Game-Based Learning for Integrated Care Implementation

This paper argues that Game-Based Learning (GBL) can be designed as an implementation-oriented strategy for embedding new integrated care organisational models into everyday healthcare practice, rather than serving only as an instructional tool for discrete clinical skills. Using the DARE Health seven-pillar model for cardiovascular-kidney-metabolic (CKM) care as an illustrative context, the authors develop a conceptual framework that combines Normalisation Process Theory (coherence, cognitive participation, collective action, reflexive monitoring), Argyris and Schön's single- and double-loop organisational learning, and the Learning Mechanics-Game Mechanics model from serious-game research. The framework treats the four NPT mechanisms as recursive and overlapping rather than sequential, and links each to a design principle and an illustrative class of game mechanics.

The principal outputs are three conceptual contributions: an implementation-oriented logic for GBL design, four theory-derived design principles, and a criterion-based mapping that locates each DARE pillar's principal normalisation challenge within one NPT mechanism to indicate where design effort should concentrate. For example, Patient-Centric Care is mapped to collective action, while Sustainable Governance is mapped to cognitive participation. The authors stress that every pillar engages all four mechanisms and that the mappings are analytical propositions rather than empirical findings.

The work is a theoretical synthesis based on published literature and involves no human participants, primary data, or prototype evaluation. Its authors identify three limitations: the relationship between NPT and organisational learning is argued theoretically rather than demonstrated, pillar assignments are interpretive and may vary across settings, and the proposed game architecture has not yet been built or tested. Future work is therefore framed as expert co-design, prototyping, and longitudinal evaluation of learning outcomes and collaborative routines.