Gamified Simulation for Onboarding Health Care Teams in Emergency Care: Development and Preliminary Feasibility Study

High staff turnover is a widespread issue across nearly all hospital departments, often exceeding 20% annually. This constant flux disrupts continuity of care and creates a recurring challenge: how to rapidly integrate new employees into complex clinical environments, both physically and functionally. Traditional onboarding methods struggle to meet this demand, particularly in services operating 24/7, such as emergency departments (EDs).

This formative study presents the design and implementation of a web-based 3D gamified simulation platform aimed at improving staff onboarding in clinical environments. The paper outlines both the technical architecture-with guidance for hospital IT departments-and the acceptability and usability for permanent staff, who play a key role in ensuring onboarding continuity. We sought to assess whether such a tool could be autonomously managed and well received by health care professionals.

The intervention consisted of 2 linked components: a real-time, browser-based 3D simulation replicating the hospital's ED and a web-based quest editor allowing nontechnical staff to update training content. The system supports self-paced onboarding through location-based tasks, object searches, quizzes, and simulated staff interactions. Two preliminary usability studies were conducted: one with 37 ED staff members testing the 3D simulation and another with 9 users exploring the quest editor. Feedback was gathered through anonymous questionnaires and a descriptive analysis.

Early results showed high feasibility and acceptability. Among 3D simulation testers (n=37), 90% (33/37) found the tool helpful for understanding the department's structure, and 81% (30/37) believed it would be useful for new staff. The inclusion of personal anecdotes and gamified tasks was viewed as engaging and motivating. The quest editor (n=9) was positively rated by 91% (8/9) of users, who appreciated the ability to autonomously update content without IT support. These findings support the dual promise of the platform (ie, pedagogical flexibility and technical sustainability).

This work demonstrates the feasibility of a gamified simulation platform designed for high-turnover clinical environments. It highlights both the operational deployment framework and the early acceptability among key staff members. While further validation with actual new hires is needed, this formative study shows promising potential for generalization beyond emergency care. The modular and editable nature of the system makes it a viable solution for scalable onboarding in other hospital departments.