Enhancing communication and root cause analysis skills in healthcare through a medical murder mystery game

Thomas Tippl

Master Digital Healthcare, St. Pölten University of Applied Sciences 2023

Aim and Research Question(s)

The aim of this Master's thesis is to identify principles for the development of a Murder Mystery game and to develop a prototype as an Alexa Skill. The usability and user experience of this prototype should be investigated, while simultaneously measuring the impact of such games on team communication. RQ1. What basic principles can be used to develop a medical murder mystery game to improve the communication and root cause analysis skills of medical providers and how can it be technically implemented as an Alexa Skill? RQ2. How do people with training in healthcare assess the usability and user experience of a medical murder mystery game as an Alexa Skill? RQ3. How do people with healthcare training perceive team communication and collaboration during a medical murder mystery game?


Errors in medical care stem from individual or structural factors [1]. Applying patient safety principles, learning from mistakes, and fostering cooperation and communication in medical teams can prevent errors and adverse events [1]. Murder Mystery games hold promise for enhancing these patient safety skills, but further research is needed to assess their effectiveness [2].


This thesis was divided into three consecutive steps: narrative literature review, prototype development and prototype testing. The results of the literature review served as the basis for the development of a low-fidelity prototype. In the next step, the developed prototype was tested for usability and user experience by using SUS and UEQ, and the communication in the team was assessed by a quantitative questionnaire.

Results and Discussion

A murder mystery story can be created by defining the following criterias: medical department, patient history and diagnosis, professions involved as charakters, source of error for each character, accusation flowchart, suspect, red herrings. The subjects rated the prototype with an SUS score of 80.8, which puts the product at the 90th percentile and is considered acceptable and excellent, receiving an A grade. [3]. Compared to other products, the mean UEQ score of the Murder Mystery game was well above average (in the top 10% range) for Attractiveness (2.0), Stimulation (1.8) and Novelity (2.2), slightly above average for Perspicuity (1.2) and moderately below average for Dependability (0.8) and Efficiency (0.8).

The evaluation of the communication questionnaire shows that the participants consider the prototype to be conducive to collaboration and communication, especially in terms of teamwork and learning opportunities, while the assessment of communication professionalism is variable, possibly due to the playful nature of the interaction.


In this master thesis, a guideline for the development of medical murder mystery games to improve the communication and root cause analysis skills of medical providers was developed. The results show the potential of such games to improve these skills. Future research should focus on further development and evaluation of this teaching method.


[1] Charité – Universitätsmedizin Berlin (2018) „Mustercurriculum Patientensicherheit der Weltgesundheitsorganisation. Multiprofessionelle Ausgabe. [2] R. Kavanaugh et. al (2022), doi: 10.1080/0142159X.2022.2071690. [3] J. Sauro (2018) „5 Ways to Interpret a SUS Score“