Chris Engle, the inventor of matrix gaming, has passed on some ideas for a COVID 19 general hospital simulation. We are pleased to post them below.
The world is facing a pandemic. It is testing our systems to the extreme. Maximizing utilization of resources is all important. This requires the following.
- Effective intelligence
- Pre-deployment of resources
- Public policy to slow the spread of the illness
- Maintenance of public order
- Distribution of goods and services
- Medical treatment as needed
- Maintenance of front line essential workers
- Evaluation of effectiveness and alteration of intervention
- Data-based decision making on when to return to normal
It is a highly complicated situation that is in a constant state of flux. Simulating this in a timely meaningful way is a huge challenge.
What follows is a simple, inexpensive, easily run, quick to initiate simulation that might be helpful. The game is about a general hospital in a moderate sized city in Middle America: imagine it being in a city of 100 to 250 thousand people. Or it might be in one district of a much larger city. The players are healthcare providers, administrators, and other stakeholders. The game consists of play sessions of around 10 participants each engaging problems and solutions, and the problems that flow from them. Sessions last between 30 tp 120 minutes and can be done by phone, video, email, or in person. The game requires a facilitator/moderator/host who does not have to be an expert. Their job is to encourage people to participate.
The Matrix Game
General Hospital is run using a Matrix Game. This is a type of game that uses words and discussion rather than numbers and mathematical algorithms to track what happens, The approach has been used since the 1980’s as a planning/training tool in a variety of fields. Chris Engle, a psychiatric social worker, invented Matrix Games in 1988. Games consist of players making statements about what they think happens next in a given situation. They are narrating events, which they make up out of their imagination. The session is a conversation between participants. The outcome of sessions is a list of brainstormed problems and solutions, with some indication about which ones are more or less likely to happen. The complete rules of the game are as follows’ The host of the event starts the session by stating a problem. They then ask the players “What happens next?” The host then allows the players to speak. The host’s remaining job is to encourage people to speak, to recap what is said, to help players through the technical rules, to occasionally re-ask the question, and to wrap the game up on time. The players make things happen by jumping in as the spirit moves them to say what happens next. This might be an event, a plan, or another problem. Whatever the player says automatically happens, it is part of the story. Other players may jump in and add to this or they may alter it or even say that something else happens instead. These also automatically happen, and overwrite the first statement. If a player says something that people think is unlikely to happen they may ask the player to roll for it. The player must then roll a six sided die. On a roll of 1 to 3, the event does not happen and cannot be repeated in this game. On a roll of 4 to 6 the event does happen and cannot be overwritten, As many players as wish may ask a player to roll and the player must pass each roll to have their event happen. This is evidence or how unlikely people believe certain moves are.
The game ends when the starting problem is solved or when the players run out of time.
Dice rolls are never required and it is not uncommon for there to be sessions without any rolls. The ideas that players come up with will range far from their areas of responsibility and expertise. They will identify problems and interventions that touch on society at large. Some input will even be silly and fantastical. All this is allowed because with each statement, the players open up a little more which makes it possible for them to speak and share incites that will help. To this end, it is helpful for top leaders to say little or nothing in games since they may overly influence participants.
It is vitally important for time be given after each session for the players to talk about and summarize what they learned. This cements lessons. This can be done by the players talking to one another or by the game host recapping events and highlighting the important points. These recaps should then be passed back to the administrators and decision makers who sponsored the event so they can make use of the intelligence for planning purposes.
Any health professional or stakeholder in decision making can usefully participate in Matrix Game sessions. They do not need any simulation expertise or area knowledge beyond what they already have. All they need to know before the event is that they are going to participate in a low key, planning meeting that will give them deeper knowledge of the big picture of the present problem and how they fit into it.
Matrix Games are usually played in face to face sessions. But they work just as well as email/text messages. They also work in phone meetings or video conferences. The medium is unimportant, and because the game consists of conversations between players, there is no need for expensive computer programs or equipment. This approach can be implemented in a high tech city or a village with no paved roads. One advantage of using video or email is the potential to have a record of each game. These records form a data set that can be analyzed at a later date using computational models.
On Use of this Game
Permission is granted for any person, institution, or company to use this game and the Matrix Game approach in general for planning and training purposes. The only request is that they cite that Matrix Games were invented by Chris Engle in 1988. Please pass this document onto any and all people you know who might be helped by it.
Note for Facilitators
People are naturally shy when it comes to making things up. It is helpful to start the game by asking each player to say one thing that people in their role would do in the face of the presenting problem. Once that is done the ice is broken and the host can take a more backseat approach.
The facilitator is responsible for establishing and maintaining a good work environment. If players engage in abusive or intimidating behavior, it is the facilitator’s job to intervene and establish order. There can be no useful work accomplished without a good working environment. It is okay for participants to say little or nothing is a game. When they do this they are being the audience. They still learn from the event and may come up with the most useful observations during debriefing because they were looking at it in a bigger picture way.
The facilitator does not have to be an expert in technical subject matter. It is perfectly acceptable and expected that they will not know certain details. This allows them to model how to ask questions and listen to answers. The facilitator does need to be an outward going person who will engage the players actively. Aside from encouraging people, the facilitator is also a player. But they need to not take too much role in the game so that they do not unduly influence play. The facilitator needs to gather up all materials from the game and return them to the administrator who sponsored the event. This may involve writing a short report.
Lastly, end sessions promptly. Make certain there is time to do debriefing within the time of the meeting. Healthcare worker are very busy, especially now, and will appreciate meetings that end on time. Overstepping their time will reduce how much they take away from it. A good opening problem to start a game is: “The coronavirus is coming. We need to deal with it. How do we prevent a disaster?”