Objective To explore healthcare staffs’ and managers’ perceptions of how and when discrete event simulation modeling can be used as a decision support in improvement efforts. Design Two focus group discussions were performed. Setting Two settings were included: a rheumatology department and an orthopedic section both situated in Sweden. Participants Healthcare staff and managers (n=13) from the two settings. Interventions Two workshops were performed, one at each setting. Workshops were initiated by a short introduction to simulation modeling. Results from the respective simulation model were then presented and discussed in the following focus group discussion. Results Categories from the content analysis are presented according to the following research questions: how and when simulation modeling can assist healthcare improvement? Regarding how, the participants mentioned that simulation modeling could act as a tool for support and a way to visualize problems, potential solutions and their effects. Regarding when, simulation modeling could be used both locally and by management, as well as a pedagogical tool to develop and test innovative ideas and to involve everyone in the improvement work. Conclusions Its potential as an information and communication tool and as an instrument for pedagogic work within healthcare improvement render a broader application and value of simulation modeling than previously reported.