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.”

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.

What healthcare can learn from nuclear power industry?

Just came back from 2014 Symposium on Human Factors and Ergonomics in Health Care in Chicago. I attend a session presented by experts from AAMI, the Association for the Advancement of Medical Instrumentation  titled Safety and Risk in Health Care and Nuclear Power: Learning From Each Other .     By learning from nuclear power industry,  healthcare industry can use technology effectively and efficiently with systems engineering, human factor approaches. The re-engineered  new healthcare delivery system should integrate people, technology, process, organization and external environment. The cross industry collaboration is critical to transform the healthcare delivery.  Simulation will play more important roles on training, assessment, usability testing and process redesign.

You can read more from AAMI monograph,Risk and Reliability in Healthcare and Nuclear Power: Learning from Each Other”

“The future is already here. It’s just not evenly distributed yet.” —William Gibson


“A Systems Approach to Improve Bedside Patient Rescue (BPR) on Hospital Floor ” presentation at INFORMS Healthcare 2013

Xiaolei Xie presented our work at INFORMS Healthcare 2013 Conference 

A Systems Approach to Improve Bedside Patient Rescue (BPR) on Hospital Floor 

Xiaolei Xie, Yue Dong, Jeanne Huddleston, Jingshan Li, Thomas Rohleder, Colleen Swartz

Abstract: In this paper, a systems approach is presented to improve operations related to bedside patient rescue (BPR) process. A five-module (triage, patient, floor, RRT and ICU) framework is proposed to systematically study the correlations and interactions among all the factors related to BPR. Under this framework, simulation model using ARENA has been developed, which provides a quantitative tool for medical professionals to improve BPR process.

“Human Risk Assessment for Simulated Central Venous Catheterization” presentation at INFORMS Healthcare 2013

David John presented our work at INFORMS Healthcare 2013 Conference 

Human Risk Assessment for Simulated Central Venous Catheterization

David M. Johnson, William  F. Dunn, Yue Dong

Abstract:   Central venous catheterization (CVC) is one of most common practiced procedures in the ICU. CVC is associated with complications and potential life-threatening outcomes. The analysis of the CVC procedure from a perspective of Human Risk Assessment (HRA) will provide more insights into the contribution of human error to the system engineering problem of the CVC procedure. This research performs an HRA methodology as a novel approach to quantifying the human error risk component associated with a CVC.


INFORMS Healthcare 2013

I am at Chicago to attend the second INFORMS conference on healthcare operations research, systems engineering and analytics. INFORMS HEALTHCARE 2013.  The Institute of Operations Research and Management Science (INFORMS) is largest professional society in the world for professionals in the field of operations research (O.R.), management science, and analytics.

Computer simulation has been purposed as a “third branch of science beyond experimentation and theory” published in Science  1992. It is one of most common systems engineering tool for process analysis and system optimization by many industries including those high reliability industries (aviation, nuclear power stations, etc.).  Most recent review about Computer Simulations in Science can be found from  Winsberg, Eric, “Computer Simulations in Science”, The Stanford Encyclopedia of Philosophy (Summer 2013 Edition), Edward N. Zalta (ed.)

Healthcare application of computer simulation can be found from listed papers below

SSH Systems Engineering based Simulation Affinity Group

Happy New Year! IMSH 2013 is coming up in less than two weeks, and I look forward to seeing everyone in Orlando.Many SSH members have a special interest in using various simulation tools (computer simulation, mannequins, etc.) to study the interactions between three major entities of the healthcare delivery system (and sub-systems): patients, providers, and processes.

A few years ago, I started to think about what is the connection between various simulation tools and its application to study complex systems after I read Dr. Stephen Small’s paper Simulation Applications for Human Factors and Systems Evaluation”  With an opportunity to learn from a Professor of Industrial Engineering (Dr. Huitian Lu) , I started using computer modeling to define, measure and analyze the complexities of a healthcare setting. So far, my simulation projects have been primarily focused on using systems engineering approach and computer modeling and simulation for (ICU care) process improvement in the complex healthcare delivery System of Systems.

You can find my related work from the links below.

Dong Y, Chbat NW, Gupta A, Hadzikadic M, Gajic O. Systems modeling and simulation applications for critical care medicine. Ann Intensive Care 2012;2:18.

Dong Y, Lu H, Gajic O, Pickering B. Intensive care unit operational modeling and analysis. In: Kolker A, Story P, editors. Management engineering for effective healthcare delivery: Principles and applications. Hershey, Pennsylvania, USA: IGI Global; 20


This is also one of the key applications of simulation that has great potential to transform healthcare delivery. I know many of you have done amazing work related to this area. But we don’t yet have a formal group to discuss this topic in IMSH. So I decided to create the “System Engineering based Simulation Affinity Group” and invite you to join me to learn and share each other’s work and then disseminate the knowledge to the SSH community and beyond.

The inaugural meeting of this affinity group will take place at IMSH 2013 in Orlando. The time and location has been set as follows:

  • Date: Sunday, January 27, 2013
  • Time: 5:00 PM – 6:00 PM
  • Room Location: Peabody Hotel Columbia 37

Please consider joining this event. Feel free to invite others who might be interested in this topic.

Please let me know you have any comments or suggestions. Thank you for your consideration! See you soon in Orlando.

Mayo Clinic Quality and Systems Engineering Conference

I will present ICU modeling and simulation for process redesign projects this Wednesday at Mayo QSE meeting. I call it “Medical simulation 2.0”.  Looking forward to have a good conversation with healthcare providers, engineers and multiple disciplines related to improvement of health care systems.  Hope see you there. 🙂

THERP and SLIM for Human Reliability Assessment #HRA

I read about Technique for Human Error Rate Prediction (THERP) and Success Likelihood Index Method (SLIM) used for human reliability assessment (HRA).  These are technique used in other high reliability industries for: error identification, error quantification and error reduction.  Healthcare needs to learn from others to apply systems approach to reduce medical errors.

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