A group of 38 nurses, seven Lego building block kits, and 45 minutes was all our nursing professional development team needed to improve staff communication and patient safety. Game-based learning (GBL) via Lego® building is a well-received training modality with a review of literature showing the potential to increase teamwork, communication, and comprehension (Warburton et al., 2022).
Lego® Serious Play®, a specific form of GBL, is a “facilitated, communication and problem-solving teaching technique using Lego® building blocks to use the concept of ‘hand knowledge’ to teach cognitive concepts” (Lego®, 2025). GBL is a frequent training modality our nurse education department uses for the quarterly skills day. Our quarterly skills days are training days dedicated to vital training requirements. We have used escape rooms, team Jeopardy, and role-plays, but our staff asked for something different. Our team held a brainstorming session, during which we decided to utilize Legos® to teach triage and communication skills.
The Idea for Lego® GBL
The idea for Lego® GBL in our facility was based on a critical incident tabletop exercise attended by nursing residents. Our nurse residents needed to complete and experience a mass casualty incident triage, but we were unable to involve them in the actual training exercise. I considered recreating the critical incident using a Lego® hospital and emergency department model. We used Lego® minifigures as our key players and victims: we had an ambulance, a stretcher, and an overturned truck.
The use of Lego® GBL learning addresses key elements of communication required for highly functioning teams.
- Staff Engagement. The training energized the staff, prompting them to run the scenario multiple times.
- Team Effort. The physical nature of the building blocks fosters a strong working environment that revolves around a shared mental model.
- Critical thinking. The team makes key decisions on triage using limited information, following the triage guidelines, and relying on clear communication.
Lego® GBL and Communication Training
Our team was seeking an innovative approach to teaching communication skills beyond a traditional code team exercise. I instantly thought back to how successful the Lego® critical incident tabletop exercise went and told the team we should consider using this for all our learners.
I then conducted research and found three articles outlining how to create an educational exercise and its proven efficacy (Bethel et al., 2021; Lambert et al., 2023; Warburton et al., 2022). We began our design by creating a timed building scenario that involved 13 bricks and eight distractor bricks, which are not required to complete the build. We then decided we wanted to have three distinct roles in our building team:
- Staff Nurse or Builder. This person was the only person who could see the build and touch the Lego® building blocks. The builder was behind a blinder and could not see the written instructions from their team members. The builder can only create the build based on verbal instructions from the runner.
- Relief Nurse or Runner: This person was responsible for verbal communication between the staff and charge nurses. They could not see the build instructions or the build itself, and they could not physically interact with the Lego® build.
- Charge Nurse or Diagram Holder: This person was responsible for being the only person who could see the build instructions. They passed on the verbal instructions to the runner. The charge nurse was behind a blind and cannot leave their workstation.
Projected Outcomes of Training
In developing this opportunity, I initially thought of what our outcomes would be. First, I wanted the learners to be engaged and to have data to support the need for future training. Second, I wanted the teams to verbalize that they improved communication in their teams. Third, I aimed to teach the principles of High Reliability Organization (HRO) communication to enhance patient safety. Finally, I briefly touched on the importance of rapid process improvement and the use of standardization documents (Standard Work and Standard Operating Procedures) to make work more consistent and safe.
Build Time: Everything is Awesome!
Our team facilitated the training, consisting of seven skills days, with an average of 15-24 participants per group. We introduced the guidelines for the activity and divided the teams into three groups. After the initial build, we conducted debriefings and reviewed the builds. All the builds were within 50% accuracy of the template, and no team finished before the five-minute time limit.
Next, I provided a brief 15-minute learning on (1) communication theory, (2) running a rapid process improvement, and (3) teamwork building. The teams had five minutes to do a team huddle. The purpose of the team huddle is to communicate a shared mental model of a task to ensure all members of the team have understanding. They identified that they wanted to make changes: (1) removing the blinders, (2) providing all team members with the build instructions, and (3) allowing all team members to touch the Legos®. The team employed more effective communication techniques during the second build. All teams utilized the 3 Cs of high-quality communication (clear, concise, and complete). Most teams finished within two minutes, with all teams achieving 100% accuracy with the template model.
Next Steps in Facility Lego® GBL
I plan to present this project to our nursing evidence-based council for further review and consideration. In the meantime, five additional units have requested this training by word-of-mouth advertising. In response to these requests, I have revised the instructions so that I could train other facilitators to run a 45-minute session. Our HRO and quality staff have expressed interest in formalizing this as part of our Pathway to Excellence drive.
Conclusion
Educators can use block learning as a tactile approach for learners to witness the outcomes of their “soft skills” training, which focuses on communication and teamwork. Lego® GBL provides a fun, engaging, and novel way for healthcare workers to experience competency training. Lego® GBL and Lego® Serious Play® offer ways for teams to interact in a manner that reduces stress by removing the high stakes of traditional simulation-based education.
Michael Brakel, RN-BC, is a Registered Nurse (RN) serving with the Veterans Affairs-Northern California Health Care System (VA-NCHCS) as a Nurse Educator. He has worked with the VA-NCHCS in various capacities, including Utilization Management RN, Utilization Review RN, Community Care RN, Affiliate Professor, and Primary Care Mental Health Integration (PCMHI) RN Care Coordinator. Additionally, he has worked as a Nurse Consultant with the VA Office of Inspector General (OIG), serving as a hotline team member and team lead. Mr. Brakel holds advanced degrees in management and psychology. He graduated from Hawaii Pacific University with a degree in nursing. Mike is certified in Managed Care Nursing, Psychiatric-Mental Health Nursing, Nursing Professional Development, and Nursing Case Management. He holds certifications as a Certified Professional of Patient Safety and a Certified Professional in Healthcare Quality in addition to his nursing credentials. Resilience, compassion fatigue, nurse retention, and the application of measurement-based screening in mental health care are his main research topics. Before coming to the VA, Mr. Brakel retired after 25 years in the United States Air Force Nursing Corps, specializing in Behavioral Health. Mike served as a nurse, charge nurse, and education specialist serving on inpatient units at Travis Air Force Base, California, and the San Antonio Military Medical Center. His last roles in the Air Force were serving as the Air Force lead Mental Health Nursing Educator and as the Deputy to the Air Force Consultant to the Surgeon General for Mental Health Nursing.
Dr. Julia VanderMolen is a Professor for the Public Health program at Grand Valley State University and a Visiting Assistant Clinical Professor with the University of the Pacific, School of Health Sciences. Her research examines the benefits of assistive technology for individuals with disabilities in public health. She serves as a board member of the Disability Advocates of Kent County and is an active member of the Disability Section of the American Public Health Association (APHA). Her current research focuses on exploring the health and medical services available to individuals with intellectual and developmental disabilities.
References
Bethel, E. C., Marchetti, K. A., Hecklinski, T. M., Daignault-Newton, M. S., Kraft, K. H., Hamilton, B. D., Faerber, G. J., & Ambani, S. N. (2021). The LEGO™ exercise: An assessment of core competencies in urology residency interviews. Journal of Surgical Education, 78(6), 2063-2069. https://doi.org/10.1016/j.jsurg.2021.05.011
Lambert, N. J., Luo, X., & Ola, A. (2023). Knowing me, knowing you: Self-reflection and understanding diversity for effective teamwork Lego® building activity. Management Teaching Review, 10(1), 21-34. https://doi.org/10.1177/23792981231190589
Warburton, T., Brown, J., & Sandars, J. (2022). The use of Lego® Serious Play® within nurse education: A scoping review. Nurse Education Today, 188(1). https://doi.org/10.1016/j.nedt.2022.105528
