NursingLink

Nurses Play Board Games to Improve Work

Ann Burch, Janet Barrette, Elizabeth Warner and Tracy Marenna play "Friday Night At the ER." The decision-making game, developed by a consultant from Johns Hopkins University, was designed to help hospital departments to work together more efficiently.

BRISTOL – Our Lady of Mercy Hospital was doing fine until about 8 o’clock, when a couple of nurses went home sick, a flood of patients showed up at the emergency room and the medical-surgical floor ran out of rooms.

A little while later, ER chief Tracy Marenna moved pieces around the game board, flipped over a card and groaned at the bad news: “I’m in big trouble here: I’m getting four more patients and I’ve already got 12 in the waiting room.”

Marenna — along with a few dozen department heads and board members at Bristol Hospital — got a fresh look at patient care, staffing levels, revenues and hospital administration Monday through a staff training workshop based around a board game. Divided into groups of four, they got to watch which decisions led to success or failure; invariably, the teams that worked together well scored highly.

The lessons were seemingly simple: Managers produce better results working collegially than when they care only about their own little piece of the system. Developing strategies is more effective than just handling a series of crises.

Played out over a simulated 24-hour day at a hospital, “Friday Night at the ER” graphically shows the downside of short-term thinking, faulty assumptions and an every-manager-for-himself philosophy.

Four-player teams try to juggle a limited number of hospital beds, a relentless influx of patients and a gradual attrition of nurses to care for them, all while racing against a clock that forced faster and faster decisions. Every so often, game cards announce another mini-crisis to ramp up the pressure.

The patient count in the ER waiting room soars as the day goes on, especially if the players running the operating room, critical care unit and medical-surgical floor don’t cooperate to free up bed space, share nursing staff and think ahead to the next challenge.

“It’s about collaboration and teamwork, about seeing your department as one piece of an enormous mosaic,” game leader William Ward told the players. “Whether it’s lab, registration, records, we tend to manage just in our own little departments. I swear at the bottom of the Atlantic there’s still a hospital department manager in dry room on the Titanic who went down thinking ’It’s OK. My department is dry.’”

Hospital President Kurt Barwis brought Ward, a Johns Hopkins University professor of health finance and management, to Bristol as part of an ambitious staff-training program. Barwis was hired a year and a half ago to revitalize the financially troubled hospital, and has taken it from nearly $8 million in red ink in 2006 to a loss of just $250,000 last year.

Marenna, Bristol Hospital’s I.T. manager, landed the job of running Our Lady of Mercy’s ER, and almost instantly was counting on teammates Ann Burch, Janet Barrette and Elizabeth Warner for help. They swapped the tokens that represent staff workers back and forth, trying to cut through the backlog of patients without resorting to the potential budget-buster of calling in expensive off-duty staff. For part of the game, they had to turn away new patients — a decision that proved costly.

When Ward reviewed the scores afterward, Our Lady of Mercy fared better than many of its competitors. But he said that hiring extra staff during peak periods is essential — in the game and at real hospitals.

“It’s cheaper sometimes to bring in temporary people at $60, $70 or even $100 an hour than to turn away admissions,” he said. “In Maryland, we figured that for every ambulance we diverted [to another hospital], we lost $7,500 in profit.”

Over-reliance on cost containment is part of an entrenched attitude in the health care field that must change, Ward said. And department-by-department goals, measured strictly in isolation, is another, he told the audience.

“Department managers often see their objectives as [just] their department’s objectives,” he said. “If you’re a lab manager looking to have the lowest cost per test, what are you going to do? Not staff evenings, not staff on weekends. But what effect does that have on the rest of the operation?”

The game results supported that idea.

“The ER backs up [in the game],” Ward says. “But it doesn’t start in the ER — it starts in the other departments.”

Courtesy of © 2008, YellowBrix, Inc.