The EPIC PROJECT

 

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Please see below for rule book

Introduction

The aim of this project is to use gaming theory to improve behaviour, increase productivity, promote positive practices (such as work place based assessments, audit, improved patient care initiatives) and reduce negative activity by doctors within the emergency department. This involves a game-like project that is fun to do so all want to participate (it is voluntary) multiple micro rewards to keep people interested and involved and increasing rewards along the way. This is akin to Levels achieved within gaming platforms. There will also be the opportunity to earn more credits by doing activities beyond the basic to enhance both the department and individuals’ skills and bring people further along the game and nearer the rewards.  

Credits are weighted to ensure that more credits are gained for activities that are more complex or more unusual and where very positive effects can be achieved for the department, greater rewards are given. Activities which are to be strongly encouraged, such as work place based assessments will also be given a credit weighting. 

Other concepts that excite people are unexpected rewards, akin to double reward points or BOGOF offers, thus there will be double credit weeks, monthly credit lottery and other bonus points opportunities for people to boost their points with either a little or no extra effort.

In the gaming world there is always a certain amount of negative as well to keep things interesting (such as sliding down the snake in Snakes and Ladders, losing a life in many games, Go to Jail in Monopoly etc.). So behaviours, practice or activities that we want to discourage we will have a credit fine system. In order to keep it with the spirit of gaming and not perceived as punishment, the weighting system for negative credits is such that the real impact of the fines is minimal, and it is the process of fining, rather than the value that has an effect.

Credits

These are cumulative throughout the attachment. The earned credits are broken down into main areas of normal or desired activity or behaviour.They would be maintained by a named and designated consultant: The Game Master with clerical support. Access to this information would be via the departmental website and all participants can see the total scores, and prizes earned or due.

Rewards Levels are attained at certain numbered points, see “Reward Levels” below.

Reward Levels

Rewards are given as certain levels are achieved by earning enough credits. Lower number of credits, for example level 1 must be achieved prior to the next level being sought, and as the levels get higher more points are required and the prizes are correspondingly better. The details of the actual prizes would be subject to budget constraints and the following is for example only. There are 6 levels, the terminology of which is based on metals of increasing value:

Levels

Based on an ‘average’ FY2 trainee current work being able to reach level 4 by the end of 4 months, we can set the following:

Level  1 (Iron)  0-1499

Level  2 (Bronze)1500-3499

Level  3  (Silver)3500-4999

Level  4 (Titanium)5000-7499

Level  5  (Gold)7500-7999

Level  6  (Platinum)>8000

Many will be able to progress but some won’t and few will attain the highest levels, as it should be in a game scenario, corresponding to the greater efforts, but greater rewards.

This project aims to encourage doctors working in all grades to become involved in something which is both fun, engaging and rewarding and uses gaming theory to encourage better performance, education, behaviour and especially rewards those who go above and beyond to excel and get involved with projects that will develop themselves and improve patient care.

Process

Trainees will have credits for clinical work automatically added, with appropriate weightings for triage category, from Symphony into the database (with adjustments for length of attachment applied automatically). This will be updated daily.

Other credits for WBA, procedures, teaching etc will be done by the specific ‘credit slip’ being filled in by the responsible senior clinician. Thus if a Specialty Registrar/Consultant does a WBA with a junior, they will fill out, date sign the form. Confirmation of completed audit or life support  courses etc must be supplied to the trainee’s clinical supervisor or the project administrator for credits to be applied. The completed ‘credit slip‘ can then be given to the Project Administrator, posted in the ‘credit slip posting box ‘ (which will be on the wall in the department) or given to a consultant for inputting. This should ensure that it is very easy to collect credits and feed them to the appropriate place for entry and it will work 24 hours a day, 7 days a week. 

InputTing Credits

As mentioned above, the day to day clinical workload will be inputted from Symphony automatically and updated daily. Further entry of credits into the database will by done by the project administrator from credit slips handed in to them by trainees, consultants or from the credit slip posting box. The administrator and all the consultants, will have the ability to input credits to all of the trainees. The database will have a drop down list of all the different credits that can be earned broken down by type (procedures, educational, WBA, etc) and it will record who is inputting the credits and the date to enable a log of the input activity for analysis.

Accessing data

This will be via the dashboard using log-in user name and password. On logging in, the system will automatically allow the trainee to see their peer group (e.g. FY2’s) points graph, anonymised except for their own name and the leader of the group. 

When trainers log in, the system will recognise them and enable them to access all the data for only their individual clinical trainees. Thus trainers will not have access to all trainees data to help maintain some confidentiality and prevent  trainees feeling that ‘big brother’ is monitoring them. The project administrator and project developers will have access rights to all the data from all the trainees to enable trouble shooting and assist trainees access information if they are still learning how to engage with the game. Any change to this can be done with the agreement of the steering group.

Administering the project

There will be a ‘EPIC Steering Group’ which will meet monthly. It’s remit is to ensure that the project is running smoothly and support the administrator, deal with any queries that are raised, help adjudicate on bonuses and other adjustments to credits or procedure (to ensure transparency and fairness) and collate and approve results of any analysis of the project.  

It will contain the following members;

Project developer (Nick Gili &/or Colin Dibble)

Project Administrator

Trainer representative (consultant)

Junior trainee representative

Senior trainee representative

Secretary to keep minutes

It will not be privy to any specific individuals data to ensure confidentiality, though issues raised may be made anonymous.  

EPIC RULE BOOK

EPIC RULE BOOK

 

Credits are automatically added to each clinician’s totals from the live system, for each patient seen according to triage category

 

TRIAGE CATEGORY

CREDITS

Red

20

Orange

15

Yellow

10

Green

5

Blue

2

Rapid Assess (Kumar)

5

Double points added between 7-8am (as activity is poor due to change over of staff)

 

Further credits are added by each clinician submitting credit slips which are then added manually by either the EPIC Coordinator or one of the Trainers

 

PROCEDURES

CREDITS

ALS

40

APLS

100

ATLS

70

Aspirate Pneumothorax

20

Chest Drain

100

Aspirate Joint

30

Central Line

50

Arterial Line

30

External Jugular Cannulation

5

Catheter Insertion

20 10

Supra-pubic Catheter (new placement)

70

Large Joint (e.g. shoulder, ankle) Manipulation

40

Small Joint (e.g. finger, wrist) Manipulation

25

Removal of Foreign Body

15

Application of Plaster

20

Application of Thomas/Pelvic Splint (or equivalent)

30

Intra-osseus Insertion

50

Cardioversion

50

Pericardiocentesis

150

Intubation/LMA Insertion

50

Breaking Bad News

25

Needle Cricothyroidotomy

150

Surgical Cricothyroidotomy

200

Sengstaken Tube Insertion

150

Suturing

15

Ring Block

10

Nasal Packing

25

I&D

15

Delivery

50

Decompression Tension Pneumothorax

40

Adenosine

15

Ultrasound Guided Peripheral Cannulation

5

Femoral Block

20

 

An initial list was drawn up prior to the start of the game and the highlighted items were added after being discussed at the steering group 28/09/12 & 17/10/12.

Catheter Insertion credits lowered after being discussed at the steering group meeting 17/10/12

 

WORK BASED ASSESSMENTS

CREDITS

DOPS/CEX/CBD (Specialty Registrars/Doctors)

20

DOPS/CEX/CBD (FY1/FY2/GPBTS/ACCS/FTSTA/ST3)

40

BONUS in first month (per WBA)

15

BONUS in second month (per WBA)

10

BONUS in third month (per WBA)

5

360 Degree Appraisal/MSF etc

50

BONUS in first quarter (per WBA)

15

BONUS in second quarter (per WBA)

10

BONUS in third quarter (per WBA)

5

 

Doctors that are here for 1-6 months earn extra credits for completing WBA’s in months 1, 2, & 3. Doctors who are here for 12 months earn extra credits for completing WBA’s in quarters 1, 2, & 3.

 

To encourage more WBA’s to be completed in month 1 or 2, DOUBLE credits could also be offered between certain dates. Anyone on annual leave could then be offered the same on the week they return.

 

 

 

AUDIT

CREDITS

Completed and Presented Audit

150

Completed and Re-audited (loop closed)

250

 

 

TEACHING/LEARNING

CREDITS

Courses Completed (e.g. ALS, ILS, APLS, ATLS)

100

Providing formal teaching (medical students etc)

30

Case Presentation (grand rounds etc)

50

On-line modules completed

30

Supervising medical students (per day)

20

Successful passing professional exams (per part)

150

 

 

FY2

CREDITS

Ward Round

10

Discharge Letter

5

Clinic patient seen (and presented)

5

 

SPECIALITY/REGISTRAR DOCTOR

CREDITS

Dealing with a complaint

30

Acting on abnormal results

30

Prepare coroners report

50

Investigate incident

30

Lead trauma team

50

Perform WBA with junior

10 20

Lead Journal Club

30

Present at M&M

50

Perform Sedation (ST3’s also)

40

Perform Biers Block

40

Senior Review

4

Perform WBA with junior credit raised to 20 credits to compensate for the time spent with junior away from seeing own patients. This was as a result of a discussion at the steering group 28/09/12.

ST’3s added after discussion at the steering group meeting 18/12/12

 

 

 

 

Bonuses can be credited on an ad hoc basis by Consultants for improved performance

 

BONUSES

CREDITS

Bonus 25

25

Bonus 50

50

Bonus 100

100

Bonus 150

150

Bonus 200

200

Bonus 250

250

Bonus 500

500

 

Credits can also be taken away

 

FINES

CREDITS

Excess or recurrent tardiness without excuse

-10

Upheld patient complaints (after investigation)

-10

Miscellaneous ad hoc fines

-10

 

WEIGHTINGS

Credits are currently weighted according to how many months each group are in the game. Doctors who are here for a 4 month period get full value for their credits, if they are here for 6 months they get .667 per credit and if they are her for 12 months they receive .334 per credit.

Any part-time staff also need to be weighted to enable them to earn points pro-rata to their hours.

 

LATE STARTERS

Clinicians starting their rotation late need to be compensated to bring them on to a level playing field. The credits missed at the start of the rotation could be added to their totals by way of a bonus equating to the credits earned over the same time period after their start date

E.G. if one full month is missed the credits earned in month 2 can be applied as a bonus. This ensures everyone is on a level playing field and people do not feel disadvantaged by not being here at the start of the game.

 

 

 

 

LEVELS

CREDITS

PRIZES

Iron

0

 

Bronze

1500

£10 £15 iTunes/Trafford Centre Voucher

Silver

3500

£20 £25 iTunes/Trafford Centre Voucher

Titanium

5000

iPod shuffle

Gold

7500

Half day off

Platinum

8000

iPod Touch 32GB

 

 

The initial prize levels of £10 and £20 raised due to iTunes vouchers not being available in these denominations, discussed at steering group 28/09/12