This is the research that generated The Expansive Hospital game, a game a bout the conflicts of interest in designing a hospital.

1. 1
Learning to cross boundaries in design by playing games
Frederick van Amstel, PhD Researcher
Construction Management & Engineering Dept.
 Center for Visualization and Simulation in Construction VISICO
 Use Anticipation in Product Design UAPD

2. How to engage healthcare professionals with architecture?
Workshop about a new Medical Imaging Center. 2

3. Can games support designing together?
Second workshop for a new Medical Imaging Center. 3

4. Expansive design: activity and spatial expansions
4

5. Organizations need to learn how to work in this way
5
 Including healthcare professionals in design and vice-versa:
including architects in healthcare activities
 Prioritizing care performance (a.k.a. patient-centered design)
 Adopting integrated contracts
 Using collaborative technologies

6. Learning cannot be promoted top-down because there is no
clear hierarchy among the organizations involved
6

7. Expansive learning theory (horizontal, bottom-up)
7
Instruments
Subject Object
Outcome
Rules Community Division of labor
Yrjö Engeström, 2001, p.136

8. Two ways of connecting activities
8
Outcome
Object
Shared
object
The object is co-produced
simultaneously by two or more
activities.
The outcome of one activity
becomes the object for
another.
Yrjö Engeström, 2001, p.136

9. Use value
X
Exchange
value
Contradiction in the object
9
Outcome
Object
Shared
object
When prioritizing use value,
there is a higher chance of
expansive learning.
Yrjö Engeström, 2001, p.136
Use value
X
Exchange
value
When prioritizing exchange
value, there is little chance of
expansive learning.

10. Addition to the theory: boundaries emerge from the
contradiction between exchange value and use value
10
Outcome
Object
Shared
object
Henri Lefebvre, 1991

11. It is very difficult to apply this framework to a construction
project because there are too many activities involved
Engineering
company
Architecture studio
Structural
engineering
Structural
engineering
counseling
Electrical
engineering Facility
Elderly housing project studied in Glanebrug 11
Hydraulic
engineering
management
Contractor
Engineering
company
Engineering
company
Engineering
company
Elderly care
Construction
management
Building
Sub-contractor
Architectural
design
Model
management
Information
technology
company Elderly housing

12. Experimental setting using a board game
• Induced boundaries
among civil engineering
bachelor students
• Simulate long processes
(25 years in 2 hours)
• Highlight the
consequences of
player’s actions
The Expansive Hospital 12

13. Double stimulation experimental method
Based on Engeström (2011) 13
Stimulus
(game)
Response
(learning)
Stimulus 1
(contradiction)
Refraction
(contradiction)
Stimulus 2
(game tools)
Single-stimulation
Double stimulation
Learning as
a process

14. Introduction to the game
14

15. Game plot: a hospital under constant expansion
Ziekenhuis Ziekenzorg Enschede, 1955 15

16. Game plot: a hospital under constant expansion
Medisch Spectrum Twente, 2013 16

17. Game roles and their interests
17

18. Money flow
18
Money goes first to the
hospital, then to players.
Player’s accounts
Insurance bank
Hospital Account

19. Construction rules
19
Building block
Pipe tile Avoid clashes
Entry points
Requirements

20. Healthcare rules
20
Patient cards Patient walking to
receive treatment
Income

21. Information strategies
21
Players must keep information,
since it gets easily lost.

22. Contract types
22
Moderating the construction guys.
Traditional Fast-track Integrated

23. Experiment results
23

24. A lot of fun!
24

25. Group that crossed boundaries for use value
Contractor
Engineer
Profitable hospital
Patients Design
Sum of final incomes: 9905
25
Nurse
Facility manager
Integrated facilities
Director Architect

26. Group that crossed boundaries for exchange value
Sum of final incomes: 1860
26
Patients in the queue
Nurse
Purchased blocks
Facility manager
Director
Credibility rating
Architect
Engineer
Income
Contractor Useless building

27. What students learn from playing the game
27
Even if you know and
agree you should
collaborate it is still
hard to give up your
own interests.
Collaboration is a
problem that cannot be
solved by structuring the
process with contracts,
methods, or tools.

28. Expansive design: activity and spatial expansions
28

29. Conclusions
 Boundaries cannot be eliminated by strategies of integration
 Collaboration is a free choice
 Players begin to collaborate when they realize the use value of
their work
 Promoting use value raises motivation for collaboration
 Games can stimulate critical thinking
29

30. 30
My Research Interests
 Participatory Design
 Activity Theory
 Frederick van Amstel f.vanamstel@utwente.nl
 Twitter @fredvanamstel
 http://fredvanamstel.com