Gamification comes to clinicians

Points and leader board put to work improving quality of care
By Mike Miliard
11:28 AM
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Gamification comes to clinicians

There's been a lot of talk in the past few years – some would say too much, and way too excited – about gamification.

Using computer game design and mechanics to teach people, or encourage them to change their behavioral patterns, certainly seems to make some sense. Harnessing digital stimuli and score-keeping to make the most of a person's natural inclination toward fun and competition has some exciting potential benefits.

But it all depends on the game, and how it's put to use. As Gartner put it in a 2012 report on the phenomenon – which predicted that, by this year, as many as 80 percent of gamified apps would be doomed by poor design – "gamification is currently being driven by novelty and hype."

"The challenge facing project managers and sponsors responsible for gamification initiatives is the lack of game design talent to apply to gamification projects," said Gartner Research VP Brian Burke. "The focus is on the obvious game mechanics, such as points, badges and leader boards, rather than the more subtle and more important game design elements, such as balancing competition and collaboration, or defining a meaningful game economy."

But, as PwC argued in another report from 2012, titled "Getting past the hype of gamification," when done right, the approach could bear valuable fruit.

"Enterprise IT agendas are already overloaded with mobility, social media, cloud, big data analytics, security, and other major initiatives, so it is understandable if CIOs are put off by gamification – the use of game design techniques in online business environments to engage and motivate the workforce and inspire customers," the report read.

But CIOs are exactly the type of people who should embrace these projects.

"CIOs are being called into these conversations much more," said Ari Lightman of Carnegie Mellon University's CIO Institute, in a statement contained in the PwC report. "They understand data at a greater level than any other executive within the organization," said Ari Lightman of Carnegie Mellon University's CIO Institute in a press statement. "They can help design mechanisms, whether it's gaming or communities of engagement, to identify the data that's required to put into the systems are working the way they should. CIOs are the ones who understand the data."

Even at the federal level, games were getting a closer look back in 2012. Speaking at the 8th Annual Games for Health Conference in Boston that year, Erin Poetter, from the ONC's department of Consumer e-Health/Innovations, said, "We see games a part of a larger initiative."

With their "miraculous ability to take complex data and make it actionable and meaningful," games are the perfect tool to help ONC expand its focus to engage consumers, she said. "Better engagement in health can make a real difference. More activated patients achieve better results."

But while it may hold promise for patients, providers are also starting to see gamification making its presence felt in their daily workflow.

Duncan Lennox is co-founder and CEO of Burlington, Mass.-based Qstream, a mobile technology company that grew out of the research of B. Price Kerfoot, MD, an associate professor of surgery at Harvard Medical School, who spend years studying the ways in which people learn and retain skills.

Qstream's platform sends out short three- to five-minutes quizzes (called "Qstreams") twice a week to users' mobile devices.

That so-called "spaced delivery" approach has been clinically proven to increase knowledge retention by up to 170 percent, according to the company.

Right now, most Qstreams users are sales reps, who use the technology to improve their on-the-job performance. But the games have also found favors at the Mayo Clinic Childrens Hospital Boston and Partners Healthcare.

Most recently, the five medical centers participating in the University of California Health Quality Improvement Network announced their deployment of Qstream as part of an initiative to improve care transitions during hospital discharge.

Duncan Lennox, Qstream's co-founder and CEO, agrees that gamification suffers from "a lot of hype; I think it's very difficult to get right."

For instance, he says, "We've seen people out there try things that are literally games – a little mini version of Angry Birds, or something. That's not what we do. It's easy to build something like that that is cute the first time, but the challenge is how do you create something that keeps the participant engaged on the 100th, 500th, 1000th time."

A good gamification strategy has to be based on "something they get value out of, and not something that annoys them," Lennox adds. "We're not trying to distract them to get them to learn, we're trying to engage them to get them to learn."

With 20 percent of patients in the U.S. discharged from the hospital experiencing an adverse outcome, half of which are preventable, UC Medical Centers decided it was necessary to fine-tune its discharge planning activities, lest it get knocked with penalties for readmissions.

So it is that clinicians there receive Qstreams delivered to their smartphones twice a week, for three months. Leader boards make for a competitive spirit and an adaptive delivery engine personalizes questions based on how they're answered – repeating ones that are problematic..

"They're trying to make sure, as patients move through the process and are discharged, that's being done at the right time, for the right patient," says Lennox.

So far, the uptake has been encouraging. "We see engagement levels – people taking their daily questions – at 94 percent or above," he says. "Which is just truly unbelievable for that type of learning activity, which typically has very low participation rates unless it's mandatory."

Especially in a line of work where complaints about technology's unwelcome interruption of workflow aren't exactly uncommon.

"Disrupting the workflow is something people talk about all the time, and that the e-learning stuff is boring," says Lennox. And approach like this – three to five minutes a day, done on an iPhone or iPad – has it's appeals, he says: "We always hear back from people who just say it's fun."

Qstream's apps are finding a foothold across healthcare as organizations look for ways to spice up continuing medical education and make strides on better patient safety practices.

"We started with the CME stuff and that's still there," says Lennox. "But as we've gotten into hospitals more generally, and it's become broader, and I think we clearly see patient safety as one of the areas that there's a lot of interest in. Obviously better quality and better patient outcomes is always the goal for hospitals groups.

In hospitals and medical schools, from the VA Boston Healthcare System to Baylor College of Medicine, gamification is proving it's more than just frivolous fun.

"We provide the platform and there are very easy to use tools in it for building your own scenarios," says Lennox. "Typically they'll start in one place – maybe it's patient safety or some other compliance issue they have to deal with, but then it will start to broaden in other areas as they start to see how engaged people are in learning this way."