While the game was designed to teach systems thinking, it has served diverse learning objectives across many industries and cultures.

The Friday Night at the ER game was developed in 1992 by Breakthrough Learning, Inc., a consulting and training firm based in Morgan Hill, California.

Demonstrating the universality of systems principles, the game is in use by service organizations, manufacturing companies, government agencies, academic institutions and others in at least 30 countries.

[citation needed] Friday Night at the ER has its origins in a business case that took place in 1990 at San Jose Medical Center, in San Jose, California, where a persistent problem of decreasing capacity for emergency patients was resolved using a system dynamics study that included a simulation model of patient flow.

[3] A high-leverage intervention to resolve the problem required collaboration across departments to share nursing staff during times of peak emergency demand.

[6][7][8][9][10][11] In 1997, Friday Night at the ER was published in electronic form in Activating the Fifth Discipline, a PC-based multimedia education program[12][13][14] Although Friday Night at the ER depicts a hospital based in the United States, it has been adopted and widely used as a team-learning tool both within the healthcare field[15][16] and beyond, finding use across diverse industries including other service organizations, manufacturing companies, government agencies, and academic institutions.

[citation needed] In 2014, an updated version of Friday Night at the ER was released with modernized and upgraded game and support materials.

In 2018, educators at the University of North Carolina at Greensboro published results of research in which students were assessed before and after using Friday Night at the ER.

A program leader or coordinator provides verbal instructions; then participants play the game on their own for approximately one hour.

The debrief is facilitated by the program leader with a structured progression of discussion questions, reflection exercises, didactic presentation, and group tasks to bring to light key lessons of the experience, its relevance to the group and how participants will put lessons into practice after the program.

In addition to variations in the gameplay, the structure and content of the debrief may be designed to teach either a narrow or broad purpose.

At each four-person table, players each manage one of four departments in a hospital: Emergency, Surgery, Critical Care, and Step Down.

Among the other details of the gameplay are “events” that occur (e.g., a doctor is late, a room is being renovated, a staff member goes home sick), requiring reaction and management by players.

A portion of Emergency arrivals flow through to other departments, so players experience the ripple effect of demand and the challenge of interdepartmental hand-offs.

Following the gameplay, individuals at each table contribute to calculating a team score that reflects the quality of service they delivered and financial performance.

Teams scores are displayed to provide benchmarks and to enable participants to relate behavior to performance.

A standard debrief to teach applied systems thinking is described in the Friday Night at the ER Guide for Program Leaders with presentation slides to support key points.

During the debrief, participants are guided to focus on collaboration, innovation and data-driven decision-making as key strategies necessary for successful system performance.

Participants see that these three strategies produce excellent performance in the gameplay, and that the same applies to their real-world endeavors within organizations.

"Health Care Change Agents: Interview with Bette Gardner, CEO and Founder, Breakthrough Learning".

{{cite journal}}: CS1 maint: multiple names: authors list (link) Gardner, Bette (2019).

Sanko, Jill S.; Gattamorta, Karina; Young, Judith; Durham, Carol F.; Sherwood, Gwen; Dolansky, Mary (March 31, 2020).