Flexee Healthcare
A struggling three-hospital system. Operating margin 2.1%. Nurse turnover 28%. ED wait times on the local news. The CEO wants margin above 4% in five years — or the board sells to Ascension. Students run the whole system: staffing, capacity, quality, payer strategy, compliance, and twenty-four regulatory events along the way.
Three hospitals. Eleven decision areas. Twenty quarters.Built on Flexee Supply Chain
Same simulation architecture, same trainer console, same competitive team structure, same Q1-Q3 handoff model. What Healthcare adds is a rewritten scenario world: narrative stakes, governance as a second win condition, active competitors that erode market share, and a twenty-four-event compliance library that nothing else in the Flexee family has.
Students inherit Regional Health Partners, a three-hospital system serving 1.2 million people in the upper Midwest. The board wants operating margin above 4%. It's sitting at 2.1%. Nurse turnover is 28% against an industry average of 16%. Mercy Regional is at 42% market share and growing half a point every quarter. University Health is capturing primary care through telehealth. The ED wait times made the local news.
Margaret Chen, the CEO, gives the team their mandate on day one: stabilize operations, get margin above 4%, stop the market share bleeding, and fix the ED before the news runs another story. If they don't show progress, the board sells the system to Ascension.
Each facility has its own character, its own payer mix, and its own role in the system. Students can't close the mission hospital without devastating community standing. They can't ignore ED crowding at the suburban facility without another news cycle. And they can't grow the flagship without OR time, physician satisfaction, and quality scores to support it.
Eleven decision areas. Thirty-eight inputs each quarter. Six of the most consequential, with the tradeoffs students actually argue about in team meetings.
Nurse ratios, float pool, travel nurse percentage, overtime policy, retention program tier. The decisions that make or break HCAHPS and turnover.
1:3 ratios improve quality but cost more. 1:5 cuts cost but drives turnover up and HCAHPS down. Premium retention is $2.1M a year — with a two-quarter lag.
Bed allocation across ICU, Med-Surg, and Observation. OR hours across Orthopedics, Cardiology, General Surgery, and Other. The allocation locks in service line trajectory.
Bed percentages must sum to 100%. OR hours must sum to 2,800. Every choice forecloses another.
Choose a quality program — Lean, Six Sigma, or HRO. Set infection prevention level. Launch a readmission program. Allocate safety hours per FTE.
HRO compounds after four consecutive quarters of investment. Interrupt it and the counter resets. Patience versus quarterly budget pressure.
Launch orthopedics, cardiology, cancer, or behavioral health centers of excellence. Each has prerequisites — physician satisfaction, quality scores, OR time, CMS rating.
Revenue ramps over six to ten quarters. Cancer center requires Six Sigma or HRO plus a 3-star CMS rating. Students wait or they don't get the revenue.
Medicare Advantage contract tier. Commercial rate strategy. Charity care policy. These drive the revenue side of the margin equation — and the community standing score.
Premium MA rates require HCAHPS ≥ 55th percentile. Commercial renegotiation takes six quarters to pay off. Minimum charity care for two quarters triggers an IRS flag.
When a regulatory event draws — HIPAA breach, Joint Commission finding, Stark Law investigation — students respond Fully, Partially, or Defer. Zero-cost deferral is an option with consequences.
Three simultaneously deferred events triggers a CMS audit costing $1.8M. Some events are triggered by the team's own decisions.
Six mechanics that separate Flexee Healthcare from generic hospital management case studies — and from every other Flexee product.
A CEO character with a mandate. A board with a five-year patience window. An Ascension acquisition threat hanging over every decision. A community mission tied to the smallest hospital. Students don't just optimize metrics — they carry the scenario.
The Board Score (0-100) blends Financial Progress at 35%, Quality Momentum at 30%, Market Share Stability at 20%, and Community Standing at 15%. A team can hit the margin target and still lose if Board Score falls below 40 at Q6 or later. Financial performance alone is not enough.
Mercy Regional grows half a point of share every quarter unless students launch COEs. University Health captures 1.5% of primary care per quarter through telehealth. Retail clinics chip away at 0.3%. Students who don't defend lose ground whether they do anything or not.
Events span CMS reimbursement, workforce regulation, Stark Law, community benefit and IRS, data privacy, certificate of need, emergency preparedness, and environmental. Some draw at random. Some are triggered by the team's own decisions. All demand a response.
GPO switching, retention investment, EHR rollout, analytics activation, HRO compounding over four quarters, commercial rate renegotiation over six, COE revenue ramp over six to ten. Every strategic bet has a delay. The simulation rewards patience — and punishes teams who change strategy every quarter looking for immediate payoff.
Regional Medical Center is the revenue engine. Community Hospital East is the suburban growth play with a crowded ED. Parkview is the mission hospital with a 68% Medicare/Medicaid mix. Closing Parkview would solve a margin problem and destroy community standing. The system isn't a spreadsheet — it's three hospitals with different jobs.
Twenty quarters, four competing teams, one trainer console. Works for healthcare MBA programs, nursing leadership courses, health administration capstones, and executive education. Three quarters of history pre-loaded so students start with a real position to analyze.
Trainer runs Q1-Q3 in thirty seconds. Four teams start Q4 with distinct strategies already on the board — balanced, cost-conscious, quality-focused, workforce-focused.
Each team enters 38 inputs for the quarter. Bed allocations sum to 100%. OR hours to 2,800. Technology tracks capped at two. Live validation before submission.
Mercy and University Health erode share. Compliance events draw. Lag effects compound. The engine runs all four teams, applies events, and releases results.
Operating margin, HCAHPS, Board Score, market share, RN turnover, supply cost per discharge — forty metrics per quarter for the debrief that matters more than the simulation itself.
Day one briefing
"Stabilize the patient, then grow. Get operating margin above 4%. Stop the market share bleeding. And for God's sake, fix the ED wait times before the local news does another exposé."
Margaret Chen, CEO — the scenario brief students see before the first decision
Your implementation guide
Sales, implementation, and training for Flexee Healthcare. He'll help you map the simulation to your course — how to pace the twenty quarters across a semester, which decision areas to emphasize, and how to structure the debrief around Board Score and HCAHPS trajectory.
CPIM · CSCP · CLTD · CTSC
Book a thirty-minute walkthrough. We'll show you the CEO briefing, walk through a quarter of decisions, and help you think through where Flexee Healthcare fits your curriculum.