[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*
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.*
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.