AbstractThe simulation exercise consisted of a scenario in which the student had to be a manager in an emerging structure. There were 3 sets of tasks to complete and the results of the student's choices were immediately provided to the student. Each choice affected the outcome in some way, positive or negative. Simulation Document After completing this exercise, I discovered how difficult it really is to make managerial decisions. The saying “You can never please everyone all the time” is true. I first learned this as a team leader for DJ Orthopedics, when I had to make some sort of lower-level management decision every day. I spent a lot of my day solving problems that arose and trying to figure out the best way to solve them. During the simulation I had to think very carefully about every decision I made, as a small mistake could have affected the entire outcome. When choosing, almost every decision had a positive and a negative side. I made decisions that I thought were solid and in some cases I was completely off track. In phase 1 I chose to modify the cardiovascular disease program and introduce obstetrics. I chose to modify the cardiovascular program based on the research conducted and the numbers presented in the simulation. Many of the people interviewed had some form of cardiovascular disease, and most were taking medications for it. I felt that modifying the existing program would be beneficial. I selected midwifery as a new service line, again based on the research conducted. There were many responses indicating that midwifery would be necessary. I performed very well in both, especially in the cardiovascular area. The team was happy with the decision and we moved on to phase 2. In phase 2 I chose to set up an intensive care unit and provide the new obstetric care service, option C. I chose intensive care due to the low costs and resistance, and also for the experience of living in the area. In managing an ICU, I have noticed that patients tend to receive higher quality care. In the simulation, however, it wasn't the best decision. The simulation believes that the quality of care does not improve and I could have reconsidered the decision. My decision to choose Process C for midwifery was a great decision. It makes the facility full-service for obstetric services and, again, is based on research and life experience.