How Simulation-Based Education Is Transforming Healthcare Leadership and Decision-Making Worldwide

Well, hey, everybody. Thanks for joining me on today's episode of I Don't Care with Me, Doctor Kevin Stevenson. As always, I appreciate you spending time with me and my interesting guests each and every week. So today's guest is no different, actually a little bit different than most of my guests. I'm talking with someone across the pond, as they say. Today's guest is Jeremy Loveless. He's the founding director of HFX Technologies, and Jeremy is talking to us from Mary Olde London. Jerry Jeremy, welcome to I Don't Care. Thank you very much. It's a pleasure to be here, Kevin. It is great to have you. You know, I've had a few guests from the UK before and been blessed to have some folks from Israel and Germany, and so thank you for joining my international guest panel. Excellent. My pleasure. Jeremy and I were just talking about an event that he's going to be attending here pretty soon in Geneva Switzerland. Jeremy where are you going and why is that? So I'm going to the World Hospital Congress and the reason I'm going is because I believe it's going to be an excellent opportunity to stay current with the trends in the sector and also to network with international leaders in the space And I must say I was I was sort of prompted to participate by, some of my contacts at the American College of Healthcare Executives who suggested it would be a good place to, to, to go and, and and just meet people. That sounds fascinating. Earlier this year, my family and I went to Italy, and I actually did a couple of mini tours of hospitals near Venice and in Tuscany. And it's just really interesting to see how other countries deliver healthcare. I was talking with someone earlier this week. I was at a seminar, and she's originally from Russia. And so we had a really interesting conversation on that. So maybe someday, Jeremy, I'll join you at a World Hospital meeting because to me, it's just fascinating. Everybody does things a little bit differently, and I think it's great to broaden our horizons. And you also mentioned that you're going to indulge in one of your pastimes while you're there as well. Talk to my audience about that. Yeah. So there was a little sweetener because obviously when it comes to investing in conferences, know, you always have to do a sort of ROI scratch pad calculation. But I think something that really tipped the balance into this being a no brainer was the fact that the CEO of the association that organizes the conference, the International Hospital Federation I believe, IHF, is clearly a cycling fan and has organized a day trip to the UCI World Cycling headquarters in Geneva and there's going to be a track day. And so I get to indulge, one of my, one of my hobbies while simultaneously, having what I hope to be a really targeted networking opportunity. So, so I'm really looking forward to that. That's the, the prime example of some work life balance there. That's awesome. Exactly. Killing two birds with one stone. That's right. So so Jeremy, tell tell my audience a little bit about HFX technologies and how we got connected because I really enjoyed what you and your folks are doing, particularly in the healthcare space. Yeah, okay. HFX Technologies, the genesis of HFX Technologies was really seeing how management consulting had developed on the back of a proliferation of decision making software, strategic decision making software tools. So, you know, back in the day, you know, consulting firms would be called in to help companies make complex decisions and build financial models and come out with a specific answer to a specific question in terms of typically resource allocation. As I started to grow the sort of footprint of HFX technologies, I saw that there was a specific opportunity in the simulation based training space or simulation based education space. So these are effectively financially tools that are grounded in financial models or dynamic financial models that are designed to train decision makers to think more strategically develop business acumen if you like business. As I went deeper and deeper into that specific part of the area, so you know, the decision science being the general area, but training decision makers in how to be more effective decision makers became a key interest. And I partnered with a design team that have been building this type of simulation for many years in Brazil. A couple of years after we started working together, they decided to build a simulation based on the experiences of one of the top hospitals in Latin America. I believe you're familiar with it, it's the Albert Einstein Hospital and they did a fantastic job. So the design team is bringing like decades of experience of building these simulations that are applied both in the corporate space on leadership development programs, but also on MBA programs. That would be a typical use case. And they did a fantastic job with this particular simulation, which was based not only on the experiences of the Einstein Hospital in Brazil, but also pulling data from the Association of Private Hospitals in Brazil as well. So the SIM is very robust and based around that sort of Brazilian context. One of the big questions I had when we developed it was how applicable would it be overseas? And I think that's what's been really exciting is seeing how easy it has been to adopt by teachers and organizations in different areas, you know, from Europe to the US, Middle East, etcetera, etcetera. Yeah. And that was one of my questions too. You know, it's because of our previous conversation. Yeah, health care is delivered a little bit differently, you know, including within the United States. And so I was wondering your thoughts on utilizing a Brazilian hospital model and how that would translate to the States, but it sounds like it does. Yeah, absolutely. So I think one of the first questions I had as a Brit was, I wonder if this would ever work in the National Health Service in a public sector environment and that has been answered in a number of different ways. So primarily, I do a lot of work with one of the big universities in the UK, University College London that has a global business school for health and we work with them on three of their programs. They have a master of science and an MBA and an executive MBA and participants who've been going through the simulation on those programs, a very large percentage of them will be working with the NHS and I've heard directly from the horse's mouth students going that was absolutely fantastic. You know that applies so much to the environment I'm in and we've definitely started to have conversations with individual NHS hospitals about the possibility of applying the simulation in that context and then continuing on that sort of public sector thread. We've also been delivering the simulation into Brazilian public hospitals as well. So the sim has been able to map from an elite premier private hospital to public hospitals in Brazil. And then more broadly where we've been seeing the sim applied in a number of different contexts or geographic contexts both Europe and also the US. And of course in the US every different state will have its own particular quirks and the simulation I think I think there are two ways that the simulation makes itself usable in these different contexts. The first is that there's a lot of customization that we can do quite easily in the simulation regarding teams have a lot of authority over what goals they want to set for their hospital and additionally instructors can adapt the news items and crises and interventions that come with the simulation. But also I think a key thing is because a simulation like this the chief goal is making people better decision makers, improving their acumen, improving their instincts. We're not designing the simulation to create a very specific answer to a very specific question. So where there are differences in the way the simulation models, the space and the space that the participants find themselves in, those differences are are small enough to not prevent the lessons being valuable if that makes Well, and that was something I wanted to know too, is because of the fluidity of health care. I mean, it's ever changing every day and sometimes hour by hour. How is the model updated? But I think you answered that question. It sounds like it's just a very dynamic model that can be customized based upon geography or whatever. Something else that kind of jumped out at me too, Much like in Brazil and certainly elsewhere, the United States, our health care system is I mean, divided is probably an interesting term, but I'll just use it, divided into not for profit and for profit. And so being able to utilize different goal sets because for profit health care, it's shareholder maximization and optimization. And then on the not for profit side, certainly you know, excess revenue over expense is important for capital investment. However, you're looking so much more closely at quality metrics and community metrics and population health and all of that. Yeah. Sounds like your models work. We'll certainly integrate all of those, right? Yeah, absolutely. I mean, one of the key things that distinguishes the game, I won't go into too much detail, but there are a number of different performance metrics against which the participating teams can can allocate a fixed number of waiting points. So you know, I I won't detail all of them, but say for example, you might have share price as a performance metric. You might have profitability. You might have revenues performance metrics. If you if your vision for your hospital is that you're a not for profit, well, share price, you don't wanna be waiting any sending any any of those waiting points to that particular metric. There are a number of others. I don't want to give away too much of the secret sauce but suffice to say, you know, that has helped to get buy in from educators across the world. Know, them seeing the ability of the teams to craft their own strategy and reflect more to a greater or lesser degree of accuracy, the realities of different types of hospitals. And then the other big thing is, is at the back end, we can also manipulate the growth environment you find yourself in, GDP growth, inflation rates and then a number of different interventions that you may or may not wish to incorporate into the experience, which make it very, very dynamic and fun. Yeah, I would think so. You know, being able to bring in local demographic information and even drilling down so far as to what would happen if you're in a three cardiovascular surgeon hospital and one of them leaves suddenly. Yeah, because those are real world decisions that we've all had to face, in our careers. You know, I've been really fortunate to have worked with a number of US university programs, whether it be just strictly MBA or MBA in healthcare or MHA programs. They're putting out wonderful candidates for health systems and other healthcare related entities. But I think what your simulation brings is that real world experience. Case in point, last weekend or last week, I went to the Baylor University, case competition, for health care management, and they had, they had teams from universities across the country. Great, great young, yeah, young and mid career folks who've gone back and being able to watch them throughout that process. But what it is, it's a very microscopic, very focused case. And the output is frankly subjective based upon that judge's opinion. And so correct me if I'm wrong, but what you're putting together is something that's very metric driven and that you know, there is a somewhat more clear winner and loser in a competition of that regard using your software. Am I am I right? Yeah. Absolutely. Yeah. The the the, the system automatically scores the teams against those different metrics on a round by round basis in accordance with the simulated numbers that their hospital has generated. And that's all a function of, you know, how intelligently they playing in a in an environment of uncertainty because of course if you increase your investments in quality, all things equal, there will be increased demand for your hospital services, but not if you've increased your spend less than everyone else. So there's that uncertainty that's very powerful. So it's metric driven. It's very much a quantitative challenge. It's quantifiable in terms of the results. But I think the most interesting thing about the simulation exercise like this is the human skills that it demands for the teams that are participating because it's quite stressful. There's a lot of information to process and decide what's important or not and then you've got to go about making decisions in this environment of uncertainty and for me I think that's probably the more the more I've been involved in teaching these simulations the more I see that as perhaps being the most powerful outcome of these of these experiences. I would agree with that. Yeah. Because as I said, our schools are putting out fantastic candidates, oftentimes they don't have that. They're very focused on book learning and And they forget that healthcare is a business about people. And I have always laughed. I was involved in public education on a school board side. So I said, The two most irrational industries in the United States, and correct me if I'm wrong, in the UK, are education and healthcare because they're very emotional driven. If you've got a child in a school, you want to make sure that you have the very best for them. And sometimes you really don't care about what other people's kids are dealing with. It's all about your kid. Okay. Same thing in healthcare. I mean, grandma is not doing well. She's in the hospital. You want everybody in that hospital focused on grandma's healthcare. But in the same vein, people make very irrational decisions. And I know you know the metric that, the vast majority of health care dollars are spent in the last six months of someone's life. And being able to be a little bit more rational about those end of life decisions, not only is more humane to the patient oftentimes, but it certainly is fiscally more responsible. But in the environment that we're in as healthcare administrators, we still have to deal with that emotion. So tell me a little bit, how can you integrate that into a simulation? Before I give you a give you my answer, I'm just gonna back out a little bit and talk about how I see there being different types of training simulations. So this simulation that we that we have here, I would call is a classic strategic management simulation that's putting the participants in the shoes of one of a number of competing hospitals and it's driven by a dynamic financial modeling engine And it's replicating the uncertainty of strategic business decision making. At the other end of the sort of scale of or the complexity of simulation design, well these are complex in their own ways, but I'd say maybe role playing simulations that are maybe more suited to the development of skills for specific roles. And so we've also got a number of simulations that perhaps cater to that, including simulations to help with difficult conversations, managing a team for the first time, all of that type of thing. Navigating difficult conversations with patients, that's something that we could easily create a simulation for for example. So there is that animal of simulation out there and I think that that type of simulation is more driven AI generated conversations so you can practice these conversations etcetera etcetera. But anyway back to this former type of simulation, this sort of strategic management sim. Navigating those trade offs, way we would be doing that would be at the most strategic level of the hospital. So it might be, say for example, a common question will be a student, a team of students might be, well, we're interested in managing a small rural community hospital, a small rural community hospital. You know, that hospital is it's not going to be particularly well capitalized. It's gonna struggle to capture like premium or high complexity services and it might just be small. There are some serious constraints around that. So they need to think, well, what metrics can they be targeting? And then what we do, we work with professors to suggest how they can use the platform to enable teams to pursue that type of strategy, which might be more focused on you know providing like the safety net for communities that don't have easy access to healthcare because in the simulation we can give, can basically we can reflect a loan, a government loan, the instructor can simply loan a company money in order to compensate for that. So I guess my answer to your question there is for that type of complex strategic financial simulation, those trade offs we navigate with intelligently using the interventions. Very good, very good. So, all right. So the simulation is used in something akin to a case competition And and you have a clear winner. You know, you you designate first, second, and third place. Is there any sort of feedback following these competitions from you, or would it be from the professor or what regarding, hey, you know, I team was scored x on this area, y on this area, why the differentiation between the teams? Because, yeah, I that's something that that I think, you know, particularly the students that I that I work with, yeah, they're always asking for constant feedback. And I would give them specific task to do and then evaluate that task. They always wanted that feedback. So is that basically back on the professor or the organization or is that something that's integrated into your mind? Yeah, it's a great question. Great question. Well, well, I think the first thing is integral to any exercise like this is reflective learning. So we're always encouraging the students to do a post mortem on not just at the end of the simulation, but on a round by round basis is that as the simulation progresses along simulated quarters of hospital operations, the students in their team should be thinking, what happened? You know, conduct a difference analysis. What were our forecast numbers? Where are they different? And let's have a think why were they different? How do we want to adapt our decisions in the next next decision making cycle in order to potentially do better? So you can never, you can never, you should never lighten that load on the students. They should be encouraged and graded for it as well. So in a university context, we often see a lot of faculty will actually not grade the performance in the simulation at all. Assuming the students are very motivated, you can leave all the grading to the reflective assignments because what you're encouraging is that the students will think about, you know, well, what have we learned? What did we do wrong? And what would we do differently next time? And sometimes the best students aren't necessarily those that did best in the simulation. They're those that really apply themselves to thinking well what went well and what went poorly. Now back to how we can help. So what the simulation engine does during the simulation itself, the professor and us, we always have access to a cohort wide view of team performance across all the different financials. We're following graphs, line graphs so we can see like wonky decision making. If someone's suddenly gone into, you know, ten million of an overdraft facility or revolving credit, you know, they haven't planned their finances very well and you can jump on that if you want to. You might prefer not to jump on it, you know, let them let them find out themselves or figure that out themselves. It depends on the type of cohort. If it's an undergraduate cohort, they're gonna need more hand holding probably. But for an MBA, for a capstone or an MHA capstone, you know, think about it. You should you should know enough to be able to figure out what's going on. At the end of the simulation, once the game has ended and the results are released, those relative performance graphs are all made available to the students to assist them in their reflective learning so they can really conduct that postmortem theoretically themselves. That's fascinating. See, And that's exactly what I was thinking. The best utilization for this would be in a university setting, be at that capstone project. And I would have greatly enjoyed something like this at the end of my graduate program, because it takes the book learning and it operationalizes that and allows you to see what each individual decision, how it impacts the entity as a whole. And that's something I think a lot of particularly new graduates, but even seasoned executives, you know, sometimes they get so lost in the minutiae that they don't recognize, you know, how it's going to affect, you know, something something else in the organization or or in the future. And so, yeah, again, when we first started talking about this a few weeks ago, I was just fascinated by it. Jeremy, again, your target market would obviously be universities. But what about those large forward thinking organizations that are doing constant org development? Can it be adaptable, say, while we've been talking a lot about hospitals and health systems, is this adaptable in other healthcare environments? My sense is, and the view I'd say if you speak to simulation developers who are very focused on sort of business engineering, They see that the lessons derived from participating in one simulation of this nature can be applied to any industry environment. So for example, if you're doing a generic MBA and you went through the hospital management simulation, you'd be learning lessons about the interdependence of different different, decisions in all industries. It would be applicable. However, from a sort of marketing perspective, generally the decision makers would prefer to work with people who have a simulation that's specific to the type of organization that they're responsible for. So yeah, my answer is sort of hedged. I would like to say yes, but in practice, people like to see sims that are specific to their their exact context. You know, something else I was thinking about too. I've been a part of a lot of chambers of commerce across the United States. I don't know about the UK. Have programs called Leadership X, you know, like Leadership Waco or whatever. I've been involved in three of those programs throughout my career. And it's always wonderful because you learn a lot about that community, but there are specific days like there's always a healthcare day. So I could even see this on an incredibly small scale, you know, being used in the community because there's always so much confusion in and around, you know, how does how does health care work? How do hospitals work? And so I could see something like this, you know, down into like maybe a three to four hour simulation for for local business leaders just to give them a feel about how decision making is really different in healthcare. What do you think? Yeah, well we've demonstrated the ability to deliver on that sort of timescale through, we've done it in academia and we've also done that for pilots at corporate as well. So obviously before corporates buy in, they like to have a decent taster and a simulation of this complexity defies a simple like one hour demo. You've got to put people in it and let them go through a few simulated practice rounds. So I reckon over four, we've delivered pilots of four hours and we've delivered on intensive financial management and accounting classes at MBA level, four hour classes using three, four, five rounds of the simulation and people aren't necessarily going to come out with it with as profound experience as they would over a two to three day workshop. But absolutely, as a taster, it's fantastic. Yeah. I was just thinking about that, how that would have enriched, health care day even more so for me and and each of those organizations. So, Jeremy, we're we're coming up against time. Any final words from you? I just just something came up, when you when you were talking about how you'd like to have done it on the capstone and how how much it brings things to life. I remember when I did my MBA it was the first time I'd come across a simulation. I found my MBA relatively relatively academically doable. I could get through the the exams and the paper writing no problem. The simulation was like a shining a bright light into all my decision making inadequacies and it was really difficult and and that's and and I came out of the NBA sort of humbled by it and it was the best thing that happened to me. Otherwise I'd have been one of those annoying NBAs who think they know everything but don't know anything. And the truth is faculty when we do faculty training, most faculty go through that exact experience. It is a very humbling thing to go through, but therein lies its power. Absolutely. Well, Jeremy Lovelace, it's been a pleasure talking to you. I really enjoyed it. Anything that can help advance the knowledge and the decision making, particularly in the healthcare industry, but in any industry, is something that we should all really pay attention to and try to strive for. So thanks so much. So folks, Jeremy Loveless, founding director of HFX Technologies. If you have any questions or any or if you'd like some more information on this, Jeremy, what's the website where people can go to? Yes. It's h f x training dot com. So that's specifically the site that's dedicated to simulation. So h f x training dot com. Great. Thanks so much, Jeremy. Thank you everybody for joining me today on, our episode of I Don't Care with me, Doctor. Kevin Stevenson. We'll see you again next week. Take care.