Clinical simulation is widely used in the civilian and military environments. There are many similarities and differences. To address lessons learned about the life cycle management process for healthcare simulation programs, an interview was conducted with Jude M. Tomasello, Program Manager, Medical Simulation and Training Program Management Office at the Defense Health Agency in Orlando, Florida. Mr. Tomasello retired from his service to the military community the week of this interview, which increases the importance of documentation of his wealth of knowledge even more important. This HealthySimulation.com article will provide an overview of the key points obtained from this interview on key principles of life cycle management for civilian and military clinical simulation programs.
You have extensive experience managing the lifecycles of manikins and healthcare simulation equipment. What are three or five key concepts that people should understand when considering lifecycle management?
Yeah, I have experience with life cycle management on the medical sim side, but I have vast and deep experience just on the standard training devices we call TADs, training aids devices, simulators, and simulations. Like I said, we have a large worldwide contract. Life cycle management is often overlooked, but it’s so important I could talk for hours about this. The life cycle management piece keeps these devices training our soldiers, sailors, airmen, and Marines. And if you don’t maintain the systems, then they will not get the training they need and are scheduled to complete. They are not going to have the level of readiness that they need to have mission success. From the other standpoint, we take a lot of time, money, and resources to develop these state-of-the-art simulators. You do that with research and development-type funds. And without a lifecycle management tail, you have kind of squandered that great investment. Right?
So you have developed this thing, and it works, and it’s tested. And now you don’t have any means to sustain it out in the field. And so again, our users are not getting the capabilities
they originally asked for with a requirement. And you know, as a taxpayer, that does not sit well with me and the others because you have an investment, and you are not getting the return required for the investment. You’re letting it sit there on the shelf unused. If you don’t have the operation and maintenance (OM) funding and you don’t have a good lifecycle management approach,
So what are the key factors to setting up that life cycle management?
So, you know, again, digging into my past experience, if you are doing something across an enterprise, whether it’s the military treatment facilities or, you know, Army Combat Training Center rotation, sustainment, you need to look across the enterprise because you are building a contract like that, you’re going to gain efficiencies. You don’t want to do a contract for each hospital, each combat training center, or each digital range. You look across entities because they have common requirements. They may not be 100% aligned, but there is a great level of common requirements that you can take advantage of and build common requirements and contracts for which you gain huge efficiencies because you are looking across the entire enterprise. That is one recommendation I have.
And I recommend good logistics knowing when things fail. You must have good data on your systems, which are accessible management information systems. And again, in my past life, we had a management information system where I could literally go to any location, any Army base, any combat training center. And get real-time information about the availability of our training systems. And with the way things are now in the digital age, there are bar codes on everything. And we’ve got good technicians on the ground. You can get instant access.
Then, as a program manager, you can react to those things. You may see trends where a particular type of server or monitor fails or some kind of relay system is failing. Then, you can act on that across the entire system. So when you’re in the lifecycle management world, information access to information and doing the right thing, knowing what to do with that information is very key. Because when you look at the DoD acquisition model, the lifecycle is 75, or 75% of the total lifecycle of a system. So that’s where most of your money sits in the operation and sustainment of these systems. Again, taking advantage of the investment that the government has made in designing, developing, testing, and fielding these systems.
I agree with your statement about missed or overlooked upkeep of the purchases. Often, we have to have this money to purchase the equipment, but people need to look past the purchase.
Right, and I don’t see it so much anymore, but back in the glory days, with many program managers, the first thing you would get cut was your training and logistics budget because you wanted to get that system out there. And, you know, you’ll worry about when it breaks or whether it has spare parts later on, but their main objective was to get the system out there. I could appreciate that, you know, in the short term, but that’s, you know, that’s not good in the long term because you’re kind of, you’re wasting your investment when you don’t look at the whole picture, and everything you need.
I compare this to buying a new car and running it without changing the oil. If you do not care for the tires and change the oil, you can run the vehicle until the engine burns up. Then, you say, okay, the car is broken, and another new car must be purchased. So, you buy another car instead of doing the proper maintenance and sustainment on the first car. So you are going to pay for it one way or the other, and you know it’s just a lot better if you keep things up to where you keep the system going for as long as possible.
What makes simulation in the civilian and military environments different?
So, medical simulation is not entirely the same, but obviously, your target is the human body. That’s what you’re trying to attain better outcomes for. It’s not an Apache helicopter; it’s not a nuclear submarine where you’re only limited to the military industrial market there. So, between the EMTs out there and a combat medic, a lot of what they go through in the training is identical. One difference on the military side is that we’re seeing more of it now. It’s called prolonged casualty care. This is where you could be in an austere environment with denied access, and you could end up having a casualty or multiple casualties that this medic has to tend to the patient for two to three, four, or even five days. When you get into a situation that long, a lot of unique physiological things start to happen. You don’t see this along with what is happening on the battlefield. Evacuating someone immediately after they’ve become a casualty does not always occur, so prolonged casualty care must be developed to train what you have to do there. But that’s a big difference.
Resources
Mr. Tomasello identified some resources available to military and healthcare simulation workers. The first is the Interservice/Industry Training, Simulation, and Education Conference (I/ITSEC), the world’s largest modeling, simulation, and training event. Held in Orlando, Florida, USA, near the beginning of December, I/ITSEC features peer-reviewed paper presentations, tutorials, special events, professional workshops, a commercial exhibit hall, a serious games competition, and STEM events for teachers and secondary students.
Another resource is Team Orlando Consortium, the world’s largest cluster of modeling, simulation, and training (MS&T) organizations. Team Orlando is a resource for partnerships with organizations that can bring ingenuity to the forefront of military training and simulation.
