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Digital media design significantly influences the quality of gaming simulation studies in healthcare. The leading challenge scholars face is introducing innovative and valuable features to university students. The data\u2013simulation\u2013gaming pyramid could serve as a blueprint for outlining how interactive simulations could be conducted. A participatory design process is important in serious game development. More recently, the literature has illustrated the contribution of extended reality. However, researchers have not explored this research framework in detail. This paper traces the participatory design process of serious games using an emergency logistics case study in Stockholm, Sweden. It underscores the importance of choosing the correct narratives and game mechanics to support the implementation of serious games using extended reality for the demonstration of non-technical skills. The research findings are threefold. (1) The participatory design process helps to place focus on the implementing philosophy that values health equality in networked hospitals. (2) Further analysis reveals that gamification could turn everyday tasks in the emergency department, which represents a stressful workplace in a hospital, into a spectrum of learning experiences for in-demand skills, including situational awareness, leadership, communication, and ethical thinking. (3) A closer inspection of the reality-changing methods shows new requirements to shorten patient queues before and after the (implementation of the) strengthened waiting time guarantee proposal in 2024. There is abundant room for principals in healthcare institutions to implement reality-changing methods to foster collaboration at the departmental, cross-departmental, and cross-institutional levels.<\/jats:p>","DOI":"10.3390\/systems13030197","type":"journal-article","created":{"date-parts":[[2025,3,12]],"date-time":"2025-03-12T07:31:42Z","timestamp":1741764702000},"page":"197","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Serious Game Design for Teaching University Students to Address Complexity Issues in the Healthcare Logistics System: Lessons from an Emergency Department Case Study"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4704-5578","authenticated-orcid":false,"given":"Yan","family":"Sun","sequence":"first","affiliation":[{"name":"School of Management Science and Engineering, Shandong University of Finance and Economics, Jinan 250014, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4057-4124","authenticated-orcid":false,"given":"Chen","family":"Zhang","sequence":"additional","affiliation":[{"name":"School of Media and Design, Beijing Technology and Business University, Beijing 102488, China"},{"name":"School of Technology and Health, KTH Royal Institute of Technology, 14156 Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,3,12]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Nto, S.E., Oluwatola, T., Samuel, O., Okagbue, H., Atobatele, S., Ibanga, A., Adegoke, A., Emuren, D., Dumbulwa, S.A., and Sampson, S. (2024). Strengthening care for emergencies: What is the level of awareness and utilization of Emergency Medical Services (EMS) in FCT, Nigeria?. BMC Emerg. Med., 24.","DOI":"10.1186\/s12873-024-00991-2"},{"key":"ref_2","unstructured":"Musson, D.M. (2008). Crew Resource Management (CRM) in the Aviation Industry. Improving Healthcare Team Communication, CRC Press."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"S99","DOI":"10.1097\/TA.0000000000004017","article-title":"Determining the educational impact of virtual patients on trauma team training during a multinational, large-scale civil military simulation exercise","volume":"95","author":"Sonesson","year":"2023","journal-title":"J. Trauma Acute Care Surg."},{"key":"ref_4","first-page":"557","article-title":"Assessing Team Performance: A Mixed-Methods Analysis Using Interprofessional in situ Simulation","volume":"25","author":"Rider","year":"2024","journal-title":"West. J. Emerg. Med."},{"key":"ref_5","first-page":"5","article-title":"Strengthening administrative knowledge through a serious game","volume":"39","year":"2023","journal-title":"Cuad. Adm."},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Beishuizen, B.H., Stein, M.L., Buis, J.S., Tostmann, A., Green, C., Duggan, J., Connolly, M.A., Rovers, C.P., and Timen, A. (2024). A systematic literature review on public health and healthcare resources for pandemic preparedness planning. BMC Public Health, 24.","DOI":"10.1186\/s12889-024-20629-z"},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Flin, R., and O\u2019Connor, P. (2017). Safety at the Sharp End: A Guide to Non-Technical Skills, CRC Press.","DOI":"10.1201\/9781315607467"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"813","DOI":"10.1136\/postgradmedj-2020-139285","article-title":"What are the non-technical skills required by junior doctors in the NHS to manage medical emergencies? A scoping review","volume":"97","author":"Tan","year":"2021","journal-title":"Postgrad. Med. J."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"359","DOI":"10.1111\/acem.14694","article-title":"Delivery system emergency department capacity and its effect on nonsystem service utilization","volume":"30","author":"Tenso","year":"2023","journal-title":"Acad. Emerg. Med."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1016\/j.ajem.2023.01.028","article-title":"A roadmap for developing an emergency department based critical care consultation service: Building the early intervention team (EIT)","volume":"66","author":"Howard","year":"2023","journal-title":"Am. J. Emerg. Med."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1733","DOI":"10.1007\/s11739-024-03560-4","article-title":"Racial differences in triage assessment at rural vs urban Maine emergency departments","volume":"19","author":"Puissant","year":"2024","journal-title":"Intern. Emerg. Med."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"660","DOI":"10.1016\/j.jen.2023.11.010","article-title":"Left Without Being Seen: Nurse Work Environment and Timely Outcomes in New York and Illinois Emergency Departments","volume":"50","author":"Muir","year":"2024","journal-title":"J. Emerg. Nurs."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"23743735241282706","DOI":"10.1177\/23743735241282706","article-title":"Exploring Factors Influencing Orthopedic Patients\u2019 Willingness to Recommend a Hospital: Insights From a Cross-Sectional Survey","volume":"11","author":"Natan","year":"2024","journal-title":"J. Patient Exp."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Ali, S., Li, G., Yang, P., Hussain, K., and Latif, Y. (2020). Unpacking the importance of intangible skills in new product development and sustainable business performance; strategies for marketing managers. PLoS ONE, 15.","DOI":"10.1371\/journal.pone.0238743"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"221","DOI":"10.1177\/10468781231161955","article-title":"Richard D. Duke: Systems Thinker, Game Science Founder & Beloved Mentor","volume":"54","author":"Lukosch","year":"2023","journal-title":"Simul Gaming"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"543","DOI":"10.1177\/0037549709359090","article-title":"Profiling Literature in Healthcare Simulation","volume":"86","author":"Mustafee","year":"2010","journal-title":"Simulation"},{"key":"ref_17","first-page":"94","article-title":"Simulation analysis of a neonatal unit with complex patient flow patterns\u2014An enhanced model for capacity planning","volume":"33","author":"Perera","year":"2022","journal-title":"S. Afr. J. Ind. Eng."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"946","DOI":"10.1002\/cae.22616","article-title":"Teaching agile hardware development with an open-source engineering simulator: An evaluation with industry participants","volume":"31","author":"Omidvarkarjan","year":"2023","journal-title":"Comput. Appl. Eng. Educ."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1016\/j.tranpol.2023.11.006","article-title":"Differences in perceptions of fuel duties and emissions trading in road transport","volume":"153","author":"Santos","year":"2024","journal-title":"Transp. Policy"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"104381","DOI":"10.1016\/j.compedu.2021.104381","article-title":"Educating moral sensitivity in business: An experimental study to evaluate the effectiveness of a serious moral game","volume":"178","author":"Tanner","year":"2022","journal-title":"Comput. Educ."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"413","DOI":"10.1080\/1463922X.2022.2095457","article-title":"Participatory ergonomics approaches to design and intervention in workspaces: A literature review","volume":"24","author":"Rodrigues","year":"2022","journal-title":"Theor. Issues Ergon. Sci."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"378","DOI":"10.1108\/IJSHE-11-2023-0547","article-title":"Game-based learning about the circular economy in building sustainable communities: A case of international and interdisciplinary university collaboration","volume":"25","author":"Waite","year":"2024","journal-title":"Int. J. Sustain. High. Educ."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"105","DOI":"10.1016\/j.jclepro.2017.04.142","article-title":"Gaming for the energy transition. Experimenting and learning in co-designing a serious game prototype","volume":"169","author":"Gugerell","year":"2017","journal-title":"J. Clean. Prod."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"103414","DOI":"10.1016\/j.agsy.2022.103414","article-title":"A participatory approach based on the serious game Dynamix to co-design scenarios of crop-livestock integration among farms","volume":"201","author":"Ryschawy","year":"2022","journal-title":"Agric. Syst."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"2988","DOI":"10.1080\/0144929X.2021.1968034","article-title":"The co-creation design process of \u2018You & I\u2019: A serious game to support mentalizing and stress-regulating abilities in adults with mild to borderline intellectual disabilities","volume":"41","author":"Derks","year":"2022","journal-title":"Behav. Inf. Technol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"ii60","DOI":"10.1093\/heapro\/daac031","article-title":"Co-creating with families and healthcare professionals: Shaping a context-sensitive health promotion intervention \u2018Face-it\u2019","volume":"37","author":"Timm","year":"2022","journal-title":"Health Promot. Int."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"231919","DOI":"10.1098\/rsos.231919","article-title":"Modelling human navigation and decision dynamics in a first-person herding task","volume":"11","author":"Sandison","year":"2024","journal-title":"R. Soc. Open Sci."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"102561","DOI":"10.1016\/j.mex.2024.102561","article-title":"Resilient critical infrastructures: An innovative methodological perspective for critical infrastructure (CI) integrated assessment models by inducing digital technologies during multi-hazard incidents","volume":"12","author":"Kassem","year":"2024","journal-title":"MethodsX"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1097\/NNE.0000000000000817","article-title":"A Multisite Study Demonstrates Positive Impacts to Systems Thinking Using a Table-top Simulation Experience","volume":"46","author":"Sanko","year":"2021","journal-title":"Nurse Educ."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1211","DOI":"10.1007\/s10459-023-10212-3","article-title":"Integrating simulation and interpretive description to explore operating room leadership: Critical event continuing education","volume":"28","author":"Broski","year":"2023","journal-title":"Adv. Health Sci. Educ. Theory Pract."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"e7","DOI":"10.2196\/games.5006","article-title":"A Serious Game for Clinical Assessment of Cognitive Status: Validation Study","volume":"4","author":"Tong","year":"2016","journal-title":"JMIR Serious Games"},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Mand, N., Hoffmann, M., Schwalb, A., Leonhardt, A., Sassen, M., Stibane, T., Maier, R.F., and Donath, C. (2024). Management of Paediatric Cardiac Arrest due to Shockable Rhythm-A Simulation-Based Study at Children\u2019s Hospitals in a German Federal State. Children, 11.","DOI":"10.3390\/children11070776"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"e21988","DOI":"10.2196\/21988","article-title":"Game Experience and Learning Effects of a Scoring-Based Mechanic for Logistical Aspects of Pediatric Emergency Medicine: Development and Feasibility Study","volume":"9","author":"Zhang","year":"2021","journal-title":"JMIR Serious Games"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"155","DOI":"10.1007\/BF01405730","article-title":"Dilemmas in a general theory of planning","volume":"4","author":"Rittel","year":"1973","journal-title":"Policy Sci."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"567","DOI":"10.1007\/s10100-010-0178-z","article-title":"Hospital management games: A taxonomy and extensive review","volume":"18","author":"Kraus","year":"2010","journal-title":"Cent. Eur. J. Oper. Res."},{"key":"ref_36","first-page":"E32","article-title":"Interprofessional Simulation Learning Game Increases Socialization and Teamwork Among Students of Health Professions Programs","volume":"49","author":"Fusco","year":"2024","journal-title":"Nurse Educ."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"176","DOI":"10.1080\/13561820.2023.2243307","article-title":"Educational game improves systems thinking, socialization, and teamwork among students of 13 health professions programs","volume":"38","author":"Fusco","year":"2024","journal-title":"J. Interprof. Care"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"e13028","DOI":"10.2196\/13028","article-title":"Serious Games in Surgical Medical Education: A Virtual Emergency Department as a Tool for Teaching Clinical Reasoning to Medical Students","volume":"7","author":"Chon","year":"2019","journal-title":"JMIR Serious Games"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"e150","DOI":"10.2196\/jmir.3667","article-title":"A Virtual Emergency Telemedicine Serious Game in Medical Training: A Quantitative, Professional Feedback-Informed Evaluation Study","volume":"17","author":"Nicolaidou","year":"2015","journal-title":"J. Med. Internet Res."},{"key":"ref_40","doi-asserted-by":"crossref","unstructured":"Tong, T., Chignell, M., Tierney, M.C., and Lee, J.S. (2016). Test-Retest Reliability of a Serious Game for Delirium Screening in the Emergency Department. Front. Aging Neurosci., 8.","DOI":"10.3389\/fnagi.2016.00258"},{"key":"ref_41","unstructured":"(2024, January 23). Care at Karolinska University Hospital. Available online: https:\/\/www.karolinskahospital.com\/care-at-karolinska\/."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"532","DOI":"10.1089\/jwh.2022.0502","article-title":"Resilience Building Practices for Women Physicians","volume":"33","author":"Hobgood","year":"2024","journal-title":"J. Womens Health"},{"key":"ref_43","first-page":"54","article-title":"Process nurse: The experience of the Emergency Department of Fano","volume":"43","author":"Belardinelli","year":"2024","journal-title":"Assist. Inferm. E Ric. AIR"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1186\/s40560-024-00722-6","article-title":"Unit-to-unit transfer due to shortage of intensive care beds in Sweden 2015\u20132019 was associated with a lower risk of death but a longer intensive care stay compared to no transfer: A registry study","volume":"12","author":"Rylander","year":"2024","journal-title":"J. Intensive Care"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"101194","DOI":"10.1016\/j.ienj.2022.101194","article-title":"Educational intervention in triage with the Swedish triage scale RETTS\u00a9, with focus on specialist nurse students in ambulance and emergency care\u2014A cross-sectional study","volume":"63","author":"Olsson","year":"2022","journal-title":"Int. Emerg. Nurs."},{"key":"ref_46","unstructured":"(2024, January 05). National Incident Management System (NIMS), 3rd ed.; [Online], Available online: https:\/\/www.fema.gov\/media-library-data\/1508151197225-ced8c60378c3936adb92c1a3ee6f6564\/FINAL_NIMS_2017.pdf."},{"key":"ref_47","doi-asserted-by":"crossref","unstructured":"Rezvani, M.H., and Khabiri, D. (2018, January 29\u201330). Gamers\u2019 Behaviour and Communication Analysis in Massively Multiplayer Online Games: A Survey. Proceedings of the 2018 2nd National and 1st International Digital Games Research Conference: Trends, Technologies, and Applications (DGRC), Tehran, Iran.","DOI":"10.1109\/DGRC.2018.8712055"},{"key":"ref_48","doi-asserted-by":"crossref","unstructured":"Rahimabad, R.M., and Rezvani, M.H. (2020, January 23\u201324). Identifying Factors Affecting the Immersion and Concentration of Players in Serious Games. Proceedings of the 2020 International Serious Games Symposium (ISGS), Tehran, Iran.","DOI":"10.1109\/ISGS51981.2020.9375239"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"e28674","DOI":"10.2196\/28674","article-title":"The co.LAB Generic Framework for Collaborative Design of Serious Games: Development Study","volume":"9","author":"Jaccard","year":"2021","journal-title":"JMIR Serious Games"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"420","DOI":"10.1111\/j.1365-2729.2008.00279.x","article-title":"Serious games for higher education: A framework for reducing design complexity","volume":"24","author":"Westera","year":"2008","journal-title":"J. Comput. Assist. Learn."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"279","DOI":"10.1386\/cjcs.10.2.279_1","article-title":"Future Story Chasers: An experience with co-creation of fiction in the classroom through a collaborative storytelling game","volume":"10","author":"Roig","year":"2018","journal-title":"Catalan J. Commun. Cult. Stud."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"e202","DOI":"10.1017\/dmp.2022.144","article-title":"Identifying the Challenges of Simulating the Hospital Emergency Department in the Event of Emergencies and Providing Effective Solutions: A Qualitative Study","volume":"17","author":"Shirazi","year":"2022","journal-title":"Disaster Med. Public Health Prep."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"945","DOI":"10.1007\/s00068-023-02386-7","article-title":"Evaluation of prehospital preparedness for major incidents on a national level, with focus on mass casualty incidents","volume":"50","author":"Ugelvik","year":"2024","journal-title":"Eur. J. Trauma Emerg. Surg. Off. Publ. Eur. Trauma Soc."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"103657","DOI":"10.1016\/j.nepr.2023.103657","article-title":"Effectiveness of a nursing board games in psychiatric nursing course for undergraduate nursing students: An experimental design","volume":"70","author":"Wu","year":"2023","journal-title":"Nurse Educ. Pract."},{"key":"ref_55","unstructured":"Orbanes, P. (2023, May 02). Everything I Know About Business I Learned from Monopoly, Harvard Business Review, Available online: https:\/\/hbr.org\/2002\/03\/everything-i-know-about-business-i-learned-from-monopoly."},{"key":"ref_56","unstructured":"Donovan, T. (2017). It\u2019s All a Game: The History of Board Games from Monopoly to Settlers of Catan, Thomas Dunne Books."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"583","DOI":"10.1080\/13561820.2018.1544118","article-title":"Identifying intangible assets in interprofessional healthcare organizations: Feasibility of an asset inventory","volume":"33","author":"Rider","year":"2019","journal-title":"J. Interprof. Care"},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"345","DOI":"10.1017\/S0266464X17000483","article-title":"Online Role-playing Games and the Definition of Theatre","volume":"33","author":"Nellhaus","year":"2017","journal-title":"New Theatre Q."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"120","DOI":"10.1080\/00038628.2021.2008299","article-title":"Architectural cognition cards: A card-based method for introducing spatial cognition research and user-centred thinking into the design process","volume":"65","author":"Mavros","year":"2022","journal-title":"Archit. Sci. Rev."},{"key":"ref_60","first-page":"411","article-title":"Impact of the Use of the Video Game SimCity on the Development of Critical Thinking in Students: A Quantitative Experimental Approach","volume":"18","year":"2023","journal-title":"IEEE Rev. Iberoam. Tecnol. Aprendiz."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"14","DOI":"10.29276\/redapeci.2023.23.117679.14-25","article-title":"Educa\u00e7\u00e3o e divers\u00e3o: A franquia \u2018The sims\u2019 no processo de aprendizado com jogos eletr\u00f4nicos","volume":"23","year":"2023","journal-title":"Rev. EDaPECI"},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"47","DOI":"10.17083\/ijsg.v7i1.334","article-title":"Serious Gaming of Logistics Management in Pediatric Emergency Medicine","volume":"7","author":"Zhang","year":"2020","journal-title":"Int. J. Serious Games"},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"110670","DOI":"10.1016\/j.cie.2024.110670","article-title":"Enhancing internal supply chain management in manufacturing through a simulation-based digital twin platform","volume":"198","author":"Cimino","year":"2024","journal-title":"Comput. Ind. Eng."},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"e28982","DOI":"10.2196\/28982","article-title":"Serious Game for Change in Behavioral Intention Toward Lifestyle-Related Diseases: Experimental Study With Structural Equation Modeling Using the Theory of Planned Behavior","volume":"10","author":"Egashira","year":"2022","journal-title":"JMIR Serious Games"},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"2561","DOI":"10.2147\/OPTH.S369697","article-title":"Video Game Warm-Up May Suggest Improvement in Ophthalmic Surgical Simulator Performance in Surgically Na\u00efve Students","volume":"16","author":"Khimani","year":"2022","journal-title":"Clin. Ophthalmol."},{"key":"ref_66","doi-asserted-by":"crossref","unstructured":"Zagata, K., and Medy\u0144ska-Gulij, B. (2023). Mini-Map Design Features as a Navigation Aid in the Virtual Geographical Space Based on Video Games. ISPRS Int. J. Geo-Inf., 12.","DOI":"10.3390\/ijgi12020058"},{"key":"ref_67","first-page":"1","article-title":"Modos y est\u00e9ticas de la espera en los videojuegos","volume":"30","year":"2022","journal-title":"Artnodes"},{"key":"ref_68","unstructured":"Hall, A. (1962). A Methodology for Systems Engineering, Nostrand Company."},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"104128","DOI":"10.1016\/j.tate.2023.104128","article-title":"The role of expertise in playful learning activities: A design-based self-study within teacher education aimed at the development of tabletop role-playing games","volume":"128","author":"Boysen","year":"2023","journal-title":"Teach. Teach. Educ."},{"key":"ref_70","doi-asserted-by":"crossref","unstructured":"Harteveld, C. (2011). Triadic Game Design: Balancing Reality, Meaning and Play, Springer. [2011th ed.].","DOI":"10.1007\/978-1-84996-157-8"},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"586","DOI":"10.1177\/1098214020986619","article-title":"Using the Homeland Security Exercise and Evaluation Program (HSEEP) Building Block Approach to Implement System Evaluation Theory (SET)","volume":"42","author":"Renger","year":"2021","journal-title":"Am. J. Eval."},{"key":"ref_72","first-page":"15","article-title":"Latent safety threats in a pediatric emergency department: Using in situ simulation to test a new trauma room concept","volume":"187","author":"Lordemann","year":"2024","journal-title":"Z. Evidenz Fortbild. Qual. Gesundheitswesen"},{"key":"ref_73","doi-asserted-by":"crossref","unstructured":"Alipour, F., Jamshidizadeh, S., Bastani, P., and Mehralian, G. (J. Health Organ. Manag., 2022). The balanced scorecard as a strategic management tool in hospital pharmacies: An experimental study, J. Health Organ. Manag., ahead-of-print.","DOI":"10.1108\/JHOM-07-2021-0256"},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"100577","DOI":"10.1016\/j.crm.2023.100577","article-title":"Co-designing a just resilience balance scorecard with experts in islands and coastal cities","volume":"43","author":"Carvalho","year":"2024","journal-title":"Clim. Risk Manag."},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"393","DOI":"10.1002\/rhc3.12285","article-title":"A Balanced Scorecard approach to the Homeland Security Evaluation and Exercise Program","volume":"15","author":"Soujaa","year":"2023","journal-title":"Risk Hazards Crisis Public Policy"},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"197","DOI":"10.1097\/PHH.0b013e31829ddd21","article-title":"An Analysis of Root Cause Identification and Continuous Quality Improvement in Public Health H1N1 After-Action Reports","volume":"20","author":"Singleton","year":"2014","journal-title":"J. Public Health Manag. Pract."},{"key":"ref_77","first-page":"1239","article-title":"Preparedness for chemical crisis situations: Experiences from European medical response exercises","volume":"23","author":"Davidson","year":"2019","journal-title":"Eur. Rev. Med. Pharmacol. Sci."},{"key":"ref_78","first-page":"463","article-title":"The Effectiveness of Table-Top Exercises in Improving Pandemic Crisis Preparedness","volume":"11","author":"Thornton","year":"2021","journal-title":"Int. J. Saf. Secur. Eng."},{"key":"ref_79","doi-asserted-by":"crossref","first-page":"17","DOI":"10.32598\/JHNM.30.1.3","article-title":"Comparison of the Effect of Lecturing and Tabletop Exercise Methods on Level of Preparedness of Nurses against Natural Disasters","volume":"30","author":"Mirzaei","year":"2020","journal-title":"J. Holist. Nurs. Midwifery"},{"key":"ref_80","doi-asserted-by":"crossref","first-page":"100370","DOI":"10.1016\/j.pdisas.2024.100370","article-title":"Building a prepared community to volcanic risk in the global south: Assessment of awareness raising tools for high school students in Goma, (East DR Congo)","volume":"24","author":"Kervyn","year":"2024","journal-title":"Prog. Disaster Sci."},{"key":"ref_81","unstructured":"Healthy Heart Hospital (2024, January 25). BoardGameGeek. Available online: https:\/\/boardgamegeek.com\/boardgame\/186721\/healthy-heart-hospital."},{"key":"ref_82","doi-asserted-by":"crossref","first-page":"648","DOI":"10.1093\/iwc\/iwx001","article-title":"Drawing Inspiration from World of Warcraft: Gamification Design Elements for Behavior Change Technologies","volume":"29","author":"Rapp","year":"2017","journal-title":"Interact. Comput."},{"key":"ref_83","first-page":"9","article-title":"Co-Designing Game Solutions for Hybrid Urban Spaces. How Game Elements Can Improve People Experience with the Mobility Services","volume":"40","author":"Opromolla","year":"2019","journal-title":"Interact. Des. Archit."}],"container-title":["Systems"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2079-8954\/13\/3\/197\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T16:51:07Z","timestamp":1760028667000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2079-8954\/13\/3\/197"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,3,12]]},"references-count":83,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2025,3]]}},"alternative-id":["systems13030197"],"URL":"https:\/\/doi.org\/10.3390\/systems13030197","relation":{},"ISSN":["2079-8954"],"issn-type":[{"value":"2079-8954","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,3,12]]}}}