A Framework for Analyzing Board Games and What They Say About the World

Board Game Academics, June 2026
Published in Vol 3. Issue II.
DOI: https://doi.org/10.70380/h2m9c7x4v1b8q

Ian Greener
University of Glasgow

Abstract

Despite some great work presenting frameworks for analysing board games, we still have some way to go in coming up with comprehensive approaches in exploring how they work and what they say about the worlds they represent. This paper presents a synthesis of the work of three writers (Bogost, Gee and Bacchi) to generate such a framework in order to try and help lay the ground for such a new framework to show the richness of board games as a source of social analysis.

To illustrate the framework, the paper concludes with an exploration of two hospital games – Clinic Deluxe (2019) and Dice Hospital (2018).

Introduction

Games, especially those that purport to represent some kind of reality, are metaphors in the sense that they are about experiencing one thing in terms of another. The key point which writers such as Lakoff make (especially in Lakoff and Johnson, 2008) is that metaphor isn’t rhetorical ornamentation. Instead, our conceptual systems and frameworks may well be organized in such a way that representations of the way things work condition the way we understand the world. If we consider argument to be a war, then when we argue, we treat the process as a competitive battle in which we aim to ‘strike blows’ and ‘win’. If we reframe the argument as a dance, then it might instead be based on gracefully responding to one another’s movements in a cooperative way.

If we accept that games can be metaphors, how can we try to unpack those metaphors and what they might mean? It is certainly the case that metaphor and analogy play a large part in work from games studies (Wark, 2007). Flanagan’s work explores ‘critical play’, taking a range of different approaches to explore the cultural interpretation of all types of games (Flanagan, 2013), and her work has gone on to explore issues such as colonialism (Flanagan and Jakobsson, 2023). Booth’s work on board games is hugely important and provides us with several ways we can investigate them (Booth, 2021). However, what we perhaps lack is a step-by-step method by which we can carry out our analyses. By making clear how we are analysing board games, we might be able to expand the range of tools available for this work, as well as get more people doing it. 

This paper aims to try and provide a method for the analysis of games based especially on the work of Bogost (2010) and Gee (2015), both of whom are well-known in games studies, and then supplement those ideas with those of Bacchi (2009), who is more associated with critical policy analysis. In bringing these three theorists together, it shows how their ideas are complementary to one another, with the potential to fill in gaps, in relation to the analysis of board games, in the work of each of the authors. The chapter concludes by analysing two board games – Clinic Deluxe and Dice Hospital (two health-based games) as a means of showing the value added from taking the paper’s approach.

Games as Arguments – Bogost

Bogost makes a strong and important case that games, because they are rule-based systems with which players engage, make arguments. Bogost’s work on what he calls the ‘procedural rhetoric’ approach is both simple and frustratingly elusive. Bogost suggests that what makes games distinctive is their procedurality, their density of process coming from their ability to incorporate algorithms into play (2010). Bogost is writing primarily about computer games, which is especially clear in his work on ‘unit operations’ (Bogost, 2006), and such algorithms represent models of how the world works. By learning to reverse engineer such models, we learn to critique these models. When we make a game about colonisation that treats indigenous peoples as free labour, which does not resist the colonist player, or perhaps even require food or shelter, we are presenting a model of the world in a way which represents the past in a particular way. 

Bogost presents a wide range of examples in his main book on the subject ‘Persuasive Games’ (Bogost, 2010), including the ‘McDonalds Videogame’ (Moleindustria, 2005), in which what appears to be a conventional supply chain management games requires you, in order to succeed, to make increasingly dubious moral decisions including rainforest clearance and increasingly questionable labour practices.  

To decode the arguments in games, Bogost’s key concept is the enthymeme, a rhetorical device dating back to the origins of rhetoric. An enthymeme is a missing part of an argument. If I say to you, ‘Of course he’s a liar, he’s a politician,’ then the enthymeme is ‘all politicians are liars.’ It’s the part of the argument that makes what I said true, and which we may take for granted. The elusive bit is that, unless you are as smart as Bogost, it’s actually pretty difficult to do this kind of analysis for games of any complexity. There are likely to be many missing parts of the argument that we have to ‘fill in’ in order to see the argument. In board games, we have to learn the rules before we can play, but moving from the rules to see the arguments that are being made may take several plays, where we consciously attempt to trace the gaps between the rules, the procedures and the view of the world they appear to prefer (or dislike). In computer games, it’s even harder than board games, as we usually don’t have a rulebook or access to the procedures by which our decisions are translated into results. It’s interesting, in that context, that one of Bogost’s examples, the original SimCity, has procedural processes that are often more complex than we might assume. It took a recent book several chapters to explain them (Gingold, 2024). 

When considering board games, we have a much better chance of identifying arguments using Bogost’s ideas because we have the rules in front of us and have to run the game systems ourselves, and this is likely, in turn, to lead to the procedural aspects of board games being simpler than those in computer games, as well as being more transparent to players.

Bogost’s work has inspired a significant range of scholarship described as demonstrating the procedural rhetoric of games, including board games. Booth (2021) presents Bogost as a key source (preferring ‘potentiality’ rather than ‘procedurality’), and presents fascinating interpretations of Scythe: Rise of Fenris (2018), Pandemic Legacy: Season 1 (2015), This War of Mine (2017), Holding On (2018), and a range of games exploring Mars Colonization, showing different variations of what he terms ‘ludo-textual analysis’. However, it is still often difficult from his examples to see the exact steps involved in his analyses, or how you would go about doing them for yourself. 

Bogost’s ideas, despite the concerns outlined here, are still hugely important. Games locate us as active agents in worlds where we make decisions (Nguyen, 2020). They have the capability to ask us to engage with situations different from those we find in our everyday lives, and so have the potential to increase empathy for others (Farber and Schrier, 2017) and understanding of complex systems (Holland, 2025). 

To fill in some of the gaps to make Bogost’s analysis more doable, the work of Gee has considerable potential. In particular, Gee’s linkage of game studies with discourse analysis (Gee, 2015) gives us some more starting points for how we might analyse the arguments games make.

Unified Discourse Analysis – Gee and Bacchi

Gee’s unified approach to discourse analysis is a hugely ambitious work at the end of an extraordinary career. Here, I will focus on three aspects: the component parts of games, affordances, and projective identity. Gee shows how, by bringing these elements together, we can explore how the action in games such as those in the Metal Gear Solid series functions as a radar screen to avoid guards, and gives the player actions, including the ability to hide around corners. He also asks us to consider how the goals of the player relate to those of the character you are playing, ‘Solid Snake’, with the view of playing the game to be a ‘better Snake’.

First, Gee encourages us to explore the ‘nouns’ and ‘verbs’ that games have, which links to both game design (Anthropy and Clark, 2014) and language studies. Nouns are the objects in games, and verbs their behaviour. Some versions of this in-game design also include adjectives, which are the properties that the nouns have, and that too is helpful. If you know a bit about coding, you’ll also know this is also how object-oriented programming languages and even game engines work. 

Board games also have nouns (objects such as pieces, cards and the board), adjectives (the properties of the objects), as well as verbs (what you can do with those objects). Nouns matter because the objects we include (or exclude) say a lot about how we view the world. In games about conquest, if we exclude any indigenous peoples, then we are making a conscious decision about who is important (and who is not). Adjectives matter because including indigenous peoples by presenting them appropriately in cards or pieces shows that we are not treating them seriously. Verbs are important because, even if we include indigenous peoples and represent them reasonably, then not allowing them to actually play any kind of role may be nearly as bad as excluding them altogether. 

Combining the elements of verb and noun, Gee also discusses ‘affordances’ – an idea from psychology that concerns how we understand the world in terms of the uses we can make of objects (Gibson, 2015). To continue with the conquest example, the ‘Dahan’ in Spirit Island are included in the game, with distinctive pieces. Their actions respond to invaders (where they will attack invaders, but only after being attacked). Their affordances are mostly related to the player (the Spirit) who makes them ‘good for’ a range of different possible actions through their actions in the game. The game, therefore, includes indigenous peoples who have limited agency, but really require the player to intervene to offer resistance to invasion.

If nouns, adjectives and verbs, and then affordances are Gee’s first two contributions, his third comes through what he calls ‘situated identity’. In Gee’s view, we have an identity as players, but we also often take on roles when playing a game. Some game identities are more obvious than others, but when playing a game, we are situated within the role we are being asked to play, and which may be very different from how we regard ourselves outside of that role. 

Gee’s work is rich and wide-ranging. There are inevitably some challenges, though. First, I’ve presented a much simpler version of his ideas here. Incorporating everything in ‘unified discourse analysis’ is a significant challenge. The second is that, despite the richness of his framework, his analysis of games in the book offers little in the way of social critique. Gee prefers, using his rich toolkit, to explore the affordances of being very small in a human world (Chibi-Robo!) or what it means to play a ‘better’ Solid Snake (Metal Gear Solid 4). However, when linked to Bogost’s work, his framework fills in some gaps, allowing us to consider how we might incorporate the best of both researchers’ ideas – from Bogost, the idea that games present arguments, and from Gee, his use of nouns and verbs, affordances and situated identity. Putting these elements together moves us toward considering what Wardrip-Fruin (2020) calls ‘playable logics’ – the way games, through their systems, steer us in particular directions, and into particular forms of agency (Nguyen, 2020). We can resist those logics, or try and subvert them, or adapt the rules (or even ignore them, in board games at least). But they still represent points that, in engaging with the game, we have to navigate.

The third and final influence on the framework presented here comes from Bacchi (2009). Bacchi’s work is again very rich, and her framework is based on the social theory of Foucault, but the central insight is to ask the question ‘what is the problem represented to be?’. Bacchi’s work has a great deal in common with the procedurality of games, being concerned with meaning construction through processes and discourse (linking to Gee). In Bacchi’s view, rules and regulations play significant roles in how we live, and this certainly relates to how we interact with board games. By ‘making politics visible’ (Bacchi and Goodwin, 2016, chapter 2), the WPR approach seeks to show how people are positioned in roles and processes are constructed in ways that position them in relation to an overarching problem, which they are then required to try and solve. 

The key term for Bacchi is ‘problematization’, which means either subjecting something to critical analysis or the process by which problems are constructed for people to try to solve. So we must critically interrogate the process by which procedures and people constitute representations of social issues – in Bacchi’s case, through policymaking, but here through the way that board games construct their worlds and the problems they ask us to solve. This is entirely in keeping with Bacchi’s hope that by ‘working backwards’ from policies (or, here, games), we can interrogate their problem representations and reflect deeply on the assumptions on which they are based.

This is a very simple, but deep thing to ask. It is an excellent bridging between Gee’s ‘breaking down’ of the elements of games and Bogost’s claims that games make arguments. Before we can say what a game’s argument is, we need to have a good grasp of its nouns, verbs and affordances, but also work out what problem it is asking us to solve.

The Method in Brief

The method I’m suggesting is as follows:

From Gee, we have the basic units of games – the nouns and verbs, or objects and behaviour. These can be considered in terms of being affordances for action: what are the objects, and what are they good for? These aspects in themselves can produce a deep analysis. We can explore a game’s components, consider the choices made in their presentation, and examine the affordances for action those components offer. We can then put these elements together and think about what their representations seem to be telling us.

Gee also asks us to consider projective identity – the role we are being asked to play in the game. Who or what is it? What does that role bring to the game? What would it mean to play it well?

Once we have the units of the game and the roles it asks us to occupy, we can consider the game as a whole. From Bacchi’s framework, we ask, ‘What problem is the game representing?’ This can be broken down into further questions. What are we being asked to solve or resolve in the game? If we combine this with Gee’s insights, we can view games as combining nouns and verbs into affordances linked to a projective identity to solve a problem the game creates and defines.

Stepping back from these elements, there is still another gap – perhaps grounded in the fact that Bogost and Gee’s work originally focused on video games rather than board games. What about other players in the game? One of the key differentiating factors between video games and board games is that the latter are more likely to involve direct player interaction across a table. While it is true that digital platforms such as Board Game Arena are hugely popular, playing a game in person with other people in a physical location is a different experience – and at least some evidence suggests we play differently when we play in person rather than online (Kaufman and Flanagan, 2013). The materiality of the pieces matters, as does our ability to parse the situation before us, as does the interaction we have with others around the table. As a result, we are more likely to actively interact with physical board games than with their online counterparts and to engage more deeply with them (Kaufman and Flanagan, 2013). 

When we have all of those elements in place, we may finally see a route to answer Bogost’s question: what is the game’s argument? This involves putting together all the insights from the previous work. What are the nouns and verbs of the components, and what affordances for action do they offer us? How are the components represented? What roles is the game asking us to occupy, and how do we interact with other players? What is the problem we are being asked to solve? And then finally, what is the argument the game is offering as a result? There are unlikely to be single answers to this question, but we can give our best shot based on what we have discovered from the building blocks of the other ideas.

Methodologically, I prefer to put all of these aspects into a big table and work them through (see Appendix One for an excerpt in relation to the games in this paper). That way, I can see what I’ve claimed in other steps and build my inferences up through the stages of analysis. This also makes the analysis more transparent to others. That doesn’t mean everyone will agree with what I’m claiming, but it should at least be reasonably clear to them how I got there, and perhaps where we diverge if someone else wants to make a different argument.

It is also helpful to consider more than one game at a time, especially where they explore the same or similar themes.  This can highlight contrasts and help uncover elements that are present or absent in the two games. The account below attempts to present the two games explored in the paper in those terms.

Dice Hospital and Clinic Deluxe

Nouns

In Dice Hospital (DH), each player starts with nearly the same components. They have their own ‘starting’ hospital board, made up of nine hospital departments and four wards – one of each of the three colours (green, red and yellow) and a mortuary, where patients (dice) whose value falls below a value of one go. At the centre is the nurse’s station, where the white nurse meeples go (three for each player). There is a supply of doctor meeples which have the same shape and size as the nurses (bespoke for the game with what looks like a syringe in one hand and a jar of pills in the other), but with doctors varying by colour (red, green, yellow and blue), while all nurses are white. At the bottom of the starting hospital board is the ‘ward’ area, made up of four areas, each of which can hold three patients, and which sets the capacity limit of the hospital, beyond which patients cannot be treated and go straight to the mortuary. On the right side of the board are treatment rooms, each of which treats a patient with dice numbers in a specific range (1/2, 3/4, 5/6) only, and to the right of them is the discharge lounge where patients whose health has been restored above 6 go each round – the more patients discharged at a time, the higher the points the player gets. Each player also gets a randomly drawn administrator (the only asymmetry in starting conditions) who has an additional power, such as preventing untreated patients from falling ill or receiving an additional points bonus for particular patient colours being discharged.

In Clinic Deluxe (CD), each player has their own player board, which shows their Clinic from an isometric perspective, with rooms (and other elements) to be placed. Onto the board will be an initial setup of a service hub, based on the random draw of their first patient type, along with a treatment room and a supply room, which need to be placed according to adjacency rules. The main board dominates the table, and is organised in terms of the main actions the player has: building, hiring and admitting patients. It is a masterpiece of graphic design, being both functional in holding pieces and showing what actions are possible and in what sequence, with the ‘business’ and ‘admin’ phases (which occur after the player actions) shown as well. Around the board treatment rooms and other room elements are laid out, with the staff and patient bags from which meeples and cubes will be drawn and placed on the player board. There are many pieces in Clinic Deluxe.

A first comparison then shows that both games include doctors and nurses, as well as modular boards for building out the actual hospital. In addition, however, CD has a main board that structures the turn ‘flow’ and organises play.

Verbs and affordances

Moving to verbs, in DH, each round, the first player admits patients based on their choice of ambulance, of patients they wish to treat (from a selection of one more than the number of players, and with each made up of random dice arranged in ascending order). The player who ends up treating the ambulance with the ‘sickest’ patients, gets first choice of hospital upgrades as well as a bonus blood bag which allows them to treat a patient without a member of staff (or save to the end of the game for an extra point), and take the first player marker for the next round. There is some competition in this phase, but with the rest of the game having less direct player interaction.

Next, the players choose from the available hospital upgrades: either a new department tile or a new specialist. A key part of the game is creating combinations of department tiles and specialists to treat patients.

After this, players treat patients. Both nurses and doctors can treat any patient, but whereas nurses can only treat patients in line with the characteristics of the particular room they are allocated to, doctors specialize so that they provide bonuses if their skills match the colour of the room or the particular combinations of patients’ values they are being asked to treat. There is therefore an incentive to optimise these combinations.

Untreated patients decrease in health (and may die), and discharged patients (patients with a die value above 6) score for the player; the more patients discharged simultaneously, the higher the score. 

Moving to affordances, ambulances are for admitting new patients (dice), but also for giving players a trade-off over the level of illness they wish to take, balanced by a wider choice of hospital upgrades if they take more ill patients. Improvements are for expanding the number of patients that can be treated, either by adding more rooms or more specialists. Blood bags offer a ‘free’ treatment for a patient, but also victory points at the end of the game if players don’t use them. Meeples (nurses and doctors) are for treating people, but they require a treatment room to do it in.  Administrators offer small bonuses, so there is a small amount of starting asymmetry between different players. 

In CD players take three actions each round, with no more than two of the same action from the options of build, hire and admit. Building expands your clinic, but you need to do this in such a way that the journey through your clinic for patients and staff is as short as possible, reducing the time they spend (which will be a deduction from your popularity at the end of the game). Thinking about adjacency on floors and between floors is key to this, as is the placement of conveyors, which allow movement to ‘jump’ between the locations where they are located. The placement of entrances (including the helipad on the roof, if you build one) is key, as is the number of entrances which allow you more movement options in the hiring action each turn. You build gardens to increase the income from rooms and ensure you have sufficient parking for staff and patients. 

Hiring staff expands your clinic to help maximise income (sicker patients give more income) or minimise cost. Doctors can only treat patients of the same degree of sickness, with nursing bridging gaps in doctor skill, orderlies to provide bonuses in terms of running costs, and doctors to treat more patients, bearing in mind their skill levels will decline each round. 

Admitting patients allows you to treat them and gain cash. Patients have to be moved from the queue on the main board into the pre-admissions space, and then onto the player board. Movement costs popularity. You balance the need for cash reserves with the need to purchase popularity. It is a good idea not to have patients left in your clinic at the end of the game (as you lose popularity for any untreated patients). 

In terms of affordances, the build action gives you a range of options. Entrances give patients extra movement points to admit them and move them into the hospital, and may also shorten routes through the hospital. Treatment rooms provide additional services but must be positioned next to other facilities to be operational, while also bearing in mind the need to minimise patient journeys. Additional facilities provide variations in treatment or the ability to ‘re-skill’ doctors who otherwise lose their expertise, as well as popularity at the end of the game. Gardens increase charges for treatment rooms adjacent to them. Parking spaces allow you to admit more patients or employ more staff, as well as providing a limit on how many of these you can have in your hospital. Conveyors shorten movement times.

In terms of the hire action, staff generally increase your popularity at the end of the game (if you can afford them). Doctors treat patients, nurses bridge doctors’ speciality to treat patients, but can’t treat them for themselves. Orderlies reduce running costs. All hiring actions require staff to move into the hospital, which leads to movement on the time track and a reduction in popularity.

Admitting patients brings money (if you can treat them), but also brings movement as patients enter the hospital, which reduces popularity. Money allows you to expand your hospital and staffing, and once per round, at the end of the round, to purchase popularity. Popularity is the aim of the game.

In terms of verbs and affordances, then, the games begin to diverge further. Building in DH is a matter of taking an improvement tile, but in CD such tiles have to be purchased using the build action, which involves locating the new facility in a 3D puzzle space to maximise its placement. Staffing in DH is a matter of choosing to hire a new specialist rather than a new building, and one who is instantly available to fuse. In CD, it involves monitoring which doctors can treat which patients, and if there are enough nurses to ‘bridge the gap’ between skill levels – especially as nurses cannot treat patients by themselves (unlike in DH). CD also requires money for build and hire actions, whereas in DH it isn’t a factor.

Identity

In DH, you are a kind of meta-hospital manager, who also allocates who oversees staffing, hospital improvement and individual care decisions. In CD, things are not that different, except you not only buyg extra facilities but are also being responsible for their layout. You hire staff, organise patients and oversee treatment. Your central decision is about the purchase of popularity, balancing against the need to retain cash to expand your Clinic.

What’s the problem?

Putting this all together, in DH, hospital management is an optimisation problem: finding the right combination of treatment rooms and clinicians to keep your hospital full with as healthy patients as possible, in order to discharge as many as possible at once. Money isn’t a part of your calculations at all, but filling your hospital with as many people as possible who are as healthy as possible – so you can discharge them all at once – is the best way to win.

In CD, running a clinic is a layout and money optimisation problem, where you need to organise your clinic to minimise movement within it, and treat the sickest patients to bring in as much money as possible to buy more popularity. Money is a central issue, and there are incentives, provided your doctors have the right skill levels, of allowing patients to grow sicker so you can get bigger payments for curing them.

What’s the argument?

In CD, good hospital management is about getting the right staff and treatment rooms to keep a supply of near-healthy patients in your care to discharge them in large groups. Treating sicker patients gives you greater agency about how you upgrade your hospital, but it means you have sicker patients to treat. 

In CD, hospital management is about maximising income (treating as many higher acuity patients as possible) while minimising movement time (for patients and staff) by laying out the clinic as effectively as possible. Doctors’ skills decline as they treat patients, so you will need a strategy for overcoming this. Maximising income allows popularity to be purchased, and the further expansion of your clinic in the next round by adding more facilities or new staff.

Conclusion

What can we learn from Dice Hospital and Clinic Deluxe?

Even from the comparison above, a range of interesting questions appears. Why can nurses treat patients in DH, but act only as assistants to doctors in CD? What difference does including money in one game make compared to the removal of this constraint in the other? Why does one game include more staff types than the other, and which other staff groups could we usefully add? Why are the games about optimisation rather than caring for patients, and what would a game look like that did focus on patient care?

All of these questions (and others that stem from the comparison) could lead to full-length papers. This paper will conclude by taking a different approach and thinking about the implications of the broader painting of hospital management as being about optimisation. 

What DH and CD teach us about the ‘real life’ game of hospital management comes from a mindset in which we become concerned with optimisation, rather than with individual patient care. DH and CD show us the agential mode that we might enter if we were seeking to discharge patients en masse or treat the sickest patients we could find. In a similar way that Twilight Struggle is not a simulation of the Cold War, but instead gives us an insight into the mindset of navigating international relations if ‘domino theory’ were true (Donovan, 2018, chapter 15), DH and CD show us what hospital management is like if you regard it as an optimisation problem. 

Taking such an optimisation lens reveals some possible dysfunctional consequences.We might engineer things so that patients aren’t discharged as early as possible. We might deliberately allow patients to be neglected so that they become sicker, so that we can treat them either as part of a clinician/room combo or to raise extra money. We might even decide that the hit to our points or popularity brought about by  a patient dying isn’t a big deal, provided we can reach a better combo or treat another patient to get money to compensate.

The kinds of dysfunctional behaviours that can occur in CD and DH also occur in real-life settings where hospital managers are put under pressure by performance management systems and end up finding ways to subvert them (Hood, 2006). This work documents a range of such dysfunctions, which appear to be very similar to those which can occur from ‘optimising’ in DH and CD. These games are not simulations, but they may well be metaphors that capture something very important about how optimisation can become dysfunctional in hospital management.

Treating board games as metaphors and unpacking them in a way which allows those metaphors to be considered and explored has the potential to illuminate how we think about the social challenges board games often include. This can help us think about how social challenges are represented in games, and how those representations can both help and limit our understanding of them.

Works Cited

Anthropy, A. and Clark, N. (2014) A game design vocabulary: exploring the foundational principles behind good game design. Upper Saddle River, NJ: Addison-Wesley.

Bacchi, C. (2009) Analysing Policy: What’s the Problem Represented to Be? Pearson Education.

Bacchi, C.L. and Goodwin, S. (2016) Poststructural policy analysis: a guide to practice. New York, NY: Palgrave Macmillan (Palgrave pivot). Available at: https://doi.org/10.1057/978-1-137-52546-8.

Bogost, I. (2006) Unit operations: an approach to videogame criticism. Cambridge, Mass: MIT Press.

Bogost, I. (2010) Persuasive games: the expressive power of videogames. 1. MIT Press paperback ed. Cambridge, Mass.: MIT Press.

Booth, P. (2021) Board games as media. New York London Oxford New Delhi Sydney: Bloomsbury Academic.

Donovan, T. (2018) It’s all a game: a short history of board games. London: Atlantic Books.

Farber, M. and Schrier, K. (2017) The Limits and Strengths of Using Digital Games as ‘Empathy Machines’. New Delhi: Mahatma Gandhi Institute of Education/UNESCO.

Flanagan, M. (2013) Critical play: radical game design. First MIT Press paperback edition. Cambridge, Mass. London: MIT Press.

Flanagan, M. and Jakobsson, M. (2023) Playing Oppression: The Legacy of Conquest and Empire in Colonialist Board Games. Cambridge: The MIT Press (The MIT Press).

Gee, J.P. (2015) Unified discourse analysis: language, reality, virtual worlds, and video games. London ; New York: Routledge, Taylor & Francis Group.

Gibson, J.J. (2015) The ecological approach to visual perception: classic edition. Hove, East Sussex: Psychology Press (Psychology Press classic editions).

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Holland, A. (2025) Cardboard ghosts: using physical games to model and critique systems. Boca Raton London New York: CRC Press (CRC Press guides to tabletop game design).

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Kaufman, G.F. and Flanagan, M. (2013) ‘Lost in Translation: Comparing the Impact of an Analog and Digital Version of a Public Health Game on Players’ Perceptions, Attitudes, and Cognitions’, International Journal of Gaming and Computer-Mediated Simulations, 5(3), pp. 1–9. Available at: https://doi.org/10.4018/jgcms.2013070101.

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Appendix – excerpt from the table the method produces

Noun	Adjective	Verb
Patient DH – Dice CD – Cubes	8 settings (0-dead, 7-discharge) plus six. Colour indicates degree of illness. 4 colours indicating severity of illness	Receive treatment (passive) Move and receive treatment (passive)

Nurse DH – meeples CD – meeple	Bespoke meeple – white Generic meeple – turquoise?	Treat patients (but no specialisms/combos)Assist doctor/bridge specialism – cannot treat alone
Doctor DH – meeples CH – meeples	Bespoke meeple – different colour by specialism Generic meeple – different colours	Hire (improvement phase)Treat patient –specialism/treatment room match combo Hire (hire phase) – cost and parking limitsMove to treatment locationTreat patient – if match with specialism (otherwise nurse bridge)Decline in skill if no laboratory
Orderly DH – not present CD – meeple	n/a Bespoke meeple	n/a Reduce cost
Treatment areas DH – modular add ons CD – modular add ons	Multiple options during improvement phase. Modular. Multiple options at any time (for cost). Have to be located in hospital.	Offer additional capacity and new combinations (working with doctors) Offer additional treatments or additional capacity – provided doctor is available
Ambulances DH – 3 slots to put dice in CD – ‘notepad’ equivalent	3 slots, between players, phase each turn Notepad offers choice of patients to admit – but no compulsion	Admit onto player board directly Admit onto player board but route has to be plotted and time taken into account
Hospital treatment improvements DH – available in improvement phase (limited) CD – range of additional treatments	Wide range of additional modules – no placement issues Lab, operating room, triage, outpatient services – must be placed in relation to other rooms and entrances	Patient/dice manipulation and combination Improving doctors, extra nurse capacity, reducing time, disregarding of illness/colour and reduce time
University DH – some choice in improvement phase CD – wider choice on board	Cards during improvement phase Meeples on board in University after drawing from bag	‘Improve’ – hire doctor Hire – in hiring phase (subject to parking/cost)
Other modules DH  – blood bags DH – administrator CD – additional rooms, , gardens  CD – conveyors, entrances, heliports, parking	Token in shape Cards Room modules Tokens to add to player board	‘Free’ treatment Variable bonuses Variable bonuses (see above), increase in revenue for treatment Travel time reduction (popularity)