This is how We Think

Hello, it has been a while for me to post here. Here I am.

I first watched Professor Richard Miller’s talk ” This is How We Dream” back 2009. It is still relevant for today’s world and healthcare industry. Please enjoy .

To learn more about Richard Miller you can visit his page or blog.

Healthcare Systems Modeling & Simulation Affinity Group Webinar

The Use of Discrete-Event Simulation in Healthcare Operations Research by Eric Goldlust, M.D.,

Why Don’t Information Industries Make a Greater Impact on Care Delivery?

Dr. Terry Young , Professor of Healthcare Systems, School of Information Systems, Computing and Mathematics, Brunel University

He and Dr. James Fackler published a paper  Why healthcare professionals are slow to adopt modeling and simulation?  to explore the reason for slow adoption of the computer modeling and simulation in healthcare.

Professo Young is also the co-founder of the Cumberland Initiative, a network of leading clinicians, managers, modellers, academics and industry specialists who are pioneering the modeling and simulation approach in the NHS. Lord Norman Warner, former Health Minister for NHS reform said in a press conference. 

“We will only do something different if we have an analytical base to enable people to change,” argued Lord Warner. “The problem in the NHS is, unless local people are confronted with overwhelming evidence that something has to be done and there is another way, in many places they don’t change their institutional behaviour.” 

The NHS is a very conservative organisation in many places. But where we are now, we badly need the kind of initiative that Cumberland is showing. The traditional thing you do is try and gee up doctors and managers but we need a bit of an injection of data collection and analysis.”

Dr. Mike Ryan on Systems Engineering Coursea Open Course

In 2005,  the National Academy of Engineering and the Institute of Medicine published consensus report Building a Better Delivery System- A New Engineering/Health Care Partnership.  2009, AHRQ published Industrial and Systems Engineering and Health  Care: Critical Areas of Research.  Both those reports introduce the great potential of systems engineering application in healthcare.  As as recent AHRQ recenty Patient Safety Learning Laboratories: Innovative Design and Development to Improve Healthcare Delivery Systems (P30) statedDespite the carefully crafted recommendations and thoughtful papers, its impact has been limited. ”   This education module will be a great help to fill the gap for healthcare providers’ education.  Thank you ! 




Healthcare needs build a new bridge.



 At Institute for Healthcare Improvement National Forum,  Don Berwick, MD, former CMS administrator used a 1930s engineering feat in Honduras as a metaphor for today’s healthcare system. 

The Choluteca Bridge was built by the U.S. Army Corps of Engineers with such design strength, it could withstand the worst of hurricanes that affected the area. When Hurricane Mitch came in 1998, it destroyed 150 Honduran bridges, but not the Choluteca Bridge. Instead, the storm rerouted the Choluteca River. So now, the Choluteca Bridge is useless.

More detail from Iowa Hospital Association blog:

Dr. Don Berwick declared that today’s health care organizations are like the Choluteca Bridge.  They were designed and built for a different river – the river of heavy-duty, high-volume, invasive procedures.  The river of serious illness. While the temptation is great to try and redirect the massive river to flow back under the first bridge, the work set before health care leaders is to build a new bridge – a bridge of authentic prevention. Dr. Berwick said, “Hospitals cure disease but they do not prevent it.  And they cannot prevent it, because they aren’t set up to do that today.  Prevention doesn’t have any cathedrals.  The result is a continuing misallocation of effort.  If the Martians came here to visit, they would call this insane.  We let bad things happen and then fix them.  Well, why don’t we stop them from happening?   Simply put, we just haven’t built the institutional structure for prevention.” – See more at:

The National Academy of Engineering and Institute of Medicine of the National Academies directed attention to the issue of systems engineering and integration with their joint report in 2005, “Building a Better Delivery System: A New Engineering/Health Care Partnership.”   The collaboration between clinicians, engineers, researchers, educators, and experts from medical informatics and management will  analyze, define, design, develop, test and implement high value and comprehensive solutions to many of the challenging problems in clinical medicine.

“In times of change, learners inherit the earth, while the learned find themselves beautifully equipped to deal with a world that no longer exists.”

“In times of change, learners inherit the earth, while the learned find themselves beautifully equipped to deal with a world that no longer exists.”Eric Hoffer

Short-term and Long-term Impact of the Central Line Workshop on Resident Clinical Performance During Simulated Central Line Placement.

Our paper just published at Simulation in Healthcare Journal.   The study demonstrated earlier simulation training offered greatest benefits.

INTRODUCTION:  The Central Line Workshop (CLW) was introduced at our institution to better train residents in safe placement of the central venous catheter (CVC). This study sought to determine if immediate performance improvements from the CLW are sustained 3 months after the training for residents with various levels of experience.

METHODS: Twenty-six emergency medicine residents completed the CLW, which includes online modules and experiential sessions in anatomy, ultrasound, sterile technique, and procedural task training. Demonstration of the synthesis of these skills including placement of both internal jugular and subclavian CVCs was assessed using a task trainer. Each resident was also tested approximately 3 months before and 3 months after the CLW. Residents were assessed using a validated CVC proficiency scale.

RESULTS: Residents’ CVC proficiency scores (percentage of items performed correctly during the assessment station) improved after CLW (0.6 vs. 0.93, P < 0.05). At 3 months after CLW testing, there was apparent skill decay from the CLW but overall improvement compared with baseline testing (0.6 vs. 0.8, P < 0.05). There was no significant difference in procedure time after CLW training. The postgraduate year 1 group showed the greatest improvement of CVC skill after CLW training.

CONCLUSIONS: Resident CVC placement performance improved immediately after the CLW. Although performance 3 months after the CLW revealed evidence of skill decay, it was improved when compared with initial baseline assessment. Novice learners had the greatest benefit from the CLW.

21st Century Health Care: Wedges, Homes, and the Future of Pedagogy



14th annual International Meeting on Simulation in Healthcare (IMSH).

Please Join us in San Francisco, California for the 14th annual International Meeting on Simulation in Healthcare (IMSH).

Saturday, January 25 | Sim Ops Symposium
Saturday & Sunday, January 25 – 26 | Pre-conference Courses
Sunday-Wednesday, January 26 – 29 | IMSH General Sessions & Annual Meeting

If Russ Ackoff had given a TED Talk…

Systems thinking is prerequisite to learn computer modeling and simulation.

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