As a surgeon I recall being startled one day, upon entering the operating room, by the appearance of the anesthesiologist assigned to my case. He was looking noticeably more svelte than usual.
“Wow, John,” I commented, “I guess I haven’t seen you for a few weeks. What have you been up to? You’re looking pretty fit.”
“I gotta win this thing,” he replied. “It’s my natural instinct.”
I didn’t know what “thing” he was referring to until I did a little more digging. Turns out that a friendly contest had been brewing between self-selected anesthesiologists and surgeons at the hospital, the ones who felt they needed to lose a little weight (or more than a little).
This weight loss competition—anesthesiologists vs. surgeons—explained the hand-written list I had noticed in passing, taped to the refrigerator door of the surgeon’s lounge. The list included names and numbers, which I now realized was the groups’ leaderboard ranking based on pounds lost to date.
I can’t even recall now what the prize was, but I do recall that John won. He gloated for weeks. The game served as fodder for an endless supply of jokes and conversation. And that’s one of the first points I wanted to make. Often, when an otherwise dull process such as weight loss is “gamified,” the game mechanics themselves—the leaderboard ranking, the setting of goals—can have a greater motivational impact than the prize itself.
A leaderboard is deceptively simple, but adds two important elements to the otherwise lonely and dreaded task of losing weight: 1) a social element and 2) a way to tap into our natural desire to compete. Both are powerful motivators, regardless of whether the ultimate prize is $1,000 or a cheap trophy.
Gamification refers to the application of game mechanics to enhance the enjoyment of an otherwise non-game experience, to boost engagement and success. It’s a growing trend in healthcare, and for good reason: Healthcare is often boring, which is one reason why it’s difficult to engage patients in critical healthy behaviors.
Gamification is distinct from the use of an actual game, per se, such as a video game, although the use of actual games is also a small but growing trend in healthcare. And, another quick note on terminology: Gamification is not related to “game theory,” which is a distinctly separate topic related to strategic decision making.
Common gamification elements, or tactics, in addition to leaderboard rankings include points, badges, leveling up, prizes, countdowns, sweepstakes and various forms of goal setting and challenges.
When gamification is applied to any industry, including healthcare, there are a few key rules of thumb to keep in mind:
1. Well-designed Incentives: If incentives are included, they need to be well designed. Rewards need to be meaningful. Preferably, players can choose their reward from among a diverse offering. Not everyone wants a water bottle or T-shirt with a brand’s logo on it.
2. Think Short Term: We also know that short-term rewards (and feedback) tend to trump longer-term rewards in their motivational impact. After all, given our natural human “present bias” (our desire for instant gratification), most healthy behaviors tend to be so difficult precisely because the rewards are longer term.
3. Luxurious Rewards: In constructing incentives, “luxury” often trumps “utility.” In other words, some form of discount on a health-related item or service seems like a reasonable reward to offer, but it could easily be construed as boring. A $10 Amazon or Starbucks gift card is more fun.
4. Be Humorous: It helps to add an element of humor, or playfulness. No one wants to be a “patient.” No one wants to have a “condition.” Humor can function as a healthy distraction, even for patients with serious conditions. Not everything in healthcare needs to be a bitter pill. So, if educational content is included as part of a gamified program or intervention, it can be written in a way that is both useful and playful.
5. The Right Motivational Mix: A combination of extrinsic and intrinsic motivation is key. Points, prizes and badges can have a profound motivational impact, but they only go so far. Patients also need to fully understand why they are engaging in the healthy behavior and they need to want to achieve the ultimate prize of better health, often not only for themselves but also for their families.
The growing trend of gamification in healthcare is important and, I believe, will deliver results when applied effectively. Just as we would critically assess the methods of any medical research, it is also critical to examine the specifics of gamification techniques in evaluating their impact. Poor methodology will deliver poor results, and that’s no fun.