ComplianceESGSeptember 03, 2020

The MEDD Toolbox – Guestblog series Play & Learn, part 3


Creative tools to improve safety culture in Healthcare

Creating lasting awareness among Healthcare professionals about culture and behavior regarding patient safety.

In recent years MEDD has developed multiple tools and games aimed for healthcare professionals to gain lasting awareness on their behavior regarding safety and how they influence their own safety and that of others. In this blog, a number of these will be highlighted and explained.

Communication is key

Communication, motivation, and collaboration are essential for quality, safety & Risk Management. It is important to be able to correct each other in order to learn from each other and avoid possibly harmful situations. Sometimes this can be difficult as correction or evaluation of mistakes can be perceived as blaming. A current trend is to move to an open culture where people feel safe to speak their minds (see the example in the sketch, Mina Boogaard, 2019). MEDD creates tools to facilitate communication around risk, and to drive culture change. Important aspects of such tools are that there is room for feedback and they spark an emotional connection.

MEDD toolkit

By providing insights in processes and risks and making them understandable, we help our customers in the field of Care and Wellbeing, Education, and MedTech to create focus. Our toolbox can help with this. The insights about wanted and unwanted behavior, that are obtained together, motivate care professionals to be proud of what goes well within their workflow, and take specific action where needed.

Our cooperation with the Haga Hospital in The Hague started in 2012 by organizing multiple creative workshops. The toolbox was developed in this same year with for example accessible tools for the BowTie method and the patient journey. Below some formats are shown:

”The creative workshops we organized with MEDD have helped us to combine safety and risk thinking with patient experience and convey this to our employees in a visual and easy way.” – C.H. (Clarie) Maat, MSc Advisor Quality & Safety Haga Hospital The Hague.

BowTie method

The Bowtie method is a visual method that can be used to analyze and communicate risk scenarios. A BowTie diagram gives an overview of multiple plausible risk scenarios, in a single picture. What we like most is the visual outcome which opens up the dialogue! Below a simplified model of a BowTie diagram is shown:

Bowtie & Medical Devices

How to make use of Medical Devices more attractive and safer for the healthcare sector by means of risk analysis with the Bowtie method? Our approach is explained in our 2-minute company-movie. As MEDD, we believe in the power of cooperation. Who else then our customers to underline this strength? In the company-movie, Jacqueline de Vos, advisor quality, safety & innovation, from the Albert Schweitzer hospital, is speaking.

MEDD Blog images
Watch Video

A people motivated risk based approach

Risk Management is not only about focusing on the things that go wrong but as well about focusing on what is going well: How and why it is going well (root causes) and how to hold on to this as a team. Don’t only focus on systems thinking and failing, or missing barriers, but rather focus on the effective barriers and positive experiences as well. The BowTie-method can be an appropriate analysis method for this and connects really well with the Safety II safety thinking.

Safety II not only focuses on what goes wrong but includes learning from things that go right. It aims at getting a holistic view of the system and an in-depth understanding of its functioning (Hollnagel, 2014).

Assigning effectivity to barriers (prevention- and recovery measurements) shows the team and management directly what goes well in the current situation. This approach will motivate since things go well more often than that they go wrong. However, it will also give insight in the resilience and the adaptability of the teams and care professionals.

Influencing behavior

To implement measures in order to direct human behavior is complicated. Whether or not desired behavior is present firstly depends on an intention or motivation for this behavior. Do people agree on what is expected from them? Or do they have a different view on this? Do they think they don’t fit in the group? Do they believe they can’t do something? Even if intention and motivation are present, lack of knowledge, skills, or habits can obstruct the desired behavior.

As Risk Based Design Thinkers in healthcare, we believe that Using Design and Serious Gaming will have a positive impact on this wanted behavior change!

MEDD Serious Game

Opening the dialogue

The game consists of a set of question cards stimulating conversations about Risk Management, Patient Experience, and Culture and Behavior. Questions about these topics have to be answered to help release a patient from the hospital following their specific patient journey.

Game rules

Every person visiting a hospital experiences a different journey. These journeys are the basis of the game, together with questions about three main topics: Risk Management, Patient Experience, and Culture and Behavior. Within the game, each player is a healthcare professional who needs to take care of their own patient with corresponding patient journey, which is represented on the persona cards. This card describes the patient with patient information and the journey through the hospital. The players guide their patients from admission to release and visit different departments doing so. The progress players make is visualized with the process-cards in front of each player. By giving correct answers to the questions, steps are taken on this journey.

The questions in the three themes are knowledge based questions or open questions with no right or wrong answers to stimulate discussions. Besides, to certain questions cards, a Do-assignment is added. This is a suggestion for an activity that could be performed during or outside of the game to encourage a dynamic discussion environment. By completing a question card and showing their knowledge about these topics, they guide their patient through the corresponding journey. However, they could experience unexpected occurrences, like having to help out a colleague or an emergency situation with their patient.

When playing time is over the player who successfully released the most patients is the winner of the game.

During the game, the game master determines whether the answers given by the players are correct or elaborated enough. The game also contains questions with answers that are specific for their own organization. The game master also has access to a general questions and answer document. This document allows them to add the correct answers, and if wanted attachments, for these specific questions. The game master also decides how long the game will be played, this can differ each time depending on the situation.

The game is delivered with a manual and the answers to the question cards.

Partners involved

We developed this boardgame together with the Haga Hospital, which is a nice example of the positive impact that the use of design can have for behavioral change.

We were looking for a way to open up the dialogue on Risk Management, patient experience, and the influence of culture and behavior on it, in a playful and accessible way. The board game we developed together with MEDD helped us to engage health care professionals with these matters. It made talking and thinking about patient safety fun and motivated the players to integrate it into daily practice!” C.H. (Clarie) Maat, MSc Advisor Quality & Safety Haga Hospital The Hague

Leiden University Medical Center (LUMC) joined as a partner in 2019 in the further development for the hospital sector. Have a look at an impression of a usability test in the LUMC (in Dutch).

Stina Duyverman-Slagter about MEDD:
“MEDD is always looking at ways to contribute to improvement and quality awareness TOGETHER with professionals in a way that is accessible and motivating.”

Experience of Stina Duyverman-Slagter from the Usability test of our Game:
“We played the game sitting cozy at the table, however with questions about Risk Management, Patient Experience, and Culture and Behavior.. The participating colleagues enjoyed it and asked if they could play it more often. It was nice to notice that they started the conversation with each other about the answers…”
Stina Duyverman-Slagter Leids University Medical Center (LUMC) – Advisor Quality and Safety / Complaints officer.

Persuasive Game Design Model

Designing the MEDD games was done using the underlying theory of the so-called persuasive game design model. The persuasive Game Design model, as designed by Anderiesen, van der Kooij, Vegt and Visch (2013) was redesigned by Mina Boogaard (MEDD, 2019). The Game Design model was further updated with gained insights and experience from our usability tests in Haga Hospital and Leiden University Medical Centre (LUMC) during the ‘Patient Safety week’ event which took place November 2019.

To make the game a success, it is important that the operational leader/manager is able to explain and lead the game and create a psychologically safe atmosphere during the game. A training or information session by MEDD can help prepare for this.

Finally, a success factor of the Game is the connection with commonly used methods for culture and process improvement tools like CRM and LEAN (for example during the ‘start of the day’) and the use of the so-called toolbox meeting in Industry.

MEDD Risk game

A risk register is a well-known method in Risk Management and project management. To classify the possible risks a risk matrix is used. For this step, we developed a Risk Game and worksheet where the players can enter the possible causes in a multidisciplinary setting. To score these causes, there are risk coins, which are used in a poker-like game setting. The goal is to open the dialogue and start discussions on the probability and consequence of unwanted events and in the end, agree on a score supported by the whole group.

Playing the Risk Game during a FMEA train-the-trainer workshop (Medical Device manufacturer, Tilcentrum):

“FRS, FMEA, PMS are all concepts coming along while taking the road to a CE declaration. In cooperation with MEDD we started a project to create more clarity, understanding and acquiring content knowledge about the process from idea to a Conformite Europienne (CE) declaration.

An important part of the project is Risk Management. In the structure of MEDD this was a nice and interactive design that was ‘played’ using Risk Coins. Several groups bet on risk and probability and finally have to accomplish agreement about the importance of these topics.

Altogether, the route to CE doesn’t have to be boring with the methods MEDD uses.”  – Ted van Scheppingen Tilcentrum, Director

Playing the Risk Game during our Risk Management workshop for Healthcare in the CGE Risk innovation center:

Improving Healthcare: Do it By Design

Starting the conversation about topics Risk Management, Patient Experience, and Culture and Behavior and connecting this to active tasks that are recognizable within daily practice contributes positively to behavioral change. Design and Serious Gaming can help with this. We are proud to hear that our Games and tools, used in teambuilding activities, motivate people to learn and change behavior.

In the end, that is why we do it.

Together, Do it by Design!


Thank you for your attention.

Do you have questions about our approach, our MEDD toolbox (DUTCH) or about ‘Risk Management in healthcare’ training (DUTCH)?

Get in contact with MEDD, Kitty invites you to be informed about the possibilities.
E: [email protected] 
M: +31.628.484.299


Author: Kitty ter Borg (Managing Partner Healthcare at MEDD)
Co-author: Ellen de Vries (Human-centered Designer at MEDD)
Header photo by Cor Ritmeester

Reference list:

  • Anderiesen, H., van der Kooij, K., Vegt, N., Visch, V. (2013). Persuasive Game Design: A model and its definitions. Delft: Technical University of Delft.
  • Boogaard, Mina. (2019). Cultuur rondom veiligheid, A game about safety culture. Delft: Technical University of Delft.
  • Hollnagel, E. (2014). Safety-I and Safety-II. The past and future of safety management. New York: CRC Press.
© MEDD. 2020 – The copyright of the content of this guest blog belongs to MEDD who has authorized CGE Risk Management Solutions B.V. to provide this content on its website.
Back To Top