Using virtual QI games to boost learning

There are huge benefits in developing a shared understanding of QI principles and methods when teams and cross-organisational groups collaborate on change. 

Learning together breaks down barriers, creates a shared language and enables improved relationships that ultimately benefit patient care.  Interactive simulations, demonstrations and games can play a key role in this. 

Simulations are widely used in face-to-face development programmes for quality improvement but few effective online versions exist.

This project set out to build an online platform to provide an engaging, interactive and fun experience for learning about QI.

The audience was split into two main groups to try to understand the user experience from the perspectives of: 

• Quality improvement professionals – delivering quality improvement training and using the game to convey core QI concepts in an interactive fashion. 
• Quality improvement training delegates – any health care professionals, clinical or non-clinical, who are interested in learning more about Quality Improvement practice. 

The game created is an easy-to-use multiplayer online game for five people plus a facilitator. It works on any device through a web browser and can be incorporated into other planned training and improvement activities.

A large number of organisations were keen to collaborate directly and join the user community, including NHS acute trusts, community trusts, mental health trusts, integrated trusts, a regional improvement collaborative and voluntary sector providers. 

The project originally took shape in the wake of the COVID-19 pandemic, when a sudden, necessary transition of from in-person to online learning took place. 

The team recognised that this had a detrimental impact on QI training. An initial survey showed that QI teams across the UK were struggling to adapt their existing learning programmes for a virtual setting. 

The urgent need for alternatives and the subsequent aim to share the game nationally were two key challenges. 

Within this context, the team also needed to learn about the steps they had to take to enter into a commercial partnership with their chosen digital partner. 

Ensuring the ongoing sustainability and development of the game platform was a further challenge.

The project:

• gathered insight from the Q community, engaging with 47 people who wanted to be involved
• ran three separate user groups with fellow improvement professionals to gain insight on what users want
• built an initial specification of the key components for a successful game
• developed a specification and digital strategy and selected a digital partner to create the platform
• developed the platform with the digital partner and gathered feedback from players.

NHS Education Scotland and NHS England agreed to support the work. The team also connected with a range of QI networks and programmes that offered opportunities to share the learning more widely.

The game provides a range of opportunities for teams to reflect on and learn about improvement. It can also be used to support more general learning about processes, systems and team working.

Quality improvement principles or methods the game can support include the following.

Iterative improvement: the game provides an opportunity to teach teams about the potential of rapid cycles of improvement. Teams can apply a Plan Do Study Act (PDSA / PDCA) approach and track their improvement between rounds.

Measurement: the game dashboard provides the host and players with potential insight into the performance of their process. The metrics show what is going well and not so well at each station as well as the overall success of the team.

Value and waste: the gameplay generates opportunities for players to spot and address waste in a process. 

Team communication and leadership: players can only see the gameplay at their selected station and need to communicate effectively and collaborate to make improvement to the overall flow of the process. 

Flow: the game simulates flow through a simple process or value stream.  Players will experience bottlenecks, delays and queues at different stations as they attempt to succeed in fulfilling customer orders. 

Root cause analysis: an essential skill for improvers is to understand why problems occur before generating solutions. Simple tools like ​‘5 Whys’ can be used to support their problem-solving process.

Reducing variation: one of the challenges the game highlights is dealing with variation in customer orders.

Standardisation: the game provides opportunities for players to standardise elements of their process and reflect on how this contributes to improvements.

Much of the learning was through the team furthering their understanding of the key components and steps needed to develop a digital platform. This involved:

• engaging with a wide variety of digital development professionals
• communicating the vision for the game while learning the process for developing the vision into a playable game
• understanding the steps needed to enter into a commercial partnership with a digital partner. 

As a trust with no designated commercial support, the team needed to engage internally with the Finance and Procurement Team, as well as with external colleagues from NHSX, the Health Innovation Network and Barts Charity before they could confidently enter into a commercial partnership.