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Serious Games Building A Medical Safety Culture

The success of an eye operation is closely linked with teamwork in the operating room. Many hospitals struggle to engage highly independent doctors in safety training and the use of surgical safety checklists in the operating theater.

In response to this common problem, the Rotterdam Eye Hospital, in collaboration with the Faculty of Technology, Policy and Management at the Delft University of Technology and Vertigo Games B V, a Dutch Serious Games developer, has recently created the Safety Game to train staff in the fundamentals of operating theater safety.

As a Center of Excellence, the Rotterdam Eye Hospital is the recognized knowledge and treatment center for ophthalmic care. Each year 140,000 operations are performed there. Improving patient safety has been a continuous priority for the last twelve years. “To err is human,” according to Director Frans Hiddema, “but every avoidable error is too many. In order to improve the safety of our care, we employ principles that are used in aviation. This sector is renowned for its safe-working practice and is therefore a great source of inspiration. Flying has become considerably safer over the last thirty years due to clear agreements and protocols and good cooperation between various disciplines.”

To start with, the OR staff took training courses in a flight simulator.

“We deliberately chose an environment that was foreign to everyone, so that no-one had a head start,” explains Hiddema. “Everyone was forced to work with each other. If that didn't happen, the aircraft crashed. However, after a few of these training courses, the challenge disappeared and so did the enthusiasm. When I came into contact with professor Veen of TU Delft four years ago, the idea arose to develop a Serious Game. We then developed a concept in collaboration with Vertigo Games for ‘designing, playing and evaluating together’. The operating room was filmed in order to create as realistic an image as possible with the OR team members as sorts of avatars. The game is now ready and research can be carried out into the effects.”

“What is very innovative about the Eye Hospital's Safety Game is that the design phase has deliberately been used to encourage motivation and education,” explains Dr Jaco Appelman, assistant professor of Systems Engineering. “The doctors and hospital staff have been actively involved in developing the game. They acted in 3D suits in the OR and discussed at length what is actually involved in all this. This resulted in fewer errors being made in the initial phase of the game, which saved a great deal of time.”

Virtual operation room
Practice and reflect on safety procedures
Individual and cooperative training mode
Statistical analysis of player behavior

While they were developing the game, the researchers made an interesting discovery. “Of course in the Eye Hospital they work according to fixed protocols, but it turned out that there were variations in how these were carried out. Every surgeon did things slightly differently. By talking about this together, the best working method could be chosen as the standard way of working. Everyone is now able work according to this best practice. Quality improvement therefore already begins in the game's development phase. By explicitly supporting this phase, you are already working on your objective from the very start. In effect, design, evaluation and monitoring are becoming increasingly aligned with each other.”

The single-player version of the Safety Game has been tested twice in the form of a walk-through. This means that you walk through all aspects of the game with the whole operation team, the design team and a researcher. The purpose of this is to see whether the game meets the requirements and is accepted, and where necessary to introduce improvements. It is now time to implement the multi-player version.