photo of SOS screenshot from serious game video

Teamwork, Leadership, Solution-Focus


This experiential learning activity is a low-fidelity simulation suitable for entry-level and advanced educators and simulationists. The purpose is to foster reflection and insight about teamwork, leadership and solution-focused problem-solving. The simulation usually lasts 3-5 minutes and at least 15 minutes should be allotted for pre-briefing and debriefing for up to 4 teams.


  1. For each group of 4-6 staff, one 24-piece puzzle is A clock is needed to time the activity.
  2. Remove & keep puzzle box lids nearby so that the final picture isn’t known to For each puzzle, remove one centre piece (marked on the back to identify the puzzle it belongs to) & hide it nearby (e.g., on your person).
  3. For more than 1 group, ideally use multiples of the same puzzle, removing the same puzzle piece from each


Activity Instructions:
  1. Provide context, rationale & expected length of time for the activity, including the
  2. Separate staff into groups of 4-6. Designate one person per group as the “observer”.
  3. Each group gets a puzzle (without lid) to
  4. Brief the groups: “This game allows a group to work Are you clear on who is in your group? There are no rules. The only objective is to complete the puzzle. You have 3 minutes to put the puzzle together starting now.”


Facilitator’s Notes:
  1. Groups finishing the puzzle will often ask about the missing Respond along the lines of: “If the puzzle was a resident & you were missing information needed for the resident’s care, what would you do?” This usually incites searching activities.
  2. If someone asks for the lid, picture or missing piece, give it to The key is for someone to ask appropriately; not just demand it or assume that you will give the missing piece. Creative individuals will sometimes look through the facilitator’s belongings without asking & we’ve never dissuaded it, as it shows risk-taking & resourcefulness.
  3. Some groups will need more than 3 minutes to complete the Time can be extended by increments of 3-5 minutes to add pressure to the task. Some groups may not finish the puzzle during the allotted time. Use your judgment about when to wrap up the puzzle-making.
  4. Be sure to leave adequate time for debriefing – it’s key to translating learning to practice!


  1. Ask the observer/s to comment on teamwork & interaction styles – g., was there a clear leader? If yes, were they elected or did they just take command?
  2. Ask the group members to comment on their role on the How did they contribute to getting the job done?
  3. Did group members use different strategies to put the puzzle together (e.g., edges, corners, colours, shapes or even looking at other groups)? How did that influence the group’s ability to problem-solve?
  4. Discuss if group members asked about & searched for missing information or not (picture, missing piece).
  5. Did the activity reflect their usual problem solving style at work (or in general)? What was different? What was similar?
  6. What solutions did they come up with to solve the twist to the activity? (i.e., the missing piece)
  7. How does this activity translate into day-to-day work? What can we take away from this activity?
  8. Have group members been in a situation when they were the missing puzzle piece (that prevented achievement of a goal)?


During debriefing, the facilitator encourages staff reflection while highlighting & positively reinforcing emerging themes:

These educational resources were developed collaboratively by Algonquin College and the Bruyère Centre for Learning, Research and Innovation in Long-Term Care. The development of these materials was supported with funding from the Government of Ontario through the Bruyère Centre for Learning, Research and Innovation in Long-Term Care. The views expressed in these resources are the views of the authors and do not necessarily reflect those of the Province.



Bruyère CLRI has partnered with a team of researchers whose aim is to develop and share deprescribing approaches with health care providers and the public.  A range of new tools that long-term care providers, residents, and families can use are now available on the website


In certain cases, especially as people get older or more ill, the use of some medication can cause more harm than good.  Deprescribing is an important, feasible, innovation to ensure medication efficacy, reduce harms, and mitigate polypharmacy. It involves reducing doses or stopping medications which may no longer be needed or may be causing harm, in partnership with a health care provider. Optimizing medication through targeted deprescribing is a vital part of managing chronic conditions, avoiding adverse effects, and improving outcomes.


Click on the links below for tools (including infographics and short videos) to help patients and providers participate in deprescribing:


There is growing awareness around the importance of oral care for overall health. Long-term care (LTC) residents are particularly vulnerable to several risk factors for poor oral health that can lead to oral bacterial disease, bad breath, mouth sores, and pneumonia. It can also be difficult for many residents to access a traditional dental office due to transportation, physical, and financial limitations. Improving access to oral care resources within a residence is one way to reduce oral health care barriers.

Establishing partnerships with the dental hygiene community can bring oral health expertise on-site. Dental hygienists in Ontario are independent health care providers whose scope of practice includes the assessment of teeth and oral tissues as well as the provision of oral health promotion and care. This brochure describes a partnership between Ottawa’s Saint-Louis Residence (SLR) LTC home and the dental hygiene program at La Cité college.

For a copy of our full report, Partnerships for Oral Health in LTC: A scoping review of the literature focusing on dental hygiene students and alternative models of dental hygiene partnerships, please contact us at


Simulation can be used as a learning tool in healthcare settings; it can offer healthcare professionals an opportunity to learn in an immersive, realistic care environment to further develop knowledge, skills, and enhance quality of care. Simulation activities can range from 3D technology that creates virtual realities to low-tech, hand-made, inexpensive supplies and our imagination.

Bruyère CLRI developed a series of simulation activities (available in English and French) to cultivate empathy in long-term care staff. Empathy goes beyond sympathy, which places us at a distance and drives disconnection.  Empathy requires that we internalize the feelings of another, and come from a place of compassion and authenticity; empathy drives interpersonal connection. So how might we teach empathy for LTC staff? Through a series of simulation activities, participants will have the opportunity to experience – for a moment – some of the challenges our residents may face as a result of their health status. Debriefing engages participants in a discussion on how to disrupt fears about disability, aging, and illness that may arise from this type of experiential learning.


Hosted by The Bruyère CLRI, Dr. Daniel Kobewka, Assistant Professor at The University of Ottawa, presented a webinar entitled From Long-Term Care to Acute Care Hospital. High Quality Care or “Avoidable Transfer?, on March 22, 2017.


Hosted by The Bruyère CLRI, Ruth Richardson, Hospice Palliative Care Nurse Educator at Algonquin College, presented a webinar on Understanding The Hospice Palliative Care Approach to Inform Communication at End-of-Life in Long-Term Care, on February 28, 2017.

Screen shot of SOS Gaming App

The Baycrest CLRI team along with 2015 summer interns created and trialed a card game called Trigger Match that stimulates team discussion and enhances specific team skills regarding the care of persons with responsive behaviours.

The resources in this toolkit were developed using a quality improvement approach and are meant to foster player and facilitator awareness and insight into working together to find care solutions for long-term care residents with responsive behaviours related to dementia.

Complete Toolkit: Trigger Match Toolkit