In the healthcare sector, providing high-quality service in a safe environment for both patient and staff is an obvious and ultimate major objective. Training is an essential component for achieving this important objective. Most organizations acknowledge that employee simulation-based training programs are an important part of the human capital strategy, yet few have effectively succeeded in quantifying the real and precise ROI of this type of investment. Therefore, if the training is perceived as a waste of resources and its ROI is not clearly recognized, it will be the first option to cut when the budget cut is needed. The various intangible benefits of healthcare simulation-based training are very difficult to quantify. In addition, there was not a unified way to count for the different cost and benefits to provide a justifiable ROI. Quantifying the qualitative and intangible benefits of medical training simulator needed a framework that helps to identify and convert qualitative and intangible benefits into monetary value so it can be considered in the ROI evaluation. This research is a response to the highlighted importance of developing a comprehensive framework that has the capability to take into consideration the wide range of benefits that simulation-based training can bring to the healthcare system taking into consideration the characteristics of this specific field of investment. The major characteristics of investment in this field include the uncertainty, the qualitative nature of the major benefits, and the diversity and the wide range of applications. This comprehensive framework is an integration of several methodologies and tools. It consists of three parts. The first part of the framework is the benefits and cost structure, which pays special attention to the qualitative and intangible benefits by considering the Value Measurement methodology (VMM) and other previously existing models. The second part of the framework is important to deal with the uncertainty associated with this type of investment. Monte Carlo simulation is a tool that considered multiple scenarios of input sets instead of a single set of inputs. The third part of the framework considers an advanced value analysis of the investment. It goes beyond the discounted cash flow (DCF) methodologies like net present value (NPV) that consider a single scenario for the cash flow to Real Options Analysis that consider the flexibility over the lifetime of the investment when evaluating the value of the investment. This framework has been validated through case studies.


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Graduation Date





Rabelo, Luis


Doctor of Philosophy (Ph.D.)


College of Engineering and Computer Science


Industrial Engineering and Management Systems

Degree Program

Industrial Engineering









Release Date

December 2017

Length of Campus-only Access


Access Status

Doctoral Dissertation (Open Access)