Academic journal article Inquiry

A Framework for Determining the Return on Investment of Simulation-Based Training in Health Care

Academic journal article Inquiry

A Framework for Determining the Return on Investment of Simulation-Based Training in Health Care

Article excerpt


This article describes a framework that has been developed to monetize the real value of simulation-based training in health care. A significant consideration has been given to the incorporation of the intangible and qualitative benefits, not only the tangible and quantitative benefits of simulation-based training in health care. The framework builds from three works: the value measurement methodology (VMM) used by several departments of the US Government, a methodology documented in several books by Dr Jack Phillips to monetize various training approaches, and a traditional return on investment methodology put forth by Frost and Sullivan, and Immersion Medical. All 3 source materials were adapted to create an integrated methodology that can be readily implemented. This article presents details on each of these methods and how they can be integrated and presents a framework that integrates the previous methods. In addition to that, it describes the concept and the application of the developed framework. As a test of the applicability of the framework, a real case study has been used to demonstrate the application of the framework. This case study provides real data related to the correlation between the pediatric patient cardiopulmonary arrest (CPA) survival rates and a simulation-based mock codes at the University of Michigan tertiary care academic medical center. It is important to point out that the proposed framework offers the capability to consider a wide range of benefits and values, but on the other hand, there are several limitations that has been discussed and need to be taken in consideration.


return on investment, simulation-based training, health care, intangible benefits, qualitative benefits


Simulation is used in areas that are difficult to see, expensive to build, dangerous to operate, and so forth. Simulations can also be expensive to develop and maintain, and their ability to meet the requirements set forth in creating them is often difficult to ascertain in advance. Nevertheless, decision makers who must make investment decisions need some means to know that an investment will be fruitful compared with various alternatives that might be available.

Most of the work to find the value of simulation to military training has been organized around cost avoidance. Little has been published in the open literature about a rigorous methodology that takes into consideration the different intangible factors during the life cycle of a simulator and the context of the organization. (1)

Current Determination of Return on Investment (ROI) and Value

The literature review showed 3 components that must be considered in determining the value of simulation: quantitative benefits, qualitative benefits, and costs and contributors to value. Putting these 3 factors together in an integrated fashion gives decision makers a view of the value simulation offers. (1,2) The 3 components of qualitative and quantitative benefits and costs are discussed below.


The costs associated with the deployment of the simulation for health care include the costs of development, acquisition costs, the costs of maintenance, and the costs of operations. Labor to operate, teach, and maintain the simulator is included as appropriate.

Quantitative Benefits

The quantitative benefits generally are easier to recognize and measure. It embraces time savings, reduction in errors, faster time to competence, equipment breakage costs, reduction in alternative training costs, and procedures performed (quantity, time savings, etc.).

These factors were included in an ROI Excel-based tool developed by Frost and Sullivan for Immersion Medical. (3) This tool includes major categories of benefits, costs, and other required information. The Frost and Sullivan tool represents the only comprehensive automated mean the authors have seen in the literature for computing ROI for computer-based simulation. …

Search by... Author
Show... All Results Primary Sources Peer-reviewed


An unknown error has occurred. Please click the button below to reload the page. If the problem persists, please try again in a little while.