Disclaimer
This blog represents my own personal ramblings and has absolutely nothing to do with my employer, the NHS, Alley Cat Games, hospital bed managers or anybody unfortunate enough to possess an actual budget. No patients, real or imaginary, were harmed in the writing of this article. The imaginary ones during the game are a different matter entirely. Any references to healthcare are general observations from somebody who apparently enjoys going home from hospital and then playing a game about running another hospital.
Eddie has quite a few favourite board games.
Actually, that sentence probably undersells the situation.
There is Pandemic, because apparently preventing a global infectious catastrophe is suitable family entertainment. There is Marvel Legendary, where superheroes repeatedly fail to cooperate unless the correct cards happen to appear. There is NMBR 9, which proves that even arranging cardboard numbers can become fiercely competitive in our household.
And then there are many, many others.
However, one of Eddie’s current favourites came into our possession in slightly unusual circumstances at this year’s UK Games Expo.
While I was extremely busy “working” on the CGE stand — and I use the quotation marks purely because anyone who has ever worked at UKGE knows that “working” involves a curious mixture of explaining board games, playing board games, discussing board games and occasionally remembering that you are technically representing a company — Eddie wandered off with my wife and discovered another stand.
There, children were being encouraged to design a board game.
This was obviously dangerous.
You should never ask a child who already plays more board games than many adults to design another board game. It is the tabletop equivalent of handing Jeremy Clarkson a set of car keys and asking whether he would like to go somewhere quietly.
Nevertheless, Eddie produced his design, submitted it and, as a prize for his efforts, was given a copy of Dice Hospital: ER – Emergency Roll.
At the time I thought this was quite amusing.
A hospital game.
For our household.
Excellent.
Because clearly what I need after spending a day dealing with surgical patients, referrals, investigations, beds, discharge planning and the occasional unexpected clinical catastrophe is to come home, sit at the dining-room table and voluntarily deal with more patients, beds and unexpected catastrophes.
Welcome to Your New Emergency Department
Dice Hospital: ER – Emergency Roll is a standalone flip-and-roll-and-write game in the Dice Hospital universe. It plays with up to six people and is theoretically a fairly quick game.
I say “theoretically” because board-game playing time never accounts for children asking questions, adults checking rules they were absolutely certain they understood five minutes earlier, drinks being knocked over or somebody announcing halfway through that they need the toilet.
The basic idea is wonderfully simple.
You have your own hospital sheet containing several wards. Patients arrive represented by coloured dice. Each round, an ambulance card is revealed and the dice are rolled, giving you combinations of patients and actions. The Chief Physician gets first choice, while everybody else selects from what remains.
Already this feels familiar.
One person makes a decision.
Everybody else deals with what is left.
Healthcare simulation achieved.
You then admit patients by writing their dice values into available beds within your wards. Patients generally need to be placed in ascending numerical order, and colours matter as well.
So you cannot simply look at a patient and say:
“Yes, there’s a bed over there. Chuck him in.”
There are rules.
There are always rules.
Fortunately, you also have ways of manipulating the situation. Stethoscopes can adjust patient values. Blood bags give you additional flexibility. Screens allow you to reset the numerical sequence within a ward. Nurses generate additional scoring opportunities, while specialist objectives reward you for developing your hospital in particular ways.
Complete wards score points.
Critical patients can score points.
Nurses score points.
Specialists score points.
Everything is wonderful.
Until, inevitably, it isn’t.
Because eventually you will receive a patient whom you cannot fit anywhere.
And then we come to the morgue.
If you cannot — or decide not to — place a patient into your hospital, the unfortunate soul can be allocated to the morgue for a points penalty.
It is brutally efficient.
No Datix.
No mortality meeting.
No discussion about whether there were learning points.
Just:
Morgue. Minus one. Next patient.
I suspect the actual NHS management process may be slightly more complicated.
Our First Game
We first played Dice Hospital ER during the summer holidays when we went to Stephen’s house.
We brought the game with us, opened the box and did what experienced board gamers always do when confronted with a new roll-and-write game.
We stared at the player sheet.
We stared at the rules.
We looked back at the player sheet.
We read the rules again.
Then somebody confidently said:
“Actually, I think it’s quite straightforward.”
This is generally the moment immediately before discovering that nothing is straightforward.
To be fair, the rules are relatively simple. Roll the dice. Choose an ambulance. Admit the patient. Use the associated ability. Fill your wards. Score objectives. Try not to create a healthcare system entirely dependent upon sending people downstairs.
Simple.
Except board games are never really about the rules.
They are about the decisions those rules force you to make.
And at some point during that first game, Eddie encountered his first genuine healthcare-management crisis.
He had a patient.
He couldn’t place the patient where he wanted.
His choices were not particularly attractive.
He could make a decision that would effectively close off a ward for future admissions…
…or he could put the poor fellow in the morgue.
Now, as somebody who works in healthcare, I have been involved in some difficult conversations.
This was right up there.
Eddie became genuinely upset.
There were tears.
Not because he was losing.
Not because somebody had taken the dice he wanted.
But because this fictional collection of pencil marks now represented a patient and he did not want to send him to the morgue.
Stephen and I attempted to provide appropriate senior clinical support.
Which consisted largely of:
“Well… we’re not entirely sure which option is better.”
Excellent leadership.
After considerable deliberation, Eddie finally made his decision.
The patient went to the morgue.
There was a moment of silence.
We moved on.
It was too late for him anyway.
And having overcome this significant emotional trauma and embraced the ruthless realities of fictional hospital management, Eddie proceeded to win the entire game.
By about one or two points.
Stephen was just behind him.
I was another point or so further back.
Which seemed particularly unfair because I had spent much of the game collecting intermediate scoring bonuses and feeling rather pleased with the efficient little healthcare empire developing on my sheet.
Apparently, none of that mattered.
An eight-year-old had sent a man to the morgue, wiped away his tears and beaten two adults.
Welcome to management.
Surprisingly Brutal for Such a Small Box
I have now played Dice Hospital ER four or five times and I really like it.
Partly because it is quick.
Partly because the rules are easy enough to teach.
But mainly because it is much meaner than it initially appears.
Not mean between players, particularly. You are not spending twenty minutes deliberately destroying somebody else’s hospital.
The game is mean to you.
Every hospital you create slowly develops its own problems.
One ward becomes difficult because you placed a high-value patient too early.
Another desperately needs a screen.
You are short of stethoscopes.
The perfect patient arrives in completely the wrong colour.
A specialist objective suddenly makes you rethink everything.
You desperately want one ambulance action, but somebody else has taken it.
You have plenty of space, just none of the right space.
Then another patient arrives.
Sound familiar?
Anybody?
NHS?
Surgery?
Bed meeting at 08:30?
It is perhaps the closest a roll-and-write has come to recreating the sentence:
“Technically we have beds, but unfortunately none of them are beds you can use.”
And that is where the game becomes genuinely interesting.
You are constantly making small compromises.
Do I maximise points now or preserve flexibility for later?
Do I complete this ward?
Do I use my blood bag?
Should I alter this patient’s value?
Should I take the bonus I want or the patient I can actually accommodate?
How badly will this decision come back to haunt me six rounds from now?
Again, none of this sounds particularly unfamiliar.
At work we call this clinical prioritisation.
At home Alley Cat Games calls it entertainment.
Why Do I Enjoy This?
This is perhaps the more worrying question.
After several games I have realised that Dice Hospital ER feels incredibly close to work.
Clearly not clinically.
Nobody should leave this article believing that real emergency medicine consists of rolling a yellow six, spending a stethoscope and drawing a circle around a nurse.
Although introducing dice into NHS workforce planning might at least make some decisions easier to explain.
What feels familiar is the constant resource management.
You never have quite enough of what you want.
Every decision affects something later.
A perfectly sensible choice five minutes ago can become spectacularly inconvenient because circumstances have changed.
You are trying to optimise several things simultaneously.
And eventually something happens which leaves you staring at the board thinking:
“Well, that’s not ideal.”
This is approximately 70% of surgery.
Perhaps that familiarity is why I enjoy the game.
There may be something slightly masochistic about spending my professional life solving hospital-related problems and then voluntarily spending my evenings solving smaller hospital-related problems printed attractively on a piece of paper.
But board gaming has never required rational explanations.
Some people relax by gardening.
Some people go fishing.
I apparently relax by recreating NHS capacity pressures using three coloured dice and a pencil.
Eddie, Chief Executive
The best part, however, remains that Eddie genuinely enjoys it.
Not simply because he won the first game — although I suspect this contributes significantly to his positive review — but because the game asks him to think ahead.
You cannot simply chase the immediate reward.
You need to preserve options.
You need to consider consequences.
Sometimes you need to accept that the perfect move does not exist and choose the least damaging option.
And, occasionally, despite your very best planning, somebody ends up in the morgue.
Educational family gaming.
For ages ten and over.
Probably.
There is also something wonderfully absurd about watching a child agonise over virtual hospital capacity while two adults sit opposite him offering completely useless advice.
And then losing to him.
Again.
Final Thoughts
Dice Hospital: ER – Emergency Roll is one of those small games that does far more than its box suggests.
It is quick, clever, portable and easy enough to teach without being remotely easy to play well. Every game I have played has produced slightly different problems, and that is probably why it keeps coming back onto the table.
The rules remain the same.
The patients don’t.
The problems don’t.
Your previous clever solution suddenly doesn’t work.
You improvise.
You ration resources.
You make uncomfortable decisions.
You move on to the next crisis.
Basically, healthcare.
Only here the whole thing takes about twenty minutes, everyone knows the rules and at the end somebody is definitely declared the winner.
So perhaps not that much like the NHS after all.
If you have never heard of Dice Hospital: ER – Emergency Roll and fancy trying it, it is published by Alley Cat Games and is currently available directly from them.
Just remember one thing.
When that first patient cannot be squeezed into a ward and you find yourself staring at the little morgue boxes at the bottom of your sheet…
don’t worry.
It’s only a game.
Unless you’re playing against Eddie.
Then it’s apparently a perfectly legitimate route to victory.
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