Focus Games, developers of game-based training and education, and Cognisco, which creates measures for competency management, have developed a different approach to providing human factors training for healthcare staff. Andy Yeoman, director and co-founder of Focus Games, outlines a route to develop and implement a serious game-based simulation and competency assessment programme offering significant benefits to multi-professional education and training in human factors and patient safety skills.
Improving safety in healthcare with game-based simulation and competency assessment.
The National patient safety syllabus 2.0 published by NHS Health Education England states that we need to think differently about patient safety and highlights the requirement for clinical and non-clinical staff to receive training in systems-thinking, risk, and human factors. Many of the challenges and pressures experienced in the United Kingdom will be familiar to healthcare providers around the world.
Game-based simulation not only offers benefits in terms of educating and training healthcare staff but supports enhanced hazard awareness and risk reduction within clinical practice. It also improves risk management at the level of service delivery in safety-critical clinical settings and offers assurances to regulatory bodies and the public about safety, quality and standards of care.
The combination of competency risk assessment and multi-user online simulation training identifies, and then reduces, risk by focussing on interpersonal communication, leadership, and decision making within complex teams.
The key features of combined online game-based simulation and competency assessment programmes are:
- Personalised and interprofessional learning opportunities: multi-professional online simulation offers safe exploration of gaps in understanding in patient safety and team-based practices
- Identification of strengths and gaps in professional capabilities: Competency assessment pinpoints strengths and weaknesses for individuals and teams
- Embeds patient safety skills and behaviours: Programmes can be linked to workplace-based simulation exercises in clinical practice to embed patient safety skills and behaviours
- Applicable to different care settings: Operating theatres, acute medical ward, maternity care, emergency department
- Demonstrates progression: individual participants can show evidence of professional development for training programme or employer appraisal purposes alongside individualised development plans
- Provides assurances to regulatory bodies: Education and care providers can validate workforce capabilities, risk management and care quality frameworks
Game-based simulation: a new approach
Simulation in healthcare has traditionally revolved around physical courses where controlled interactions occur between clinicians and a patient, often using a mannequin. While this offers valuable exposure to isolated clinical skills it does not recreate the complex levels of collaboration required to deliver safe and effective patient care in the workplace. In situ simulation exercises are a more effective activity, but these can be difficult to schedule alongside clinical service requirements and other practical issues.
Table-top exercises are a familiar feature in major incident training and sometimes used for service reconfiguration planning. Focus Games develops simulations that apply these principles to individual role related non-technical skills of situational awareness, communication and leadership, and team-based skills and behaviours relevant to multi-professional working. These exercises are eminently suitable to remote online delivery (following the considerable success witnessed in the leisure gaming industry), and there are established national and international bodies of practice that now study and offer guidance on the design and delivery of serious games for professional purposes.
Games help solve problems, build relationships, and encourage improvement.
Incorporating scenario-based assessments
The assessment of any progressive learning process is of limited value to individuals or organisations and professional bodies if it is simply a check for memory recall or the ability to eliminate the obviously wrong answers.
Cognisco’s scenario-based Situational Judgement Tests (SJTs) are designed with and by practitioners and educators as subject matter experts to provide reliable evidence of professional judgement and decision-making relevant to role and level of responsibility. They present realistic in-practice scenarios (comprising written vignettes, images and/or videos) and enable individuals to gauge their understanding of key principles by exploring and evaluating a range of possible decisions or courses of action. And rather than simply looking for sound judgement, they also measure the level of confidence the individual reports about the decisions they make.
The outcome provides a clear understanding of the assurance with which people make decisions and confidence in the type of judgements and decisions they will make in any given scenario.
Simple games for complex issues
Changing thinking and behaviour can also be achieved with far simpler games. This is especially important if:
- Your intended audience has no intention of engaging with the issue you want to address
- You need to attract the attention of very busy people
In both cases you must keep the intervention simple and make it appealing. Be realistic; assume that you will have a maximum of three minutes to communicate your message and make an impact on thinking and behaviour.
Focus Games has developed a range of ‘casual’ games that can be played on any device. These games are designed to tackle ‘difficult’ issues and change players’ behaviour, in under three minutes.
The first of these games was developed for the NHS in 2016. Flu Bee Game is designed to persuade healthcare employees to get the seasonal flu vaccination by tackling common myths and misconceptions. The overarching objective is to address and influence those players with ‘vaccine hesitancy’.
A simple HTML5 web application, it works on any device but is intended mostly for mobile phones so people can play on their own device whenever they chose.
Since 2016 the game has been used in more than 25 UK and French hospitals and 500 care homes. Over 50,000 health and social care employees have played the game and 5,000 have shared their thoughts by completing a short post-game questionnaire, which revealed:
- A 35% improved perception of vaccine
- A 38% increase in flu vaccination
A Queen’s University Belfast study with 430 nursing students showed that 84% of student nurses who did not intend to get vaccinated changed their minds after playing the game: ‘Knowledge and likelihood to get vaccinated improved. An innovative learning tool,’ said Dr Gary Mitchell, Queen’s University Belfast.
These findings suggest that even a superficially simple serious game can have a significant influence on the way that people think and behave.
Why consider this approach and why now?
Hybrid working is new to everyone. Staff are in different places, teams are semi-detached, and isolation is a challenge. Group learning is now more important than ever. It is also more difficult.
Games are the perfect solution for hybrid working. They are fun with a serious purpose and come with clear, measurable outcomes for assessment.
They create a ‘safe space’ for groups to collaborate and learn online, face-to-face or at a distance.
The ease with which a simulation activity can be scheduled reflects new hybrid working practices.
A session can be set up in advance and accessed remotely by individuals or groups according to availability and access to IT resources. It reduces the burden on local departments to simultaneously release groups of staff from a specific clinical service, while also permitting access to trainees on rotations regardless of their location.
Similarly, facilitators can co-ordinate activity remotely, which provides greater flexibility for accommodating availability. The game can also be easily aligned with physical simulation training exercises to optimise the benefit of participation for individuals or teams.
The assessment package is also undertaken remotely by individuals at times convenient to them.
Feedback is individualised and signposts specific resources for follow up based on gaps in understanding.
And repeating the assessment package at a future date allows evidence of progression or attainment of specified standards to be demonstrated.