After almost 20 years of engagement with healthcare simulation, I have become increasingly curious about the "why" behind human behaviors - whether it is in the clinical space, the administrative space or even within our personal connections. The lens through which I view my working world is the belief that simulation is in the business of behavior change - from gap analysis to skills development and systems testing/implementation. While I have frequently presented on methodologies for demonstrating Return on Investment (ROI), the reality is that we have no chance of creating positive ROI unless we are solving for the real drivers of current (suboptimal) performance. Accurate needs assessment comes first.