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Virtual QI simulations and games – supporting online learning

We want to build a suite of virtual quality improvement simulations and games to support online learning as part of building QI capability across health and social care

Read comments 52 Project updates 3
  • Winning idea
  • 2020

What is the positive change that has emerged through new collaborations or partnerships during Covid-19 that your project is going to embed?

The rapid transition to virtual working in response to COVID-19 has been challenging but has also enabled greater cross-system collaboration and learning, particularly between primary and secondary care.  Across the UK and the rest of the world, we are learning to use video conferencing and collaboration software to support teams to learn together, respond to problems and to apply quality improvement methods to deliver rapid change.

There are huge benefits in developing shared understanding of QI principles and methods when teams and cross-organisational groups collaborate on change.  Learning together breaks down barriers, creates a shared language and enables improved relationships that ultimately benefit patient care.  Interactive simulations, demonstrations and games can play a key role in this.  More than ever before, QI teams across the NHS are sharing ideas, resources and learning as we try to adapt how we support staff across the system to respond, recover and redesign services.

What does your project aim to achieve?

The national vision is for leaders at every level of the NHS to develop improvement capabilities among their staff and themselves.  This will improve services for patients in the short term and for the next 20 years.  This project will develop an online platform to support health care professionals to achieve this aim by learning together using games and simulations.  These simulations are widely used in face-to-face development programmes but few effective online versions exist.

‘Gamified’ learning engages participants in ways that other approaches don’t – turning theory into practice and allowing groups to test their learning in safe environments.  Our survey shows that QI teams across the UK are struggling to adapt their existing learning programmes for a virtual setting.

This project will build an online platform to provide an engaging, interactive and fun experience for learning about QI, designed to supplement existing training programmes that many organisations have already developed.

How will the project be delivered?

Our team has considerable experience in improvement, development and innovation in healthcare.  We have consulted digital strategy experts and previous Q winners to develop our outline approach for delivery:

  • Select our digital partner – we will identify an experienced digital design partner to support successful development.
  • Establish a user community – we have begun to build a UK-wide community of users who can help us develop and test this platform
  • Design our strategy and roadmap – full market review, define what users require, plan the development roadmap
  • Develop the concepts – collate and adapt existing games and understand how they translate into a virtual setting – both game mechanics and learning outcomes
  • Evaluation framework – build in measures of uptake, learning and user experience
  • Agile development – early delivery of a prototype and iterative development with our users mitigates risk
  • Sustainability – licensing structure or secure national funding to support business model

How is your project going to share learning?

There is fantastic potential for this project to support shared learning across the NHS and beyond.  Almost every health and social care organisation with QI ambitions is struggling with the challenge that we hope to address.

In just two weeks, our survey identified 26 organisations that are keen to collaborate directly with us and join our user community including 13 NHS Acute Trusts, 5 Community Trusts, 3 Mental Health Trusts,  2 integrated Trusts, a Regional Improvement collaborative and voluntary sector providers.  NHS Education Scotland and NHS England have also agreed to support this work.  We have connected with a range of QI networks and programmes that offer opportunities to share learning more widely.

Our diverse user community will support us to gain a deeper understanding what is needed to address the challenge.  They will shape our strategy and play a key role in the co-design, testing and evaluation of each iteration of the platform.

How you can contribute

  • Please use the comments below to help us shape our idea. You can complete our survey:
  • Potential collaborators - how could this be sustainably developed regionally or nationally?
  • Help us understand the appetite for this: what does your team/organisation need?
  • Share learning from previous digital projects - what are the success factors and pitfalls to avoid?
  • Our survey has so far shown that:
  • - 90% of respondents are currently delivering QI training online.
  • - Respondents reported challenges with adapting existing games to a virtual setting, including gaining participant engagement, facilitating team working and linking the simulation to the key QI learning points.
  • - All respondents said they would be interested in using a suite of interactive online games that could demonstrate QI concepts in both an individual and group setting
  • - Ease of use, cost and connectivity with existing IT systems were flagged as the most important factors for organisations when considering this proposal.

Plan timeline

15 Mar 2021 Launch virtual user group
23 Apr 2021 Identify digital partner
3 May 2021 Commence discovery work with digital partner & users
31 May 2021 Complete strategy, roadmap and updated budget
31 May 2021 Develop evaluation framework - uptake, learning outcomes, user feedback, customer satisfaction.
1 Jun 2021 Commence phase 1 - design start-up model
30 Jul 2021 Complete initial development iteration
13 Sep 2021 Complete iteration 2
18 Oct 2021 Complete iteration 3
1 Nov 2021 Commence phase 2 - Launch
12 Nov 2021 Confirming licensing / funding model
26 Nov 2021 Develop marketing campaign
30 Nov 2021 Launch marketing
30 Nov 2021 Live platform available with viable functionality
1 Dec 2021 Commence phase 3 - Sustainable development
3 Jan 2022 Jan 2022 onwards - scheduled development of new functions

Project updates

  • 17 Nov 2021

    After months of developing our specification and engaging with digital developers, we are delighted to announce that we have selected award-winning Focus Games ( as our digital partner to develop our innovative digital QI game.

    Now that we’re finally entering into the design and development phase of the project we’re really excited to start to translate the ideas and concepts that have been developed in our discovery phase into something tangible. We will be looking to continue to draw on the expertise of our wider user group as we start to test and iterate the game and will be in touch with those who have expressed an interest in supporting this.

    We aim to move quickly with the development of our game between now and the New Year and will continue to share updates on our Twitter Account  ( so keep an eye out to stay in the loop!

  • 9 Sep 2021

    We’re now at the mid point of our Q Exchange project and have made some really positive progress and learnt a huge amount throughout the project so far. To summarise our progress to date:

    • January 2021 Successfully awarded Q Exchange funding.
    • February 2021 Gathered initial insight from the QI community, with 47 people from across the UK showing an interest.
    • March 2021 Ran 3 separate user groups, gaining valuable focused insight on what users may want from our platform.
    • April 2021 Worked through the outputs of the user groups and started to build up a specification of what we’re looking to deliver. This has continued to be refined and developed on an ongoing basis.
    • May 2021 Initial engagement with digital providers to gain insight into the digital design process.
    • July & August 2021 Formed a developed specification and digital strategy to inform more focused conversations with digital developers.

    We have found this process really rewarding so far and have appreciated the engagement from other members of the QI community in helping to develop our idea. Stepping into the unknown world of digital development has been incredibly interesting and an area in which we are continually learning more about. Our next steps for the project look something like:

    • Choose a digital partner to develop the game with.
    • Start to build a wireframe concept of how our game will look with our digital partner based off our working specification.
    • Involve our user group with play testing our wireframe concept as part of the co-design process.
    • Develop a finished product that we are happy matches the requirements set out in our working specification.

    We’re really looking forward to moving into the design and development phase of our project and will continue to share updates as we progress!

  • 26 Jan 2021

    Huge thanks to everyone who has expressed an interest and supported this idea so far.  We’re delighted that our proposal has been successful and this project will be funded!  It’s not too late to get involved – please complete our survey and leave your details if you haven’t already.  We will be in touch soon to convene our user community and get things started!


  1. Really interested in helping with this and just looking at games for Lean at the moment. I am also friends with one of the makers of Playing Lean who might be a good person to talk to about adapting the boardgame to be run virtually . I played it last week very interesting using breakouts and mural boards.

  2. Guest

    Cal Allen-Ridge 1 year, 5 months ago

    Hi all,

    Absolutely love the idea behind this project, internally my colleagues and I are currently looking at how we adapt a face to face game onto a digital platform without loosing the learning and fun of interaction!

    Previously, we have also looked at how an insurance game can be adapted through breakout rooms and shared documents.  It is great to see in the comments already some of the other ideas coming from across the community.

    It would be great to see how many of these digital tools also add value to teaching QI methodology even when we are able to start to move back to face to face teaching.

    I have updated the survey response with our contact details and we would love to get involved and support where we can.

    Cal and Caitlin - QI team UHBW



  3. This looks great and a fresh way to approach QI.  Keep us posted on the progress.

  4. Guest

    Louise Crane 1 year, 6 months ago

    This looks really interesting and happy to be a guinea pig if needed.  We are really interested in making QI accessible to all roles within the Trust and involving Experts by Experience.
    Kind regards  Louise

  5. Would be very interested in this. If you want any more interest in testing of any materials do get in touch, we do facilitated online QI training modules for staff in Leeds Teaching Hospitals monthly, and other sessions ad hoc too.

    1. Good afternoon Alison

      Long time no speak

      Finally back in the QI and Patient safety world

      Am developing QI skill within the independent sector and intrigued with the  facilitated on line training you mention- i am just about to purchase some Mr. Potato head as a fun into to QI

      are you happy to share your approach and tools



  6. Hi Jonathan

    Could please resend the survey. May have missed the initial email. My details are Many thanks

  7. Guest

    This sounds like a great project, be interested to keep up to date. Are any of your project team on twitter? I have completed your survey :)

    1. Thanks Michelle, we’ll be in touch soon. You can follow us on Twitter @KHFTQI and @JonGrellier

  8. Guest

    Rachel Volland 1 year, 6 months ago

    This project sounds really interesting and worth while, engaging people in QI can be tough at the best of times on top of that to do it virtually can be a big ask.  I would love to hear more and be kept up to date.  Thanks

    1. Thanks Rachel, we’ll be in touch soon!

  9. This is a great idea, gutted I didn't see this earlier, let me know if you still require a digital partner, I lead a not-for-profit tech startup focused on governance technology and this is right up our street. Here is a link to the website if you want to find out more .

    All the best


  10. Hi, this is definitely needed and I would love to get involved with this Agile project. I’m moving all QI training to virtual so having access to fun, educational tools and simulations would be very welcome.

    Heather Warner, Improvement Lead, Worcestershire Acute.

    1. Great!  Thanks for completing the survey, Heather.  We will be in touch soon!

  11. Just starting with our virtual QI offer and also incident investigation training would love to be involved and be interested in working with you

    1. Thanks for the support Barbara - we'll be in touch soon!

  12. We've set up a short survey to gather some greater understand of how people are currently dealing with this challenge and also what you all need from a platform like this.  Please take the survey and circulate it through your networks:


    1. Just think the idea is brilliant to be creative and show enjoyment and understanding through fun activities would greatly help build peoples capability and I have completed your short survey. We currently are beginning to deliver virtual training within an Integrated Care System in Nottinghamshire across all types of sectors. It would be enhanced to have a range of tools to cater for all aspects of clinical and non-clinical participants of the training. Would love to be involved in a user group to explore further.


  13. Hi Jonathan

    This looks great and would really help to engage staff with QI in this new environment.

    Very happy to help and test!


    1. Thanks Christine!  Would be great to have you involved in our user group.  We're planning to put out some dates soon to gather interested people to help us develop and test the idea.  I'll be in touch!

  14. Guest

    Christian Subbe 1 year, 10 months ago

    Locally I can quote three games that are being played:

    - Behaviour change game - a bit like 'Cards against humanity' but with behaviour change mechanisms as the options.

    - The Flow Game - board game with rules to distribute teams & resources as the hospital gets' fuller.

    - Game of stools - developed in Bangor but available as a board game to reduce C.diff.

    1. Christian - really interested to hear more about those ideas!  I'll be in touch about potential involvement in a user community to support the development of the platform.

  15. Hi Jonathan,


    I echo the comments that this is a great and much needed idea. I would love the opportunity to see what others are using and what ideas we can develop. We have just started to use a virtual Mr Potato Head on Miro which, although early days, has received some positive feedback.

    Good luck with your idea and would love to be involved.


    1. Great to hear that you're already working on stuff Chris!  Thanks for the support.  I'm hoping to bring together a user community to support the develop of this idea, so I'll make sure to keep you in the loop.

  16. Guest

    Kristina Sexton 1 year, 10 months ago

    Hi Jonathan,

    Great idea - having interactive games for QI training courses always goes down well and really helps embed the learning for those new to the principles. The current climate of microsoft teams etc. has really affected this, so a suite of tools that could bring this to the world of online training would be great!

    Would love to be involved!

    1. Thanks Kristina - would be great to have you involved!  I'm think it might make sense for us to convene a virtual co-design group / user group to gather early ideas.  I'll drop you a line.

  17. Hi Jonathan, what a great idea and would be good to see this developed through the wide talents of the Q Community. We've recovered our Learning for Improvement course using MS Teams, for example using coin spin and we'd be very interested in tools that would give a more interactive feeling and experience for staff.  Susan @fv_quality

    1. Hi Susan, thanks for your support! Yes, I think so many of us are in the same boat.  Lots of rapid learning and creativity going on with the use of Teams and Zoom, but I feel certain we could design something that would make it easier to trainers and participants alike.  I've been in touch with the FCA team who are also interested in linking in with this.  I'll keep you in the loop.

  18. A great idea!  I have been tasked with creating a virtual programme of QI learning for our Trust and would just love to be able to do something practical and exciting to demonstrate QI methodology.  Would be great to share ideas and learning going forward.

    1. Thanks Donna!  Great to hear that you are thinking along similar lines.  Have you tried adapting any of your existing games/simulations?  It would be great to know which ones you would like to be able to use in a virtual setting.

  19. Guest

    Dan Richter 1 year, 10 months ago

    Great idea - I was literally saying the same thing was needed to a colleague who works in QI at a neighbouring hospital.

    I'd be really keen to help this project if my skills fit the requirements.

    1. Thanks for your support Dan!  Would be great to hear more about your thoughts on this. Happy for you to get in touch via

  20. Guest

    katja Doerholt 1 year, 10 months ago

    Looks like a great project, I really think this is the way forward and will allow for more people to participate and therefore support your aim to widely influence  through existing networks.

    1. Thanks for your support Katja!

  21. Your project idea is very relevant and there's a real gap and need for this in the world of improvement and capability building in improvement. Its great that you are thinking broadly and considering games that cover not just IHI approaches but lean/ continuous improvement techniques as most trusts/ organisations move towards a more blended improvement approach. I'll be supporting your idea and will share any other tools I come across. Might be worth contacting Dr David Williams creator of Mr Potato head and coin spin PDSA exercises for some ideas on how these could be done virtually in the event he's got ideas for a virtual simulation approach. Good luck

    1. Hi Chioma, thanks for your comments and support! Its really encouraging to hear that so many others are thinking about this.  Great idea to contact David Williams.

  22. So far it’s just been limited to use of break out rooms and a little use of the whiteboard sharing facility in zoom. We are also trying to wrap our heads around teams. We’ve had support with zoom because our team is invested in an online teaching methodology called Echo but there’s so much room for creativity/learning. This is a perfect time to be having this conversation. Thank you.

  23. We are having the same conversations at my work so I will ask around for ideas and will be watching closely and hopefully will be able to contribute.

    1. That would be great, thanks Cat.  I'd love to hear your ideas and what would really add value for you and your colleagues.

  24. This is a brilliant and much needed idea Jonathon, the more accessible and fun the learning tools are the better for improvement everywhere. Really looking forward to hearing more about this.

    1. I will have a think/ask colleagues and get back to you, there are so many possibilities with this. Would you mind sharing your email address or prefer replies on here?

    2. Thanks Joanna!  Do let me know if there are particular things you would want to see from an application like this.  I'm really keen to hear from peers who are tackling the same challenges.  I think there is scope to develop anything from generic games (PDSA, 5S etc) to more specific simulations (emergency care flow, theatres demand and capacity).

  25. This sounds like a great idea Jonathan! People are moving more and more towards online education and training in so many areas now that it is really the way forward. This could really help promote QI methodology as gives a very convenient and accessible platform. Keeping it interactive and flexible should really help engage with a wider audience.

    1. Thanks Theresa!  Yes, we've seen really good results with group simulations and games in face-to-face training.  It helps deepen understanding of core QI principles and also develops helps teams reflect on how they work together.  Its often the thing that people remember most about the development programmes.  The move to online brings loads of benefits, but I think we're struggling to replicate the quality of that experiential learning.

  26. Guest

    Penny Neild 1 year, 10 months ago

    A truly collaborative initiative, recognising the particular importance of interaction and entertainment in learning QI in the virtual environment - this would be a very welcome suite of resources Jonathan - good luck!

    1. Hi Penny - thanks for your support!  Its so important that this stuff is fun and interactive.  It helps build understanding and can also be a great way to get diverse groups of stakeholders working together at the beginning of an improvement collaborative.  Could work well in a Big Room!

  27. There’s definitely a need for this and this would be an effective and exciting way to engage people in QI

    1. Thanks Alison.  I think that's right - we have some great ways of getting people engaged with face-to-face training and really learning from doing in those simulations. It would great to be able to replicate that in a virtual environment.

  28. Definitely an unmet need, Jon. Other collaborators include QSIR Faculty.

    1. Thanks Hesham - that's great advice, I'll get in touch with them.  I think there are a relatively limited set of these activities that are currently in widespread use, so I'm sure we could develop something that would be very widely applicable, regardless of any organisations particular brand of QI.

  29. Great idea Jonathan

    Good luck. Look forward to hear more.


    1. Thanks Sophia - if you have any thoughts about what kind of things would be most useful on a platform like this, please let me know.

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