A collaborative board game simulating hospital discharges for interprofessional learning & patient-centeredness

MethodsThe 45-60 minute game was played near the beginning of day-long I-MPACT Kick-off Workshops. All 5 Kick-offs had gameplay:

Feedback about the workshops was gathered through two versions of an emailed, online survey sent soon after Kick-off Workshops 2 (SEP. 2016) and 3 (FEB. 2017). Response rates: SEP. 2016: 53% (27/51) and FEB. 2017: 67% (35/52). These surveys included one question each that directly addressed gameplay. Additionally, the I-MPACT team emailed a longer-term follow-up survey in May 2019 to participants of Kick-offs 2–5. Response rate: 17% (16/94). This survey asked new, standardized questions directly about the game.

1 2BackgroundI-MPACT (Integrated Michigan Patient-Centered Alliance in Care Transitions), a statewide Blue Cross Blue Shield of Michigan collaborative quality initiative, assembles hospitals and physician organizations to work as local “clusters” with patients to improve care transitions and reduce readmissions. These new quality improvement teams have members who represent a variety of disciplines, organizations, administrative hierarchies, and experiences as patients.

Problem Statement: New interprofessional teams with patient members do not have a shared, ready-to-hand understanding of the complexities of current systems before they begin working together to identify possible improvements.

Aim: To aid in forming these new cross-institutional and interdisciplinary teams efficiently, I-MPACT provides experiential education through the “Get Me Outta Here!” board game. Designed by Integrative Designers at the University of Michigan in conjunction with the I-MPACT team, this team-based board game simulates the often elusive discharge process. The game provides:

• A basis of shared vocabulary and references for diverse teams from various communities of practice (including frontline staff, administrators, quality improvement specialists, & patients).

• A learning environment for the development of new communities of interest concerning care transitions. Playing the game demonstrates how behaviors emerge from complex adaptive systems such as healthcare, especially common communication breakdowns and the roles of healthcare providers and patients.

Reflections & Lessons LearnedThe Get Me Outta Here game simulates the discharge process in order to reveal common system breakdowns and communication oversights to participants who are working to improve them.

• A new game puts all players outside of their comfort zones and creates opportunities for learning from each other and working as a team. Survey responses show an overall agreement about the effectiveness of the game for learning.

• To improve feedback and response rates, future evaluations of the game could be more specific about group and individual experiences and immediately follow gameplay.

• Patient-centeredness can be a powerful tool for uniting interprofessional teams, and the Get Me Outta Here game simulates this by reinforcing teams who focus on the shared patient journey in the center of the table.

• Additionally, patients can be overlooked as teammates, both in clinical and quality improvement settings. The game models these behavior patterns by having players who are in the role of patient have unique rules and parameters.

Implications and Future Work: Most survey respondents recommend the game to new healthcare professionals.

The I-MPACT team is looking to apply this novel interactive board game as an educational tool in an interprofessional healthcare education curriculum, such as a bootcamp class for new healthcare professionals. If trainees are given the opportunity to work together and appreciate the discharge process in an interactive simulated scenario, they might be able to develop different attitudes, behaviors, and skills to work together to change our processes for the better.

Results96% (25/26 survey respondents, SEP. 2016)

felt the Get Me Outta Here game was moderately to extremely valuable for identifying and addressing care transitions issues

Elizabeth Vander Veen, MDes, MS CCC-SLP – Integrative Designer, Univ. of Michigan

Karly Hendee, MS,RN – QA Nurse Coordinator, University of Michigan

Nkiru Okammor, MS,BSN,RN – QA Nurse Coordinator, University of Michigan

Susan Holmes-Walker, PhD, RN – Clinical Quality Facilitator-II, Henry Ford Health System

Lynda Heinig, BSN, RN – Care Manager, ACO/CIN SE MI SJMHS/SMML Trinity Health

Nicole Ewald, RN, CFN, CMI-III, DABFN – Clinical Program Manager, The Physician Alliance

Grace Jenq, MD – Associate Professor, Michigan Medicine

CREATED BY I-MPACT (INTEGRATED MICHIGAN PATIENT-CENTERED ALLIANCE IN CARE TRANSITIONS)

CONTACT: eavv@umich.edu & i-mpactcc@med.umich.edu

Set-up:

• A large workshop group splits into “medical teams” of 4–7 players for simultaneous play.

• Teams receive simulation materials, rules, and objective: to discharge 3 patients as efficiently as possible.

Gameplay:

• Choosing disciplinary roles different from their usual work, including that of patient, participants complete role-specific sequential tasks related to the discharge process (far right).

• Players are free to communicate within their teams.

• One patient player is present as a teammate, but has special rules that elicit common behaviors between patients and medical professionals.

3 Debrief:

• A facilitated discussion takes place with the whole group following the gameplay, encouraging reflection on patient-centeredness and team communication.

83% (28/34 survey respondents, FEB. 2017)

agreed that Get Me Outta Here game was a credible simulation of the complexities of the discharge process

1: APR. 2016 2: SEP. 2016 3: FEB. 2017 4: SEP. 2017 5: SEP. 2018

239 Total players of the game 23 Clusters participated (23 hospitals & 16 physician organizations)Participants: Physicians/Physician Assistants/Nurse Practitioners, Registered Nurses, Social Workers, Quality/Administrative Personnel, Retirees, Health Care Providers, Administrators, Case Managers, Staff Nurses, Data Abstractors, Patient Advisors

Below and right: Follow-up Survey Results 2019

Project Completed with Support from: Smucker-Wagstaff Project Grant, Penny W. Stamps School of Art & Design, RMA University of Michigan; Blue Cross Blue Shield of Michigan Collaborative Quality Initiative I-MPACT

Doctor

PhysicianAssistant

Care Manager

PatientNurseCHECK ON PATIENT PATIENT EDUCATION

ROUNDSDISCHARGEORDER

MEDSLIST

PRESCRIPTIONS

ARRANGERIDE HOME

COORDINATEEQUIPMENT

DAY OF DISCHARGE MORNING AFTERNOON

47%

55%

54%

37%

23% 15%

9%

8%

31% 23%

0% 25% 50% 75% 100%

...was an e�ective learning tool during the I-MPACT Kicko�.

Strongly Agree Agree Neither Agree nor Disagree Disagree Strongly Disagree

�e Get Me Outta Here Game...

...promoted in-depth thinking about current care transision processes.

...stimulated conversations about roles and responsibilities related to care transitions in the hospital setting.

1

13

Would you recommend the Get Me Outta Here Game

as an educational learning tool to teach new healthcare professionals

about care transitions?

No

Yes

How it works:

GAME

Get me

Outta Here!