Gamification — the application of game elements and digital game design techniques to everyday problems, such as business dilemmas and social challenges — is not new. On the contrary, gamification has been commonplace in fields like education and military for years. However, it wasn’t until recently that the concept of gamification started to generate interest in the healthcare industry. Many healthcare leaders view gamification as a potentially critical component to patient engagement, wellness adherence, and outcome improvement.
In response, software developers have begun “gamifying” applications for healthcare in droves. Some of these apps are targeted to health providers as a way to spark patient engagement and wellness adherence. Others are geared to payers as a tool to get their members interested and invested in prevention, thus cutting the overall cost of care to the insurer. And some are aimed at patients (a.k.a. consumers) to support personal nutrition and fitness goals.
While there’s an abundance of healthcare gamification options to choose from, these applications have yet to become widely adopted in the industry. This is especially true when it comes to healthcare providers. For example, gamification ranked dead last out of 44 technology initiatives we asked healthcare providers to prioritize in our recent Top 10 Health IT Trends for 2015 survey. This was surprising given the level of interest gamification has generated in healthcare as of late.
Gamification — the application of game elements and digital game design techniques to everyday problems, such as business dilemmas and social challenges — is not new. On the contrary, gamification has been commonplace in fields like education and military for years. However, it wasn’t until recently that the concept of gamification started to generate interest in the healthcare industry. Many healthcare leaders view gamification as a potentially critical component to patient engagement, wellness adherence, and outcome improvement.
In response, software developers have begun “gamifying” applications for healthcare in droves. Some of these apps are targeted to health providers as a way to spark patient engagement and wellness adherence. Others are geared to payers as a tool to get their members interested and invested in prevention, thus cutting the overall cost of care to the insurer. And some are aimed at patients (a.k.a. consumers) to support personal nutrition and fitness goals.
While there’s an abundance of healthcare gamification options to choose from, these applications have yet to become widely adopted in the industry. This is especially true when it comes to healthcare providers. For example, gamification ranked dead last out of 44 technology initiatives we asked healthcare providers to prioritize in our recent Top 10 Health IT Trends for 2015 survey. This was surprising given the level of interest gamification has generated in healthcare as of late.
Some chalk the lack of adoption up to the healthcare industry not being ready to embrace gamification. In other words, there are so many other high-profile initiatives consuming provider resources that gamification is being placed on the backburner. This viewpoint definitely has merit, but it doesn’t tell the whole story. The other end of this equation is the fact that many of the healthcare gamification tools available today have yet to deliver on their promise of improving patient engagement, wellness adherence, and outcomes.
When you ask Michael Fergusson, CEO of the healthcare gamification company Ayogo, the reason for the gamification/healthcare disconnect is clear — most of the gamification apps being created for healthcare aren’t games at all.
“Most of the healthcare gamification offerings available today simply try to encourage certain behaviors by rewarding users with points or badges and creating leaderboards,” says Fergusson. “Slapping these features on an app doesn’t make it a game. Nobody needs to be coaxed into playing a game. It’s a universal human behavior that everyone has done at some point in their lives. To gamify an application, you simply need to facilitate this natural behavior. You don’t want to impose a framework that is unnatural to most people. This actually takes the gameplay out of the equation. Unfortunately, this is the way most healthcare gamification apps have been designed to date.”
The 5 Essential Elements Of A Game
According to Fergusson all games contain five essential elements:
- Agency: There must be real, meaningful decisions or choices that a participant needs to make at important junctions.
- Challenge: A conflict or difficulty must be overcome. For longer-term engagement, the challenge should have a progression curve (from easy to more difficult).
- Uncertainty: There must be legitimate uncertainty as to the outcome. According to Fergusson, this is where most healthcare gamification apps fall short. In his opinion, most healthcare gamification tools try to impose certainty where it doesn’t belong. They design their platforms to direct you toward one desired outcome (i.e. healthy behavior) rather than letting the game unfold. To Fergusson, this practice is counterintuitive. When uncertainty is removed from the equation, the participants’ decisions don’t matter, the game becomes less enjoyable, and engagement suffers as a result.
- Rules: All games must have rules. Not just written or spoken rules, but rules that are discoverable throughout the course of play. For example, you can read a rulebook for ice hockey from cover to cover and nowhere in the book will you learn about how you need to go where the puck is going and not where it is. The only way to recognize and understand this rule is to actually play the game.
- Outcome: There must be a meaningful, recognizable outcome. This doesn’t have to take the form of a win/lose/draw. Instead, it can simply be a recognizable outcome for the participant. For example, there often aren’t any real winners or losers in a game of hide and seek, but there are definitely recognizable outcomes (e.g. children recognize good hiding places when they are not found, etc.).
Building A Better Healthcare Gamification App
Fergusson is the first to admit that applying all of these gaming principles to healthcare applications is challenging, but he believes he is beginning to uncover a successful formula.
“I’ve always believed that real healthcare decisions aren’t made in doctor’s offices — they’re made standing in line at Starbucks,” he says. “What I mean by this is a healthcare gamification app needs to provide people with the appropriate triggers, opportunities to act, and motivations when they are out in the real world doing everyday things. Therefore, effective management of the healthcare context of an individual is crucial to the success of any healthcare gaming app.”
According to Fergusson, social connections and positive peer pressure are also instrumental when trying to change behavior or instill new rituals or habits. Therefore, exposing elements of the game to social networks and providing outlets for feedback is also a key consideration for healthcare gamification.
However, to Fergusson, it’s the narrative layer of the game (i.e. developing the protagonist(s) and constructing a true beginning, middle, and end to the story) that is possibly the most important aspect of any healthcare gamification app.
“Aligning the aspects of the game with an individual’s concept of self is extremely powerful,” says Fergusson. “Making people identify and care about their avatar — the protagonist in the story — is the key to engagement over time. When done correctly, the arc of the story itself becomes the reward for the participant.”
Fergusson’s company, Ayogo, has injected these concepts into its healthcare gamification offerings Empower and GoodLife. The results have been promising thus far. For example, Ayogo is currently working with a group that is trying to help extremely overweight people change their habits and adopt healthier lifestyles.
“You can’t prompt a person that’s 250 pounds overweight to go walk on a treadmill,” says Fergusson. “Many people that fit this description have a difficult enough time leaving their apartments. Therefore, the motivation and tasks you provide these individuals need to be carefully crafted.”
Fergusson is careful to point out that his company doesn’t design the healthcare programs themselves. Ayogo simply creates the engagement and adherence platform around the health program a provider or payer develops. The company white-labels this platform (so Ayogo’s clients can brand it as their own) and makes it available as a SaaS (software-as-a-service).
However, Ayogo takes its part in this process very seriously. The company even hires television writers to develop the narrative components of its games. “Our game narratives are educational, emotional, and even melodramatic in places,” says Fergusson. “Most segments of the story also end with cliffhangers to entice the participants to take the next step in their journeys. People are eager to see what happens to the protagonist next.”
The gamification program Ayogo developed for the group treating the morbidly obese is producing positive results. “The experimental group in this pilot is substantially outperforming the control groups,” says Fergusson. “We’ve seen this same trend through multiple rounds of pilots now, and we’ve been able to sustain these results over time as well.”
