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Behavioral game changers - EY - Global

Progressions 2012

Behavioral game changers

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Health interventions — particularly for managing chronic diseases — must reach people where they spend time.
  J. Leighton Read, MD
  Alloy Ventures, Venture Partner

It's been almost 30 years since my first experience in game design. In 1984, I led a team of experts from Harvard Medical School in designing The Original Boston Computer Diet. Players of this computer game could choose the personality of their simulated nutrition coach, who led them in a daily cycle of planning and reporting food choices and exercise.

Feedback — delivered via text, graphs, animation and sound — emphasized persistence and planning over poundage. The game was fairly successful, with some patients reporting sustained weight loss. Repeated interactions over several weeks with an obviously computer generated counselor were evidently more effective than reading a diet book.

Much has changed since then — that initial game was deployed using floppy disks on computers such as the Apple IIe and Commodore 64 — but the potential for games to motivate healthy behaviors remains every bit as significant. In the past year alone, start-up companies and academic groups have initiated dozens of projects to realize this promise. Many of these are capitalizing on the rapid growth of games delivered on mobile devices and social media platforms. Today, institutional sponsors of such programs will be looking for a strong evidence base before widespread deployment.

The case for using games to improve outcomes is compelling. Health interventions — particularly for managing chronic diseases — must reach people where they spend time. Games can enable this, since they have already claimed significant mind-share from television, books and cinema and reach deeply into almost every demographic category.

Consequently, games can channel these hours of engagement to address persistent behavioral challenges such as diet, exercise and adherence to therapy. Games can enhance the effectiveness of health messaging, allow individuals to practice useful thought patterns and behaviors and encourage them to explore and learn from failure in safe virtual environments.

Design elements —e.g., narrative setting, feedback, points, levels, competition, teamwork, trading and even self-representation using avatars — can play a key role in increasing patients' motivation.

Games can be explicitly designed to attract players for either short- or long-play sessions (minutes versus hours) and over short or long durations (playing off-and-on for days versus months). In health care, decision-support games — guiding patients, providers and caregivers through complex health decisions involving large amounts of data — might be designed for sessions that are a few hours long over a duration of a few days.

On the other hand, games to promote lifestyle changes will likely be designed for sessions that are shorter (a few minutes at a time) and more frequent, but over longer durations (many months or years). Patients could be engaged over such long durations through social networking platforms infused with game elements. In such settings, peer expectations and encouragement can augment traditional levers such as points and levels to motivate behavioral change.

In recent years, behavioral economists have focused increasingly on the challenge of influencing health behaviors. This includes issues of choice architecture — wording, default options, prompts, reminders, background information, etc. — that can significantly influence decisions and behaviors.

This is an area where games could provide valuable insights, since game designers are masters at nudging players in a particular direction. To quote a blog post by the celebrated game designer Raph Koster: "We have carefully designed the games to always be prompting players to do something. We use eyelines to tell players to go someplace, we push quests on them with glaring icons and pop-ups, we put constant reminders up … games have developed incentives to get you to go do stuff. … You throw [players] into situations where they have to take action."

We are still in the early days of gamifying health care. As we move forward, games will need to deliver health benefits and integrate into care settings without disrupting trusted relationships with clinicians. Games will learn from real-time data and evolve through rapid, small experiments — more like software-as-a-service or cloud computing than the classic model of design, deploy and assess.

Games are powerful motivators of human behavior, and game designers have a deep understanding of persuasive design. At a time when health care is focused on outcomes and seeking sustainability, the case for gamification has never been stronger.

In 2004, Leighton Read and Professor Byron Reeves of Stanford University co-founded Seriosity, a start-up focused on studying elite players and using insights from games to make workplaces more satisfying and productive. The two are also co-authors of Total Engagement: Using Games and Virtual Worlds to Change the Way People Work and Businesses Compete (Harvard Business Press, 2009).

This article was featured in our report Progressions 2012 - the third place: health care everywhere.

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Progressions 2012: health care everywhere
Progressions 2012: health care everywhere
Disruptive innovations and unsustainable costs are propelling life sciences companies into the behavioral change business. Learn why in our annual life sciences report.

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