Beyond bed counts: translating NHS operational challenges into playable public understanding

Healthcare systems face increasing strain due to demographic change, service fragmentation, and climate-related disruptions. Traditional models of capacity planning fail to capture the dynamic nature of patient flow, particularly in urgent and unscheduled care. To address this, we present Flow, a proof-of-concept serious game under development by the Design HOPES project, designed to visualise patient journeys across NHS Scotland’s urgent care pathways. The game is being co-designed with clinicians, service designers, and system managers, and is grounded in operational data from Ninewells Hospital, a leading site in implementing flow-based care models. Co-design was critical to uncovering the site-specific practices and challenges of patient flow at Ninewells, enabling the integration of contextual knowledge into the game’s mechanics, structure, and narrative.

Rather than functioning as a clinical dashboard, Flow is a narrative-driven experience designed to engage public users in understanding how everyday healthcare decisions such as opting to visit an Accident & Emergency (A&E) department versus alternative treatment options can influence system efficiency, care outcomes, and environmental sustainability. The game’s structure and logic were informed by a participatory workshop involving NHS professionals, which surfaced key system bottlenecks, data silos, and coordination challenges. This paper outlines the translation of these insights into game mechanics and design principles. By simulating real-world constraints and triage pathways, Flow aims to improve public system literacy and foster more informed decision-making. The project contributes to the evolving discourse on the role of serious games, co-design methodologies, and experiential tools in advancing sustainable public health education.