaluate how big the lifts needed to be for their ICU transfers in a new hospital. But most published guidance describes testing that is comprehensive and resource intensive.
So, is it worth it?
Yes, according to the latest publication from Nora Colman’s team from Atlanta. In their recent publication – The Business Case for Simulation-based Hospital Design Testing – the author team calculated the costs and savings associated with conducting simulations prior to the opening of a new 400 + bed children’s hospital. Their description of results is astonishing…
“The cost to conduct the simulation was $1.6M (0.01% of overall project cost). Seven hundred twenty-two latent conditions were identified, and 57% of those latent conditions were mitigated by design changes. Ninety million dollars in costs were avoided by making design modifications before construction. Twenty-eight percent of latent conditions (n = 117) would have been cost-prohibitive to modify after construction.” (1)
Taking a critical eye, I’d say there are a lot of assumptions in their calculations. As the authors say, there is no universally accepted method for reporting financial impact, so they use the term ‘cost avoidance’, rather than return on investment. But there is a strong signal here about the extent to which supposed ‘standard’ design approaches for healthcare spaces might not be fit for purpose and need to be tested by the people who will be working in them.
Congratulations to the team for this comprehensive work. When new healthcare spaces are created or existing ones are renovated, we have a responsibility to ensure these spaces support the delivery of safe, efficient and effective care. And now we can even tell our leaders how much money they might save in the process!
Happy simulating!
Victoria
References
- Colman N, et al. The Business Case for Simulation-based Hospital Design Testing; $90M Saved in Costs Avoided. Pediatr Qual Saf. 2024 Nov 15;9(6):e775
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