The Boardgame Design Project, Part 6: Playtesting Version 2

It’s been a little longer than I intended since my last update to this series, but I’m going to try and catch up to where I am now with the development of Acute Care.  In the last article, I described most of the changes I made after my first few playtest games, but there was still a little more…


A nurse’s day tends to have a certain pattern to it.  And in order both to make the game more interesting and more realistic, I decided to introduce some elements into that mimicked some of the real time stressors on a nursing unit.  

Between 7am and the end of the 10 o’clock hour, every patient must be Assessed.  In real life, this would incorporate actually performing a general head-to-toe assessment, documenting it, and just to sort of lump it all together, also some of the time involved with the big medication pass at 9am.  In game terms, every starting patient has a little token on it, and if you don’t spend 2 extra actions to remove it before 1100, their acuity increases by 1.

Then, between 1100 and 1300, every nurse must take lunch.  That means spending 3 actions in any one hour or losing one of their action cubes for the rest of the game.

And then after a couple of “free” hours in the afternoon, the nurses have to do their end-of-shift prep, which would include things like 6pm meds, writing shift summaries and other documentation, and preparing to give report to the oncoming nurse.  Mechanically, this requires spending just 2 extra actions to complete your prep or suffering -3 Quality. 
Getting It Back to the Table

With new cards and mechanics all ready to go, I was able to get back into some playtesting.  Both alone in simulating 2- and 3-player games and with actually playing a few games with other people, I was pretty pleased with what I saw.  Keith also helped me a lot in grinding out some 2-player games using his own copy of the prototype.           

What it Does Well…

As of right now, the thing I’m most pleased with is actually how much the game mimics a day on a nursing unit .  It just sort of feel right from a narrative perspective: the tension of having so much to do in the morning, and then having to work together to cover as everyone gets down to lunch, and even the slight afternoon lull is actually pretty realistic.  

From a cooperation point of view (since it was the primary design goal), I think it’s also going pretty well.  The playtest games I’m in are almost always filled with discussions about who needs help, what things we should focus on, and often, what things we can let slide.  

The Big Problem

The main thing is that the game is still too easy.  It’s tense and feels almost out of control early on, but it’s still manageable, and then by the time the lull happens, enough patients have been discarged, transferred, or otherwise removed from play that they have tons of actions to take care of most everything and still pour effort into Quality Improvement. 

So, the real problem is that there just aren’t enough patients in the late game to make it challenging.

In our post-mortem sessions, one thing that was brought up was to change the Acuity of the starting patients.  Based sort of on “reality”, I had each player start with one Acuity 2, two Acuity 3, and two Acuity 4 patients before now.  But in just a couple of turns, you can discharge the Acuity 2 patient and not even have to do their assessment, which sort of nets out to only taking 3 actions to do (again, a no-brainer).  I haven’t exactly figured out what the Acuity of the 5th patient should be yet (3, 4, or 5), but I’ve got them all available in the new prototype, so I’ll just try to playtest it out.  

Another issue was the number of new patients in the Event Deck.  In the last version, I basically had 2 new patients per player in the deck.  But I hadn’t really thought that through, because the deck also includes 1 Code Blue per player, which eliminates one of their patients.  And it also includes some Transfer to CCU cards, which give them another chance to remove a patient.  So, in adding it all up, there was a net of less than 1 new patient introduced per player throughout the game.  To work on this, I’m upping the the new patients to 3 per player, and along with making it a little harder to discharge that first patient (by increasing their Acuity), I’m hoping to tighten up the game through its later turns as well.  

Some other issues that I’ve identified dealt with most of the cards that directly gave Quality Keys, which seemed either too easy to achieve or were just no-brainers to spend your actions on, and the Complication Deck, which definitely adds in more stress when you don’t care for patients, but also seems to “miss” a lot in reality.

The Next Goal

So, where do I go from here?

First, of course, I’m going to continue to playtest and revise the game as needed.  But the next big thing I need to do is to actually, formally write the rules.  Up to this point, I’ve been going on what’s in my head, what’s written in this blog series, and a few things like turn order and player options on the game boards I’ve been using.  But both for the sake of my current and future playtesters (sorry, Keith) and just to make sure that I’m being more coherent in my thought process, I really need to get a document created.  

And then I’ll post it here, for all of y’all to finally be able to read and, just hopefully, get a better idea of what Acute Care is all about. 

The Boardgame Design Project
The Boardgame Design Project, Part 1: Design Goals
The Boardgame Design Project, Part 2: Brainstorming Mechanics
The Boardgame Design Project, Part 3: Wrapping up the Conceptual Phase
The Boardgame Design Project, Part 4: Prototyping and the First Playtest!
The Boardgame Design Project, Part 5: Making Revisions


  1. I dont know how your system of time works, but as a quick idea: To introduce more patience you could have an Emergency Card that is snuffled in about half way through the event deck that brings in a sudden rush of patients. You could have different types of emergencies and you would randomly shuffled them, then only one would be placed in the deck. This would give an element of surprise as to what the emergency is. Big Car accidents would have lots of broken bones where a large fire would have lots of burn victims. I am sure you could come up with others.

    Food for thought, hope it helps.

  2. Keith

    The time system the game uses is one hour per turn. With six action cubes to place each action represents about 10 minutes. This is why the lunch break requires three cubes.

    I think more patients one way or another is likely to be a part of the next round of modifications. Either more inbound or fewer outbound.

  3. Keith

    I think one of the things this design will continue to do is to struggle with a split personality. It is easier to score positive points when you have fewer patients consuming resources. So emptying beds becomes a primary focus of play even if they get emptied through additional patient decline and suffering. The goal of nursing, as I understand it, is primarliy one of providing quality care, not getting rid of patients (sending them home being good but celebrating a code blue clearing a bed being bad). More patients will reduce the extra action points available, make for more trade-off decisions, and make games closer scoring (all good things) but will it resolve where unnurse-like gaming the patients conflicts with the world of nursing the game is trying to give us some insight into.

  4. Chris Norwood

    I think this is a good idea, but it would have to be for a different game.  Something like this would be more appropriate for a game about the Emergency Room, which would have to deal with that sort of thing.  But on an Acute Care unit, it doesn’t really make sense to have this sort of sudden emergency.

  5. Chris Norwood

    To some extent, I think I’m fine with the split-personality.  I totally understand that gamers are going to game the system, and as long as there are theme-appropriate benefits or penalties for doing so, it’ll still be cool.  I’ve already taken some liberties with reality here and there (for instance, it’s pretty ridiculous to have up to 5 Codes Blue in a shift), and I think that as long as its possible to play the game with the right motivation (with, say, new nurses or nursing students), I can live with gamers celebrating Codes because it would be better for the game situation. 

  6. sven ryglert

    Is the game finished yet?

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