283:
measure team performance. After a brief stretch break, participants reconvene for a debriefing. The debrief is facilitated by the program leader with a structured progression of discussion questions, reflection exercises, didactic presentation, and group tasks to bring to light key lessons of the experience, its relevance to the group and how participants will put lessons into practice after the program.
29:
311:. Players’ management tasks include determining staffing levels, accepting internal patient transfers, and remaining open to additional patients or diverting new ambulance arrivals. Among the other details of the gameplay are “events” that occur (e.g., a doctor is late, a room is being renovated, a staff member goes home sick), requiring reaction and management by players.
318:
Consequences of player decisions in the gameplay are both local and systemic. The structure of the game board, role assignments and the accounting system influence players to focus on department performance; yet as the game progresses it becomes evident that the more one tries to optimize a part, the
239:
depicts a hospital based in the United States, it has been adopted and widely used as a team-learning tool both within the healthcare field and beyond, finding use across diverse industries including other service organizations, manufacturing companies, government agencies, and academic institutions.
322:
During the gameplay, players keep track of certain data on paperwork forms at each department. Following the gameplay, individuals at each table contribute to calculating a team score that reflects the quality of service they delivered and financial performance. Teams scores are displayed to provide
286:
The structure of the program may be varied. For example, the gameplay's 24-hour simulation may be conducted in two 12-hour segments with a short debrief or planning meeting in between segments. Another variation has groups playing in separate rooms with a slightly different instruction or game-board
338:
During the debrief, participants are guided to focus on collaboration, innovation and data-driven decision-making as key strategies necessary for successful system performance. These three strategies are examined and they are shown to be interdependent. Participants see that these three strategies
314:
Demand rates in the gameplay, by hour, from mid-day Friday to mid-day
Saturday, represent the typical pattern seen in hospitals. Emergency arrivals ramp up during Friday night (a time when people more often engage in risky behaviors that lead to emergencies); while arrivals to other departments in
282:
Participants in a group (from 4 to 200 people) are assembled at tables equipped with game boards and associated materials. A program leader or coordinator provides verbal instructions; then participants play the game on their own for approximately one hour. The gameplay is followed by scoring to
161:
has found use for a broader range of learning objectives within diverse organizations. Demonstrating the universality of systems principles, the game is in use by service organizations, manufacturing companies, government agencies, academic institutions and others in at least 30 countries.
298:
At each four-person table, players each manage one of four departments in a hospital: Emergency, Surgery, Critical Care, and Step Down. The gameboard hospital is consolidated and simplified (relative to reality) to enable players to progress through a simulated 24 hours in just one hour.
342:
While these three strategies are not new ideas to most participants, the question is posed in the debrief, “Why, then, don’t we routinely put these strategies into day-to-day practice?”—as they demonstrated in the gameplay and as seen in the real world? An axiom from the field of
1189:
Sanko, Jill S.; Gattamorta, Karina; Young, Judith; Durham, Carol F.; Sherwood, Gwen; Dolansky, Mary (March 31, 2020). "A Multisite Study
Demonstrates Positive Impacts to Systems Thinking Using a Table-top Simulation Experience".
213:, loosely based on that case, to teach management principles and the practice of systems thinking within healthcare and other organizations. The game development process included a computer-based simulation model (using the
302:
Each department contains spaces in which patients are treated by staff, and game cards determine new patient arrivals as well as “ready to exit” indicators for patients. The game board may be seen as a hybrid version of a
119:
The game simulates the challenge of managing a hospital during a 24-hour period. Players perform distinct functions, but they come to realize that they also depend on one another. While the game was designed to teach
205:
study that included a simulation model of patient flow. A high-leverage intervention to resolve the problem required collaboration across departments to share nursing staff during times of peak emergency demand.
315:
the hospital decrease as the weekend begins. A portion of
Emergency arrivals flow through to other departments, so players experience the ripple effect of demand and the challenge of interdepartmental hand-offs.
287:
structure in each room so that behavior and results can be compared. In addition to variations in the gameplay, the structure and content of the debrief may be designed to teach either a narrow or broad purpose.
347:, “structure drives behavior,” is presented and participants are led through an exercise in which they examine how various structures within their organization may (unintentionally) inhibit desired behaviors.
143:. Its initial purpose was to broadly teach people to think systemically, collaborating across functional boundaries to achieve system goals. The game's design objectives were:
1168:
942:
Bacon, Cynthia
Thornton; Trent, Peggy; McCoy, Thomas P. (November 2018). "Enhancing Systems Thinking for Undergraduate Nursing Students Using Friday Night at the ER".
335:
with presentation slides to support key points. The debrief includes team reflection exercises, guided group discussion, didactic presentation and group tasks.
112:
game. Played on game boards at tables with four players per board, each gameplay session is followed by a detailed debriefing in which participants relate the
1253:
Cady, Phil (2021). "Applied systems thinking: The impact of system optimization strategies on financial and quality performance in a team-based simulation".
910:
267:
28:
623:
503:
573:
539:
1238:
274:. They concluded that it is a useful teaching strategy for complex problem solving and application of systems thinking concepts.
217:), populated with time-of-day, day-of-week hospital arrival rates, and other data from public and private sources. The game was
1298:
339:
produce excellent performance in the gameplay, and that the same applies to their real-world endeavors within organizations.
776:
1323:
153:
to promote an understanding of key systems principles in a way that enables people to gain insight about their relevance.
1318:
1308:
1303:
917:
127:
Each session includes 1.5 hours of game play followed by approximately 1.5 to 2 hours of debrief and discussion.
823:
Schneider, Sandra; Zwemer, Frank; Doniger, Andrew; Dick, Robbin; Czaprinski, Tim; Davis, Eric (November 2001).
390:
174:, demonstrates effective team learning about the behavior of complex systems through an experiential activity.
1133:
Young, DNP, RN, CNE, Judith (January 2018). "Using a Role-Play
Simulation Game to Promote Systems Thinking".
1313:
140:
869:
1104:
711:. Health Research and Educational Trust of New Jersey Healthcare Education Seminar. Princeton, New Jersey.
401:
188:
171:
1162:
409:
378:
109:
468:
Insight about the underlying structure in organizations that drives behavior and motivation for change
1087:
198:
183:
1120:"Health Care Change Agents: Interview with Bette Gardner, CEO and Founder, Breakthrough Learning".
413:
139:
game was developed in 1992 by
Breakthrough Learning, Inc., a consulting and training firm based in
1070:
1278:
1225:
967:
370:
308:
1009:
201:, where a persistent problem of decreasing capacity for emergency patients was resolved using a
1030:
671:
1992 National Forum on
Quality Improvement in Health Care, Institute for Healthcare Improvement
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951:
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394:
366:
121:
728:. Systems Thinking in Action Conference, Pegasus Communications. San Francisco, California.
344:
304:
202:
197:
has its origins in a business case that took place in 1990 at San Jose
Medical Center, in
777:"Review: Activating the Fifth Discipline: Volume 1: "Mental Models and Systems Thinking""
528:
471:
Personal insight about the effectiveness of one's management and communication practices
845:
824:
147:
to create an experiential learning tool that would engage people in a learning process;
1292:
1282:
1229:
423:
374:
270:
published results of research in which students were assessed before and after using
1176:
Gardner, Bette (2019). "Developing
Essential Leadership Skills through Simulation".
971:
745:. 2006 Congress on Healthcare Management, American College of Healthcare Executives.
290:
The program generally requires 3.5 to 4 hours to complete the gameplay and debrief.
263:
259:
649:
The
Integration of Systems Thinking and TQM - The Next Step in Quality Improvement
1203:
1146:
955:
613:
563:
493:
124:, it has served diverse learning objectives across many industries and cultures.
1051:
178:
708:
Systems Thinking: A New Approach to Quality Improvement and Healthcare Delivery
460:
the presence of mental models and their impact on behavior and decision-making
218:
113:
1266:
809:
457:
the need to collaborate, to share responsibility for organization performance
565:
Managing The Rapids, Stories from the Forefront of the Learning Organization
386:
116:
experience to their own work and gain insights for performance improvement.
1274:
1221:
1154:
963:
889:
872:
Quality and Safety Education for Nurses (QSEN): The Key is Systems Thinking
854:
150:
to simulate and illustrate dynamics that are common to complex systems; and
691:
451:
Guiding principles for working together; improved ability to work together
405:
331:
A standard debrief to teach applied systems thinking is described in the
323:
benchmarks and to enable participants to relate behavior to performance.
1212:
251:
was released with modernized and upgraded game and support materials.
382:
214:
988:
437:
Leadership development, strategic planning or team-building retreat
827:
Rochester, New York: A Decade of Emergency Department Overcrowding
350:
Numerous variations to the standard debrief have been reported.
209:
In 1992, healthcare management consultant Bette Gardner created
95:
652:. Bay Area Quality Improvement Network. Cupertino, California.
187:
and popularized systems thinking as a discipline essential to
742:
Applied Systems Thinking with the Friday Night at the ER Game
692:
1993 Organizational Development Network National Conference
221:
with groups and presented at conferences starting in 1992.
597:"Transformational leadership. Systems thinking in action."
474:
Improved competence in applying a newly learned discipline
434:
An early meeting of a new, cross-functional project team
77:
For any team that needs to improve performance, ages 16+
868:
Dolansky, Mary A.; Moore, Shirley M. (September 2013).
463:
the role of information and feedback in decision-making
687:
Friday Night at the ER: A Systems Thinking Simulation
244:
has been used for training in at least 30 countries.
1239:"What a Board Game Reveals about Fighting COVID-19"
684:Gardner, Bette; Reynolds, Joyce (17 October 1993).
91:
81:
73:
65:
57:
49:
41:
739:Ryba, Rhoda; Spreadbury, Barbara (27 March 2006).
646:Gardner, Bette; Harmer, Chet (16 September 1992).
595:Gardner, Bette; DeMello, Steve (July/August 1993).
527:
1090:. Johns Hopkins Bloomberg School of Public Health
1105:"Changing Organizational Culture through Gaming"
333:Friday Night at the ER Guide for Program Leaders
615:An Introduction to Systems Thinking with iThink
498:. Crown Business Publishing. pp. 541–542.
1135:The Journal of Continuing Education in Nursing
1054:Management Simulation: Friday Night at the ER©
1107:. University of North Carolina at Chapel Hill
1086:Warshanna-Sparklin, Salma (9 November 2015).
362:Prepare groups for a major change initiative.
8:
1167:: CS1 maint: multiple names: authors list (
1071:"Friday Night at the ER® A simulation that…"
839:(11). Blackwell Publishing Ltd.: 1044–1050.
725:Friday Night at the ER: A Team Learning Game
359:Improve collaboration across business units.
69:75 minutes game play + 90 minutes debriefing
19:
268:University of North Carolina at Greensboro
232:, a PC-based multimedia education program
1211:
844:
916:. Friday Night at the ER. Archived from
878:The Online Journal of Issues in Nursing
764:). The Learning Circle/Arthur Andersen.
666:Friday Night at the ER: A Learning Game
484:
215:IThink simulation modelling environment
1160:
319:worse the system as a whole performs.
18:
1008:Tomczak, Aleksandra (5 August 2013).
884:(3). American Nurses Association: 1.
443:Orientation program for new employees
7:
612:Richmond, Barry (15 November 2004).
400:Clarify success factors and support
365:Introduce principles and methods of
228:was published in electronic form in
722:Gardner, Bette (16 November 1994).
663:Gardner, Bette (December 7, 1992).
454:New or heightened awareness about:
266:surveys. In 2018, educators at the
1033:Board Game: Fright Night At The ER
846:10.1111/j.1553-2712.2001.tb01113.x
397:and other improvement disciplines.
14:
1103:O'Connor, Megan (22 April 2015).
562:O'Reilly, Kellie Wardman (1995).
170:A predecessor learning game, the
85:No healthcare knowledge is needed
989:"Friday Night at the ER website"
254:Reports of the effectiveness of
27:
1178:Organization Development Review
802:Activating the Fifth Discipline
758:Activating The Fifth Discipline
247:In 2014, an updated version of
230:Activating the Fifth Discipline
87:A program leader is recommended
16:Experiential team-learning game
705:Gardner, Bette (11 May 1994).
495:The Fifth Discipline Fieldbook
447:Examples of outcomes include:
440:A training or education course
430:Examples of settings include:
1:
96:http://fridaynightattheer.com
1204:10.1097/NNE.0000000000000817
1147:10.3928/00220124-20180102-04
995:. Breakthrough Learning, Inc
956:10.3928/01484834-20181022-11
944:Journal of Nursing Education
694:. San Francisco, California.
1255:Healthcare Management Forum
1029:Umbehr, Josh (6 Feb 2008).
833:Academic Emergency Medicine
157:Since its initial release,
53:4 per board, 4 to 200 total
1340:
1128:(4): 10–12. December 2017.
568:. Pegasus Communications.
262:surveys, testimonials and
110:experiential team-learning
1122:Medical Training Magazine
775:McHale, Jo (2 Sep 1999).
600:Healthcare Forum Journal,
26:
1267:10.1177/0840470420950378
1088:"Friday Night at the ER"
526:Senge, Peter M. (1990).
492:Senge, Peter M. (1994).
391:Total Quality Management
756:Peter M. Senge (1997).
385:, Process Improvement,
166:History and development
141:Morgan Hill, California
1014:animated presentation"
1012:Friday Night at the ER
993:Friday Night at the ER
534:. Doubleday/Currency.
402:leadership development
272:Friday Night at the ER
256:Friday Night at the ER
249:Friday Night at the ER
242:Friday Night at the ER
237:Friday Night at the ER
226:Friday Night at the ER
211:Friday Night at the ER
195:Friday Night at the ER
189:learning organizations
172:Beer Distribution Game
159:Friday Night at the ER
137:Friday Night at the ER
105:Friday Night at the ER
61:5-10 minutes per board
34:Friday Night at the ER
21:Friday Night at the ER
1299:Experiential learning
618:. isee systems, inc.
410:customer satisfaction
379:Theory of Constraints
258:are largely based on
45:Experiential learning
1324:Management education
530:The Fifth Discipline
294:Gameplay and scoring
199:San Jose, California
184:The Fifth Discipline
1319:Leadership training
673:. Orlando, Florida.
414:conflict management
371:Balanced Scorecards
23:
309:process-flow chart
1237:Taylor, Shannon.
1016:. House of Skills
418:change management
404:in areas such as
278:Program structure
101:
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1309:Systems thinking
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1163:cite journal
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925:. Retrieved
918:the original
911:"What's New"
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66:Playing time
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1184:(2): 58–59.
1094:16 November
1037:. Medgadget
602:36(4):25-8.
179:Peter Senge
1293:Categories
1213:1805/26648
479:References
327:Debriefing
305:stock-flow
181:published
131:Background
114:simulation
58:Setup time
36:game board
1283:221325943
1230:214644324
1073:. Fulcrum
810:222212571
387:Six Sigma
235:Although
224:In 1997,
177:In 1990,
74:Age range
1275:32844701
1244:16 April
1222:32209839
1155:29384582
1111:25 April
1077:12 March
972:53257585
964:30388292
895:25 March
890:26812094
855:11691666
804:. OCLC.
631:10 March
581:March 9,
547:March 9,
511:March 9,
406:teamwork
1061:9 March
1041:9 March
1020:9 March
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786:9 March
307:map or
92:Website
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260:Likert
108:is an
82:Skills
42:Genres
1279:S2CID
1226:S2CID
968:S2CID
921:(PDF)
914:(PDF)
395:Agile
1271:PMID
1246:2020
1218:PMID
1169:link
1151:PMID
1113:2015
1096:2015
1079:2014
1063:2014
1043:2014
1022:2014
1001:2014
960:PMID
929:2015
897:2015
886:PMID
851:PMID
806:OCLC
788:2014
781:CIPD
633:2014
620:ISBN
583:2014
570:ISBN
549:2014
536:ISBN
513:2014
500:ISBN
375:Lean
354:Uses
135:The
1263:doi
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