Let’s Play Hospital. Behind the Scenes at a Columbia Mailman Health Systems Simulation
“Welcome to Gotham!” John S. Winkleman, a faculty member in Health Policy and Management (HPM), speaks to a room full of 29 current and future health care executives participating in the Thomas P. Ference Health Systems Simulation at Columbia Mailman on a Friday in August.
Gotham is a fictional metropolis home to five large hospitals competing to provide the best patient care while maintaining a healthy bottom line. Over two and a half days, participants, divided into teams, make a series of decisions that will determine their hospital’s fate amid shifting market conditions.
Winkleman, director of the Simulation over the last nine years, has already organized 15 of the group exercises this year, both on the Columbia Mailman campus for all HPM graduate students and for Northwell Health Fellows, the American College of Healthcare Executives (ACHE), New York City Health + Hospitals, NYP LEAD (Leadership Education and Development), and Bocconi University in Italy. Participants have included doctors, nurses, health management students, medical students, and professionals at all stages of their careers—united by a desire to level up as health care leaders.
“We always have a mix of backgrounds and experiences. Everyone brings something to the table, and everyone goes away with a new perspective on effective teamwork,” Winkleman says. “Teams compete against each other. Everyone wants to win. But in the end, it’s not who comes out on top but the decisions they make and how they make those decisions together.”
The Games Begin
On the morning of the first full day, participants get the lay of the land. Their hospitals are underperforming, and Winkleman explains that it’s their job to steer their institutions in a positive direction. Teams start on equal footing, with the same share of revenues, the same number of clinicians and beds, and the same set of service lines—inpatient, emergency, ambulatory, oncology, and ancillary services.
Soon teams split up. In separate rooms, they review the situation and decide how to allocate resources across service areas while also investing in quality improvements, community health initiatives, marketing, donor cultivation, and more. The Purple Team agrees that they need a different mix of patients. They debate whether to make many small changes or go big in one area to get ahead of the competition. Separately, the Red Team decides to invest in its oncology service line. They surmise an aging population could drive greater demand in that area.
As they consider options, five faculty advisors answer teams’ questions and gently help them think strategically and sidestep pitfalls. For the August simulation, advisors include faculty instructors from across Columbia University Irving Medical Center: Betty Chang, MPH ’21, Kate Garrett, Lee Hirsch, MPH ’15, and Aaron Myers, MPH ’21. Several of this group either helped design the Simulation or were themselves former participants.
In 2009, Thomas P. Ference, a longtime Columbia Mailman faculty member, together with Winkleman and Garrett, created the original version of the Simulation, which used colored paper. Today, participants record their decisions using a slick online dashboard, which each round spits out a raft of metrics in the form of a balance sheet, capacity report, marketing report, and more. The dashboard also alerts them about changing conditions in Gotham via a newsfeed. (At the end of the first full day, conditions change dramatically, sending teams scrambling to respond.)
Throughout the process, round by round, teams are asked to think strategically, not just reactively. They collaborate to create a mission and vision statement, as well as an advertising concept to emphasize their unique value proposition.
“The overarching idea of the Simulation is to get people out of their silos to think about how interdependent various areas of the hospital are. Thinking big on a systems level helps anyone do their job more effectively. Nowhere is this more true than a hospital, where there are so many moving parts and details are a matter of life and death,” Winkleman explains.
A Winning Strategy
At the end of the simulation, the Red Team came out on top. In their first round, they made a big but ultimately unsuccessful bet on oncology, while skimping on their marketing budget. A few rounds later, however, they had course-corrected and seized on a winning strategy that funneled funds into strengthening relationships with insurance reps.
Sydney Brister, an administrative fellow at Northwell Health and member of the Red Team, called the Simulation “an incredibly insightful learning experience,” largely because of the diversity of expertise and perspectives in her group. “Our team was comprised of individuals from various professional backgrounds, including medical doctors, consultants, and project managers,” she added.
Continuing, Brister reflected, “A key element of our success was how we communicated. We established an environment where dialogue was open, enabling us to identify and address potential missteps early in the process. This allowed for rapid course correction, ensuring we remained on the path and efficiently resolved challenges as they emerged. We realized quickly that we had made a decision that was not the best and we quickly corrected ourselves in total agreement throughout.”