Ready Patient One

Outlining the key steps for healthcare marketers in effectively applying game mechanics to boost the patient connection-and ultimately drive business  

Whether we like to admit it or not, many of us know the unique rush that comes from swiping a series of multicolored jelly beans in Candy Crush. We’ve experienced the thrill of landing a triple word score in Words With Friends, and we’ve known the satisfaction that comes from-of all things-successfully harvesting a field of wheat in Farmville. Gaming is a universal pursuit, triggering not only our competitive instincts but also our desires for achievement and recognition. And with the rise of app- and social-media-based games, there are more people playing than ever before; the number of online gamers is expected to reach 2.7 billion by 2021, according to gaming analytics firm NewZoo.

The widespread popularity of gaming has led marketers to seek out ways to employ game mechanics as a tool to boost consumer engagement. While this concept isn’t new-and some even consider “gamification” a buzzword gone by-the idea is taking hold in healthcare due to recent technological advancements, the continued rise of smartphones and digitization, and the treatment demands of chronic diseases. In fact, the healthcare gamification market reached more than $16 billion in 2016, according to Global Market Insights.

If done right, applying game mechanics to healthcare marketing efforts has significant potential to ensure that patients are activated, educated, and engaged throughout the duration of their care, which could drive business impact and-most importantly-improve patient outcomes.

Game on

It has long been known that games have the potential to teach and motivate people to behave through carefully constructed game mechanics, the rules and methods designed for interacting with the game and driving gameplay. For healthcare marketers, gamification can help provide motivation for wellness, increase health literacy, drive behavioral change surrounding medication adherence or lifestyle support (such as monitoring diet and exercise), and activate patients who might not otherwise engage with their healthcare. Current examples of innovative healthcare games are numerous; consider Bandit’s Shark Showdown, a gamification app designed by the Johns Hopkins School of Medicine to treat stroke patients. To play, patients use a robotic arm to safely maneuver the game’s hero-a dolphin named Bandit-through a sea full of sharks. By contracting their arm muscles to move the virtual dolphin, the game’s creators hope that patients can relearn their fine motor skills and encourage tissue repair, especially during the critical three-month time period after a stroke occurs.

There’s also SnowWorld, which was developed for burn victims. The simulation immerses the patient in a virtual world and has them hurl snowballs in time to music, which distracts them from their pain. It has been shown to not only reduce patients’ reports of pain but also reduce pain signals on MRI scans. The technology, produced by the Human Photonics Laboratory at the University of Washington, has also been applied to help soldiers mitigate the effects of PTSD and pain as they are being treated for their wounds.

As these types of games become more prolific in healthcare, many pharmaceutical companies have jumped straight into the gamification arena. However, very few of these efforts have led to success. Too often, pharma companies’ gamified efforts fail because they focus more on the desired outcome than on patient goals, and the games themselves don’t excite, engage, and motivate the users. We recently spoke to leading experts in gamification and sought to understand the keys to navigating successful gamification in pharma. As one of our interviewees, Karl Kapp, author of The Gamification of Learning, succinctly stated: “[Gamification] is about borrowing elements used in games and applying them in non-game situations.”

Overcoming the obstacles

While the prospect of using gamification to drive behavioral change in the pharma space is exciting, it takes a significant amount of skill and investment to design a game that truly captivates patients and keeps them going back. Moreover, pharma marketers often encounter pitfalls when they don’t fully understand how to apply game mechanics within healthcare. One of these pitfalls is rushed implementation, which results in a poor design and a lack of user input and feedback. “Companies shouldn’t think of [gamification] as a fad,” says Kapp. “People rush into it, and they think it’s going to solve every problem: ‘Oh, just gamify it and you’ll have such engaged patients.’ Then, that doesn’t work because it’s implemented poorly and rapidly, and without a vendor who has done this before.”

Pharma companies are used to researching solutions and designing treatments in isolation, carefully controlling patient involvement. Leveraging customer data, user research, and dynamic and frequent consumer feedback, however, is what can make the platform and overall game experience better. The effects of failing to engage with patients early and often-and not using data to drive decision-making in the development process-is magnified in the healthcare space, where the topics themselves are deeply personal and often accompanied by additional stresses that make engaging patients in any program difficult. Pharma organizations shouldn’t develop a program and randomly implement game mechanics without first conducting research with the target audience and then seeking players’ feedback.

Many companies also fail because they don’t understand player motivations. For some players, they feel a sense of intrinsic (internal) motivation; they like playing a game because it results in feelings of accomplishment, fulfills a desire for social interaction, etc. This type of motivation typically results in short-term adoption because people generally are drawn to what’s new and exciting. However, to achieve long-term adoption-and truly motivate the patient-pharma marketers need to combine intrinsic rewards with extrinsic (external) awards or incentives. According to Kapp, in some cases, small extrinsic rewards can be effective motivators when tied to tasks that employees know they should be doing. For example, “I’ve seen apps where the reward that you could get is a $10 Starbucks card,” says Kapp. “The amount of effort and time to get that card was disproportionate to the actual $10. It seems the idea of getting money for ‘free’ can be highly motivating when presented in the right context.”

A winning strategy

To achieve success and overcome the many obstacles standing in the way of effective gamification, Kapp recommends that “the fundamentals of the solutions are solid and evidence-based, and you continuously monitor how it’s working after launch.” Moreover, pharma companies should use gamification not as an intervention in isolation but as a piece of a larger, holistic behavior or support program with patients.

Here are four key steps that drugmakers can take to ensure that game mechanics are applied effectively.

1. Perform design research with patients and leverage a professional game designer. It’s not enough for pharma companies to simply design something that looks nice or innovative; what’s created must be easy to understand, learn, and navigate. Furthermore, it must complement the context and scenarios in which patients will use it, so it doesn’t feel like a daily chore or an inconvenience. After performing market research to understand and organize patients’ needs and preferences, companies must define patient segments and then collaborate with design researchers to help ensure that concepts fulfill unmet needs.

Then, companies should tap an experienced game designer to carefully consider why game mechanics should be used and guide the development based on the data. If using game mechanics will benefit the goals and needs of patients, and the specific motivations of the patients are clear from the research, a game designer should collaborate with the design research team to create and oversee the game concepts, setting, story, and game play. Game designers understand the nuances of the psychology of games and will be able to strategize about what mechanics will motivate specific patient types to foster engagement and adoption. Also, they understand that one type of game mechanic will not engage the entire audience, so multiple mechanisms should be implemented to work separately or in tandem.

Once the game mechanics have been developed, the design research team can test the concepts quickly and inexpensively so that prototypes can be validated prior to the expense of building or manufacturing. “I’m a big proponent of prototyping in small groups so we get a sense of how to modify it and change it,” says Kapp. “You can launch something and people don’t even know where to go. The users aren’t ‘gamers.’ We learn where they have trouble using the app via pilot programs because everything isn’t always intuitive.”

2. Develop a game currency that’s meaningful and valuable to patients. Gaming currencies can take the form of points, chips, gems, and other metaphors, and they can be cashed in for tools that will help advance the player closer to winning the game, like better armor or a higher ranking. However, players have to want to try to earn the currency, otherwise it holds little value. Pharma marketers should collaborate with design researchers and game designers to test currency concepts through pilot phases that capture both quantitative and qualitative feedback. This upfront research allows the team to identify the appropriate mix of both intrinsic and extrinsic motivators to drive results.

“Think about ‘progress mechanics’ where you focus on smaller steps, not the end goal. This can be used as a reward currency that enables patients to ‘level up’ in the experience because they took an action,” says Gabe Zichermann, worldwide expert and author on gamification, user engagement, and behavioral design, and an advisor to patient engagement platform HealthPrize. “This provides a tangible value within the digital environment by changing the experience.”

3. Give patients immediate, easy-to-understand feedback that’s relevant to the goals of the game. Game mechanics have the unique ability to measure behavior or activity, tell people exactly how they’re doing, and inform them on what they have or have not accomplished. For example, while numerous studies have found that fitness trackers do not have a measurable impact on weight loss over 24 months, the ability to track steps could lead to different patient outcomes, such as improved cardiovascular health.

According to Zichermann, it’s important to reduce people’s shame of failure and replace it with positive reinforcement, and help people achieve success in small steps instead of trying to achieve a big goal immediately. “If you’re doing a ‘quit smoking’ program, that’s your ultimate goal, but if you try to completely quit right away, you’re destined for failure,” says Zichermann. “Real-world positive reinforcement is very expensive and very specialized. In software, it’s very easy and cheap to express that. You need to show people they are focused on the large goal, but also the smaller steps.” Consistent and meaningful feedback-like the ability to view your weight-loss progress on an app or accumulate points for proper medication adherence-can spur continued engagement.

Pharma companies also need to focus on helping patients interpret what they’re seeing within a game or application. For example, while certain numbers and percentages regarding patient health are common in healthcare, it can be difficult for the average consumer to determine what they mean. It’s extremely important to qualify and quantify data to provide education to patients so that they understand how to interpret their results.  

4. Make improvements based on patients’ gaming behaviors. With pharma companies currently investing millions into their digital infrastructure, taking the time to track and analyze user data often gets lost in the sunk costs of building the innovation and getting it out the door to pilot. However, successful gamification efforts require pharma companies to go beyond tracking the number of app downloads. Many pharma organizations are tying engagement back to pharmacy data to see if patients who engaged were more likely to be adherent to therapy. Others are using different metrics, like the patient activation measure, to determine whether patients who engaged had higher health literacy and were more engaged in their care.

By assessing these types of metrics to better understand the impact of gaming, pharma companies will be well-equipped to continue improving their gamification efforts. While many attempts to use game mechanics in pharma and healthcare have not succeeded,  they have led to important discoveries about motivation and engagement that will help position others for success. Gamification is no longer just a buzzy topic, which makes room for more thoughtful, creative, and successful efforts.

Rachael Pius, Business Consulting Manager; Maurice Solomon, Digital Connected Health Strategy + Execution; Victoria Summers, Associate Principal; and Melissa Visintin, User Experience Manager; all with ZS Associates