Serious Gaming: Entrusted 2.


Back in the middle of this year I got the chance to act as control in Paul Howarth and Ben Green’s hospital simulator game intrusted. See past blog report  here. Fund had been secured to run the game again for a different group of healthcare professionals and again I got the chance to help deliver it.

 

The format of the game was to be slightly different this time. It was intended that all the players would be part of a single hospital; although the narrative was continued from the last game in that the participants were now running the old hospital post- merger, otherwise the basic premise and three levels of players was retained. I went over early with Paul to Manchester to help sort things out before the game and go through the changes that had been made to the game since last time. It was nice to get a better grasp on the mechanisms of the game as last time my control role wasn’t really focused on them.

20181128_182702

The plenary Briefing.

After the attendees had arrived and the plenary briefing delivered we set up the room for the next day and retired to the bar. A pleasant couple of hours was spent with the control team drinking, chatting and playing a board game. In our case a run through of a the rather good Black Orchestrawhere you attempt to assassinate Hitler, we did with a briefcase bomb… There is a serious point to this, I’m of the opinion that gaming together, regardless of the game, can only improve a person’s and group’s skill level when acting as part of a control team.

20181128_220701

The evening’s recreational game.

After breakfast at the hotel we started early with the game and watched the players try to organise the hospital. A failure on their part to stock take what staff cards they had available at the start meant that they had plenty in turn one but then struggled in the second and subsequent turns. There were insufficient resources at the scenario start to deal with everything perfectly, this was meant to engender a discussion from the bottom- up to the board level players to get more resources this didn’t really happen for a good few hours. As this time, I was supervising the admissions/ Intensive Care unit and surgical wards I saw that the players worked incredibly hard to process the patients through the hospital and to a degree I start to empathise with them. This became apparent when the board level players came into the main room to describe their latest social media campaign. I sensed a degree of annoyance go through some of the players that they had been working hard whilst the board had been coming up with new hashtags for a twitter campaign. It was very interesting to see that as in the last game I saw how hard that the board/ directorate were working and I know full well that social media presence and public perception is of utmost importance in today’s media saturated landscape so I would not want to do the board a disservice and suggest that they were having an easier time of it than those in the main room running the basic hospital functions. One of the points of contentions was a refusal to hire the extra nurse, of non- British nationality, that were needed to man the wards. The staffing crisis got so severe that the intensive care unit was not used for a couple of turns.

20181129_085915

A pair of the wards staffed and with paitents.

Whilst the new mechanics are improved I think that a few player aids to speed up the learning of the game could be utilised in and subsequent run of the game.  I’d suggest that the quicker that the players understand and are comfortable with the basic mechanics the sooner that they can be different problem and scenarios can be injected in the game to generate the inter- department and inter- hierarchy discussions that will provide the greatest learning experience for the attendees.

20181129_104607

Discussions around anesthetist’s staffing level in the surgical theatres.

In the debrief there were some great comments by the attendees which showed that they got a lot from the game and again it was great to see gaming being used for something so beneficial.

Cheers,

Pete.

Serious Gaming: EnTrusted.

[Note: I sent a draft of this post to Paul of Story Living Games, I’ve left his comments in as italics as they do help clarify a few things.]

 

Paul, the man who was instrumental in getting Pennine Megagames up and running, does also run games for a living with his company Story Living Games clicky. While they are often for schools they are not exclusively so; a recent example of his work was the NHS hospital simulator EnTrusted that he was commissioned to develop along with Ben Green. For the first run of the game several extra people were needed to act as control to deliver the game.

With reference back to my previous post and my interest in seeing how games are used in a serious setting I was rather pleased to be asked to act as one of the control. To that end I went over to Manchester to on a Tuesday afternoon. The game was to be run over an evening and a day to a wide selection of people who work within the health sector who aren’t exactly frontline staff (such as nurses, doctors etc.) *there were some doctors involved, but the idea was to place players in unfamiliar roles to gain an appreciation of other pressures*; as such the game was intended to give them a degree of insight into the pressures of running a hospital for an administrative point of view. *not just administrative, but also operational, hence wards and surgery* As a means of recording the day and to provide some feedback on how things went, I think to satisfy the funding requirements that allowed the event to take place, a film crew was present recording what was going on and capturing a few ‘talking heads’. As far as I’m aware it has not been made public yet.*the video wasn’t a feature of the funding requirements, but rather a way to capture instant feedback, explain the rationae behind it to a wider audience and promote the use of serious games*  

After the obligatory small talk with nibbles and a drink the evening started with an icebreaker: this was a team variant of the well-known Kim’s Game. After this the attendees were given the outline of the rest of the event. They were to be split into two teams: red and yellow, each one representing a different hospital (they were told that due to the higher than expected interest in the game it was easier to run two hospitals than one large one) and within each hospital they were to be split into three hierarchies: the board, who made the big decisions on the strategic direction of the hospital, the staff, who dealt with the running of the wards and such like (these were represented by board game- esque mechanics) and the directorate who were to act as the conduit between the two levels and be the day to day managers of each hospital. My control role was to monitor the directorate in one of the hospitals. The attendees playing the board were taken into one room to develop a new name, logo and mission statement for each hospital whilst the staff players were in another room to learn how the wards were run at a mechanical level. The directorate players had a free choice as to which to attend; obviously their choice in this would influence how they were to approach the game the following day. I observed the staff training as I wanted to see how the wards were run. *The different tasks were to encourage the creation of different teams and priorities as quickly as possible in a game situation. Other elements included the boards not being made aware of the turn structure and timings in their briefing*

DSCN1421

The process diagram of how a ward was run- far simpler than it looks at first glance.

Ben led this session and explained how the patients, represented by cards, would enter the hospital then had to be assessed and treated before going onto a ward.  To treat a patient the surgeon had to complete a puzzle (visio-spatial for the most part), the difficulty of which was increased depending on the workload they wanted to take on rather than one puzzle per patient. After this they went on the wards where they had to be treated with nurses of the correct skill. Added to this were pre- arranged cases who went straight into the wards. Patient cards were tracked by a different colour that were cycled through and if that card had not been treated by the time that the colour came around again it would result in a negative discharge for that card. Furthermore, nurses gained tiredness tokens and had to be rested after a maximum of 4 shifts (colour changes) a tiredness token being removed for every colour changes rested.

After the attendees had been briefed, control stayed behind for a briefing on our duties on the following day before we checked into our accommodation and then went to the pub.

The next morning, thankfully no worse for the previous night’s socialising, we arrived early to and got straight into the game. My main jobs on the day were to liaise with Phil who was my opposite number for the other hospital to coordinate the injects that were introduced to each team to give them other problems to debate on and overcome and to go round the wards and leave feedback cubes on how well each ward was doing based on the success or otherwise of the staff level players. The idea was that this metric of was to be collected by the directorate level players as a snapshot of how well the hospital was performing at a given time. As an example of an inject one that I introduced was that a laptop was left on public transport by a (non-played) member of staff, this being a breach of the newly introduced data protection act. To remedy this the hospital had to draft a press release on their patient confidentiality policy and send staff for mandatory retraining. To do this I assigned one of the directorate staff to get all of the staff level players to go and do a simple puzzle (or the kind usually used to treat patients) this was just to represent the time taken up with this extra work taking them away from their job/ main role in the game. Phil and I had a list of these to work through and we made sure that they were going introduced into the game in a way that made narrative sense. I did think at the time that the attendees were taking my interruptions with bad news and further difficulties incredibly well, they just dealt with the matter at hand efficiently and without any complaints. I doubt a hobby group of players would have dealt with the same pressures with such good graces. In an interesting move by the game designers one directorate team (mine) was based in the hospital room alongside the staff players whilst the other shared a room with the board in a separate area; this led to a very different approach when it came to relations with the staff and arguing their case.*Whilst this was partly to see how players responded and worked, it was also due to the different structures within real Trusts – one option we didn’t take was adding a senior nursing position to the board. This may have made it too easy for the board team to gain an overview and bypass the directorate.*

 DSCN1424

An example of an inject sheet.

I felt that the feedback part of the game was less successful- whilst it did provide a metric of performance it wasn’t one that was being recorded by the players, partly as they were not explicitly told to record it and partly as they never thought to. Further to that it was generated by a random/ partly subjective method and as such divorced from the mechanics of the game. If the data had been collected by the player it would have been of very little use to them in working out exactly what had gone wrong other than putting in a new general policy and informing control. If it had been tied to the game mechanically, even if this were not made explicit to the players it would have been better.

 

The big twist in the event, and the reason that there were two hospitals is that they had to merge. This meant that both hospitals had to put together a joint team that would make sure that the infrastructure and staffing structure of the joint hospital went smoothly. My control duties did not extend  that far so I’m unable to offer much insight in the process. I will say how ever that it seemed very much like the ‘other’ hospital moved into ‘my’ hospital and forced the board players in to subordinate roles. *this was an interesting development – the merger was originally only a possibility and most of the afternoon would be spent on gathering data, planning, putting teams together and implementing at a late stage. The Department of Health control made the decision to start earlier after frustrations with the board teams. Ironically, whilst the Sunrise board seemed better informed (their directorate was based in the hospital) and have fewer scandals and issues to deal with, they did not put themselves forward as much as their rivals when it came to putting what had been seen as an interim board together. Confidence seemed to count far more than competence*.

Whilst the merger discussions were taking place, it came to light that the staff in the hospital I was responsible for were ‘bending’ the rules of the system by healing more patient cards by doing lots of easy puzzles rather than one hard one in the same amount of time. I brought this to the attention to Ben who said I should up the negative feedback and talk to the directorate staff about over work. This was largely ignored so Ben said to tell them that one of their (non- played) colleagues had committed suicide due to over work. I thought this was a bit too much, not on a personal level was I bothered by it but I thought it was too emotive a topic to introduce into the game, it wouldn’t have been the call I made. Either way it was up to me to make the announcement and it was one of the trickier in game things I had to do. The feel of the day was serious but with a light hearted edge to it and announcing the death of an albeit fictional character meant it I had to very quickly decide on how I was going to phrase it and get the right level of appropriacy in the tone of my delivery. Fortunately the players took it very well and seemed to adjust their gaming behaviours accordingly.

The merger seemed to work well although it did highlight the slight differences in how the different control ran each hospital; getting consistency across control is a perennial problem in megagames, especially on the first run of any game. It also left a few players with less to do as the directorate and board teams were now twice as big for not quite twice the work. Phil and I worked this into the game by having the outsourced cleaning support workers start industrial over looming job redundancies. *Ben and I did discuss different interpretations of rules before the game – he wa less concerned, partly because different Trusts operate in different ways and therefore that would create more tensions post-merger if it happened.*

Overall the game worked very well. All of the attendees seemed to be very engaged with the whole thing and I’d like to think that they took something away from it that was worthwhile to them. Personally I think that Phil and I’s control roles could have been merged, as could the board control for that matter, as it would have brought in greater consistency for one thing. It was, however, fascinating seeing megagaming being used in a professional/ educational context by those who were not viewing the whole exercise as a day’s entertainment of time with their favourite hobby. Hopefully this will not be the only time EnTrusted gets run.

Book Review: ‘The Pentagon’s Urban COIN Wargame (1966)’

It is well known that I’m a sucker for anything with COIN when it comes to games and books (and academic endeavours too) so when this book was released by John Curry’s History of Wargames Project clicky I ordered it straight away and similarly when I arrived I read it straight away…

DSCN1425

The book is a reprint for the archives of what is to all intents and purposes a megagame. The game that the Pentagon created was meant as a training tool to better understand urban insurgencies and to generate insights in those who may have to deal with them in the future.

The game has three sets of players: Government, insurgents and general population, the latter being split by socio- economic class. Initially the insurgents are hidden within the general population and are unknown to the Government, in a similar manner the Government has players hidden within the general population that are unknown to either the general population or the insurgents.

Play is split into 24hr long cycles with a day/night phase in which players have to do assigned task in certain parts of the city (such as go to work to get paid) or to keep up appearances if they are undercover. The game ends when certain victory conditions have been met; interestingly the general population can ‘win’ by increasing their personal wealth and backing the winning side on the final turn. The final turn not being announced in advance.

 

Being a serious military game there was a lot of record keeping built in. Players were expected to keep an accurate record of their locations visited within a turn, so it could be analysed later.

 

Although I’ve designed/ run a couple of games now and played/ controlled in many others I wouldn’t say that I’m an expert, but a few things do jump out at me. The insurgency is rather generic: given the era that the game came from it is assumed that the insurgencies is a communist one (the historical examples that are cited the majority are) or at least a war of national liberation that is using communist ideology to achieve that. Whilst more background would help player engagement and immersion with the setting and roleplaying opportunities it would also frame the responses of the government especially with how to approach ‘carrot’ rather than ‘stick’ responses to insurgent demands. It was interesting to see that there was a role for the press within the game; although this was referred to tangentially rather than explicitly.  The control forms seem like a lot of work to do and whilst they track the location of the player it doesn’t record the most important aspect: that of the social interactions of that player. It would be through such interactions that opinions would be formed and alliances made, especially for those players making up the general population.

 

One thing that really intrigued me was a comment in the introduction that a copy of these rules was found in Paddy Griffths’ own archive; for it was he who started megagaming as a recreational hobby (and then taken forward by Jim Wallman). Is the game the genesis of the modern hobby as we know it? Time and some more archive work may yet tell us….

I am tempted to try and get a game organised to try this out with a few players- I think 20 players would be a manageable number to recruit and test the game out properly.

 

Cheers,

 

Pete.