Remote Service Futures (RSF) Game

The game is a design tool to use with communities, following a process of information exchange and relationship building. It is important that you do NOT attempt this game as a stand-alone exercise without getting to know the community first, as the necessary trust and communication to carry it out successfully will not be established. The game is designed to be played when:

  • change to health services is anticipated but not imminent, for example when a local practitioner is nearing retirement
  • there is potential for the community to influence the outcome of the decision making process, and
  • service providers, managers and practitioners from across the relevant agencies are a committed to devoting time and energy to the process.

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When to use the game

The game can be used:

  • to find community priorities
  • to compare and contrast the priorities and choices of one or more stakeholder groups
  • to create workable health care plans for the future
  • as a tool to create new job descriptions
  • as a learning tool for people who wish to know more about health and related services and how they are designed currently, and
  • as a training tool for staff to help them consider different viewpoints when planning.

How to do it

Essential materials for the game include:

  • Set of Skill Strips
  • Set of anonymised Practitioner Cards
  • Template for Planning Sheet
  • Key for anonymised Practitioner Cards

These can be found in the Link opens in a new windowRemote Service Futures: Service Design with Communities Toolkit on the website of the Centre for Rural Health.

The basic format of the game is as follows:

  1. Community members split into working groups.
    Groups of 4-7 are ideal. It is a good idea to assign a facilitator to each group and give all groups access to knowledgeable and communicative managers who can ensure that their plans will conform to applicable safety and other standards and regulations.
  2. Each group discusses the data and information generated in the project and decides on a list of 5-10 of their most important health and social care needs.
    Try to encourage everyone to contribute and try to avoid any one person dominating the discussion. This may require strong facilitation!
  3. Using the skill strips, the groups prioritise 10 of the skills that they consider to be most relevant to meet the needs identified in step 2 above.
    Make a note of these for later comparison.
  4. Using the anonymised Practitioner Cards, along with an approximation of their budget (obtained during the context mapping), the groups consider which professional(s) have the skills that they require and could be afforded within their current budget.
    The cards are anonymised so that community participants do not simply focus on one favoured practitioner, but rather focus on which skills and practitioner would meet their needs. If none of the Practitioner Cards (or combination thereof) is satisfactory, you could work with the participants to create a new job description for a hybrid professional to work in their community. See the Rules of Play section (below) for more information on carrying out this stage of the game.
  5. Groups come together and each presents back their plan. The community then debates the potential merits and disadvantages of each plan and attempts to reach a consensus.
    It is important at this stage that service providers present are honest with the community about any potential challenges to their plans. If you consider that a design could not be delivered for some reason, e.g. current assessments of what is clinically safe, then you should be upfront about it. If your concerns are mainly due to the “hassle” that you will have to go through to bring it about, be honest about that too. It is important to assess what can be delivered and not to agree to unrealistic promises.

Rules of Play

Designs must take into account real-life planning constraints such as:

  • The European Working Time Directive that constrains how many hours a week professionals (other than GPs) may work: this may place constraints on some plans for out-of-hours services, though it may be possible to consider ways around this.
  • Professionals must not be required to do things that are unethical, illegal or dangerous under current public sector guidance.
  • Avoiding difficulties associated with lone workers such as professional isolation and maintaining skills.
  • Issues of recruitment: the positions must be attractive to potential applicants. A remote island is unlikely to attract a highly qualified professional to move all the way there for a one-day working week.
  • Blended positions should be logical. For example, in the real world a single handed GP may not want to carry out social care duties.

Pros

  • An honest and transparent process
  • Anticipates change
  • Considers flexible models that work for community content, needs and wants
  • Considers how the community experiences their services to be important
  • Requires joined up thinking and multi-agency working. The game can be shortened to suit planning needs. For example, if only community needs are to be agreed upon, play stages 1 and 2. If you are looking for a flexible job description for a worker based in the community, try stages 1, 2 and 3 only. Alternatively it can be played amongst groups of managers as a training tool for community engagement. Separate ‘community member’ role cards are available for this purpose.

Cons

  • It is not recommended when an outcome has already been decided and you want the community to accept it, or when change is imminent or already occurring within a community.

Top Tips

  • Issue contact sheets with the names of every service provider who has attended events, what they do, and direct contact info if possible.
  • Plan to begin at least half an hour after the advertised time. Make clear in all publicity materials that it is NOT a drop in event and participants should plan to stay for the duration of the event. People arriving late often miss the object of the game and will potentially find it a bewildering and unhelpful exercise.
  • When playing one of the longer versions of the game, it may be helpful to plan the event for a weekend day and offer lunch to participants, either afterwards or following the plan formation and before reporting back and discussion.
  • Estimating community budget can be difficult. Do not forget to take into account potential overhead costs on top of salary. It may be worth trying out the game with the current service configuration to make sure that the numbers add up. Remember, the salary amounts on the Anonymised Practitioner Cards can be changed to reflect the reality of your area. Using an unrealistic budget will only confuse the planning process within the community.
  • Ensure that there is a service manager available to advise each team (or to rotate between teams) because the game is a great opportunity for in-depth discussions about the challenges, constraints and opportunities in planning throughout the entire process.
  • Before ending this event, it is useful for service providers to spend 30 minutes discussing with the community the actions that they will take forward from the day, as well as their plans for when they next meet with the community. At this point they could discuss which mechanisms the community would prefer for continuing on the process started in Remote Service Futures. For example, a core of enthusiastic individuals could form a planning group that providers could continue to meet with, or there may be existing structures in the community that would be more appropriate to use, such as a well-respected community council or patient representative group.

Sources and further information

The Remote Service Futures Game is taken from a toolkit developed by the Remote Service Futures Project which was delivered by the Link opens in a new windowCentre for Rural Health – a collaborative research institute between the University of the Highlands and Islands and the University of Aberdeen. This project was funded by the Knowledge Transfer Partnership Scheme, Highlands and Islands Enterprise, University of the Highlands and Islands, and NHS Highland.

For more information on the project and the resources available in the Remote Service Futures toolkit, please contact EmailDr. Sarah-Anne Munoz, Senior Research Fellow in Rural Health, University of the Highlands and Islands, Centre for Rural Health, Old Perth Road, Inverness, IV2 3JH