Idea to retire: Patients as passive recipients of health care

Managing health care in today’s turbulent economic environment has become a critical issue for all health care stakeholders. Health care is facing the challenge of modernizing and at the same time economizing. The increasing dominance of economic reasoning in health care demands cost-containment and emphasizes self-responsibility, financial stakes, and participation of health care users. Under the logic of health care consumerism, the autonomy of patients has forced medical organizations to be more customer-focused. At the same time, health care consumers assume greater responsibility for their own health care and are being asked to make more decisions—and more complex decisions—than ever before.

One of the top priorities for many governments is to promote (and provide) good health care services to their citizens, which is good for economic productivity. One aim is to improve the overall quality of the health care system by making health care more patient-centered, reliable, accessible, and safe. Governments and health care leaders, aware that ever-increasing health care expenditure is an unsustainable trend, are looking for ways to boost efficiency while improving access and increasing quality.

However, one idea that needs to die is the assumption that the only task of public sector health care “services” is to deliver service efficiently; it must be effective as well. There is a strong debate about the ongoing dehumanization of health care services. Health care experts and researchers observe that many health care ecosystems engage in mechanization, thinking of the patient as set of interacting systems instead of as a person. Another idea that needs to die is the vision of the patient as a passive recipient of care.

Gamification can change health care

Gamification is applying game thinking and game mechanics to non-game environments to engage audiences and solve problems. The goal of gamification is to motivate people to change behaviors or develop skills and drive innovation. Gamification focuses on intrinsic motivations, doing something because you want to. Games are also immediate, as they can be accessed on smartphones and other mobile devices.

Research firm Market and Markets estimates the gamification market will grow from US$421 million in 2013 to US$5.5 billion in 2018. Three trends are driving players in the health care space toward gamification, according to a recent report by consulting firm ICF International: (1) the trend toward value-based care, (2) the increasing role of the patient as consumer, and (3) the millennial generation as desirable health insurance customers. A fourth trend, the increased proliferation of smartphones and tablets, wasn’t cited in the report but seems to underscore its conclusions.

We believe health care providers can take lessons from games like Candy Crush, FarmVille, World of Warcraft, or Angry Birds and use them to improve their business.

Health care gamification is about using game-thinking and game mechanics in health care contexts as a persuasive approach to improve efficiency of care delivery and patient outcomes. With the right implementation, gamification can be very effective in health care delivery and clinical settings. Health-related tasks are often perceived as boring and tedious, which is why it’s difficult to get patients to adhere to healthy behaviors no matter how critical they are to their well-being. Ultimately, the goal of gamification is taking something one has to do, and turning it into something one wants to do by making it fun. Gamification-based applications have huge potential for improving outcomes across the entire health care ecosystem.

Patient benefits

Game based apps are proven to boost patient engagement, encourage patients to proactively seek health care, improve medication adherence and provide preventive care, among other benefits. The effect on patient-doctor interaction and delivery of patient care can be transformative when effective gamification is applied.

The Pain Squad™ App was developed by the iOUCH research team at The Hospital for Sick Children (SickKids) in Toronto to help kids with cancer track their pain. To accomplish this, SickKids needed to encourage their young cancer patients to fill out detailed reports daily. By tapping into kids’ love of gaming and technology, they were able to give them some control over their pain and give doctors the tools needed to understand the experience of pain from a child’s perspective. Each patient was given an iPhone loaded with the Pain Squad Mobile App. Twice a day, they received an alert via their phone informing them that it was time to complete their pain report. The app was designed to feel like a crime-fighting video game and contains many police clichés, including a spiral notebook, a dark office, and a steaming cup of coffee on an old-school desk. Each pain report iss stylized to look like a detective’s notepad. Diagrams of the body look as if they were sketched on the pad and after each question regarding the patient’s pain is completed, the pages appear to “flip” over the wire spirals. Each of these stylistic choices was made to keep the patients engaged and entertained.

The Pain Squad app saw unprecedented results, with a recently documented 81 percent compliance rate (vs. 11 percent compliance for paper-based pain journals). It is now available in the iPhone app store and is being used in other hospitals across Canada. It has also been recognized internationally as a highly innovative and effective creative solution.

Value-based care is driving the industry toward more of a focus on prevention, and prevention of diseases like diabetes or cardiovascular disease often involves changing behavior, an area where games show promise. Those who are healthy can stay that way by becoming more knowledgeable about disease prevention, age-appropriate screenings, and the benefits of an active lifestyle. As people gain more knowledge and insight about their conditions, they will want to set goals, measure their progress against those goals, reach milestones, and compare their performance against certain benchmarks. If patients take these steps to be actively engaged in staying healthy, they will apply gamification principles whether they realize it or not.


Physicians, nurses, and technicians can also improve operational performance and efficiency through gamification. When applied to daily tasks such as hospital administration or procurement, gamification can make the interaction with health care IT systems more pleasant. This is especially true in clinical settings where hospital systems have traditionally offered uninspiring user experiences.

To provide good medical care, regular training and education of staff is important. A 2007 study from the Department of Surgery of the Beth Israel Medical Center in New York found that video game skills highly correlated with surgical skills.1 Surgeons who played video games for more than three hours per week made 37 percent less errors and were 27 percent faster than their non-playing colleagues.

Septris, from The Stanford University School of Medicine, is a game focusing on the management of septic patients.2 As Sepsis strikes 750,000 people in the U.S., has a mortality rate between 25 and 50 percent, and costs $17 billion every year, treating and managing such patients is important to decrease mortality and shorten hospital stays. The game begins with the cartoon image of two patients on the left side of the screen. On the right side are their vital signs — those cues that can tip off sepsis’ presence. Along the bottom of the screen are diagnostic tests and treatment options. As every second passes, the patients’ images sink down the screen, their vitals deteriorating. It takes less than two minutes for a Septris patient to die, which means observations and decisions must be made quickly. The game’s objective is not just to keep the patients alive, but to cure them.

General Public

The commercial potential for health related services and products are attracting several industry players to invest in gamified apps. Apps that motivate people to live healthier lifestyles are driving the rising demand for health care gamification. For example, gamification can be effectively used in the delivery of health and wellness programs in organizations, including corporations, educational institutions, and public sector organizations. Some examples come from companies like Striiv, FitBit, and Nike, with Nike+ and the Nike+ FuelBand that help you keep track of your daily activities.

According to the World Health Organization (WHO), 30 percent of cancers are preventable by maintaining a healthy diet and exercising regularly. GE Healthcare launched a gamification/social media hybrid campaign to increase cancer awareness and prevention. The goal of GE’s campaign, called #GetFit, is to spread this message and to get people to share the simple changes you can make in your daily life that will lead to a healthier lifestyle and reduce your risk of cancer. To participate, people need to share their healthy choices and activities on Facebook, Twitter, or Weibo including the #GetFit hashtag. For each post on a social network that includes #GetFit, people will receive 10 points. People may also create teams and compete against others around the world.

Overall, gamification offers a new paradigm to all members of the health care community and, when implemented properly, can help drive increased knowledge and improved outcomes. Gamification offers a low cost means to positively impact the continuum of care. Because of these factors, the increased presence of gamification in health care will continue to resonate with health care stakeholders.

1Rosser, J. C., Lynch, P. J. Haskamp, L., Gentile, D. A., & Yalif, A. (2007).  The impact of video games in surgical training.  Archives of Surgery, 142, 181-186.

2Evans, K., William, J. Strehlow, M., Maggio, P., Shieh, L. (2015). “Septris: A Novel, Mobile, Online, Simulation Game That Improves Sepsis Recognition and Management”, Academic medicine: journal of the Association of American Medical Colleges, 90(2): 180–184.