How to prod along gamification in healthcare

By Jonah Comstock

Gamification has a perennial presence at health tech conferences, but never seems to take central stage. At a late-day session at HIMSS16, Amanda Havard, Chief Innovation Officer at Health: ELT and Charlie Schroder, a digital strategist and consultant, talked about what’s holding the space back and how health stakeholders can launch gamified apps that work.

One topic that frequently comes up in gamification discussions is “pointsification”, or apps where the only game-like strategy is the use of badges and points to motivate people. While Havard and Schroder acknowledged the controversy about whether that really counts as gamification, they also said that points and badges are very powerful motivators and shouldn’t be dismissed.

“If you want somebody to do something, go to the next screen, or get them to physically go to a place, use the location services, have them check-in, and give a happy little exploding confetti reward for that on the phone, and you’d be shocked at how effective that is,” Havard said.

“In Silicon Valley we’ve played around with a number of incentives including cash rewards versus badges and points, and badges and points win out every time over cash, over anything tangible, and it’s across every demographic,” Schroder added.

The two cited several examples of healthcare gamification efforts with powerful effects. One game, from 1997, was designed to help kids manage diabetes and led to a 77 percent reduction in urgent care visits. In another case, kids who played Super Mario Bros before surgery had a dramatic reduction in anxiety both before and after surgery. In another, people were motivated to exercise after doing virtual exercise in a game with an avatar that looked like them. 

During the question and answer period of the session, Havard and Schroder addressed why such positive data didn’t lead to broader adoption or more attention on the space. 

“There are a lot of question marks over therapy that’s a digital tool — Where does that fall? Who needs to say that’s ok? Is there liability attached to that?” said Havard. “I tend to think that the unknown aspect here is what’s really keeping this from blowing up. If you think about what would happen if you had a drug that posted these kinds of numbers, that’s great, but that’s because there’s already a concrete vetting process of how you do a clinical trial, how you evaluate a drug.”

In order to make gamified apps and health games work in the real world, Havard — whose background is in working with Medicaid populations — had a number of concrete suggestions for healthcare stakeholders. The overarching theme was the importance of taking games seriously. 

“You need executive buy-in,” she said. “Obviously every organization is different, but you need the people far enough to the top to understand what you’re trying to achieve with better health outcomes. Think ‘We have decided to start analyzing our populations in such a way that we can give them targeted health initiatives, and this is how we’re going to do it, we’re going to see it through.’ That’s what I’m talking about when I say executive buy-in. You know this is a decision you’re making. Please don’t do this flippantly, it won’t go well.”

Additionally, she said, it’s important to recognize the diversity in populations and build with a specific group in mind.

“You have to have clearly defined goals in terms of clinical outcomes and clearly defined patients,” she said. “We can’t harp on that enough. Realistically, we’ve all seen that modular things have a great success sometimes instead of broad strokes that reach across an entire population. You don’t have to reach every member via a gamified app, via a mobile platform, via a game, today, tomorrow, or whenever you roll it out. Figure out what your pain points are, what the golden outcomes are, and go from there.”

Finally, she said, successful interventions make designers a part of the process from the start.

“If it does not feel like the most popular apps downloaded from the app store, if it’s not that smooth, that easy, that clear, that pretty, that anything, you’ve done it wrong,” Havard said. “Effective tech is usable tech. If you want to see an effective implementation, it has to be usable. That is not an afterthought, that is not ‘hire a designer after you’ve built it and see if you can pick colors’. … That is critical.”