Sam Glassenberg, CEO, Level Ex02.28.24
In the realm of medtech, the collective aim of sales representatives, trainers, and marketers is to instigate behavior change. This spans optimizing how surgeons choose devices, how they use those devices, and how they identify which patients are indicated for a procedure.
Let's delve into what drives that behavior change.
In a surprising turn of events in 2016, all of these meritorious efforts were eclipsed immediately—by a single video game. Thanks to Pokemon Go, over 40 million Americans got up and started walking (for miles). It was a game unbounded by age—half of its players were over 21. Hitting the streets, this game transformed metropolitan downtowns into “zombie apocalypses,” showcasing the transformative power of video games.
While we may perceive Pokemon Go as an isolated phenomenon, it isn’t. Every successful video game does what Pokemon Go does. Every. Single. One.
Video games are, hands-down, the most effective tool to drive behavior change. Usually, that behavior change doesn’t manifest as a walk around a strange neighborhood. Instead, it’s motivating players to return every day, to share with their friends, to engage with sponsored content, and so on.
Tens of millions of those players can name 50 Pokémon characters, but they can’t show you where Switzerland is on a map. That’s because video games are exceedingly good at driving learning as an unintended consequence of play.
Ever wondered why you remember endless information from “Where in the World is Carmen Sandiego,” but almost nothing from history class? It’s all thanks to an incredibly deep discipline steeped in cognitive neuroscience: game design.
Expert video game designers have mastered the delicate equilibrium between reward and frustration, challenge and skill, to maximize the release of neurochemicals in the brain at the right moment. Chemicals like dopamine increase neuroplasticity and reinforce neural pathways to ultimately maximize learning.
This is why it takes you several tries to beat Level 1 of Angry Birds—and within an hour, your brain has become expert at predicting parabolic flight and is firing that bird between two narrow obstacles at 50 yards (and why you’re still playing, 30 hours later).
These methodologies are equally effective on all humans, including surgeons.
Physicians are challenge seekers—a primary motivator for pursuing their field. The challenge(s) they seek may be a hand-eye coordination challenge, clinical challenge, or diagnostic challenge. Some resemble physics puzzles (advanced endoscopic maneuvers), strategy games (surgical/trajectory planning), hidden object games (find the polyp), or reductive reasoning puzzles (complex disease diagnosis). Medical professionals use these advanced cognitive skills daily in their practices, and these are the same skills honed by core game mechanics used in successful video games.
When these neuroscience-based design approaches are applied to medical device marketing/sales/training, the results are equally impressive. Doctors understand product benefits faster, and experience rapidly accelerated learning curves that spare days in cadaver labs. Efficacy studies continually demonstrate that these approaches notably improve physician performance over didactic methods.
Of course, it’s also important to note these games triple foot traffic at conference booths.
This is the result of deliberately applying game design methodologies. In other words, unleashing real game design experts on specific business challenges offers unique benefits. They can achieve tasks such as recreating the “Aha!” moment of a particular device, designing a game that allows the player to use the standard of care and then play again with the improved device, or designing a game that empowers a novice to develop the mental model of an expert without practicing on hundreds of live patients.
For example, an intubation game that allows players to struggle their way through performing a direct intubation on a difficult airway, immediately followed by the same procedure being performed with a video laryngoscope that allows them to perform it in a fraction of the time. By scoring the player based on procedure time, the player discovers the benefits of the product through their own actions. This is the benefit of game design over gamification.
Newsflash: Quizzes aren’t fun. They weren’t fun in 5th grade, and they aren’t fun now. And badges? The videogames industry didn’t even invent those. We stole them from the Girl Scouts.
Gamification, as it has been applied in the healthcare industry, involves naive opportunists taking advantage of well-meaning trainers and marketers to scrape the most shallow and obvious features of video games and slap them (ineffectively) onto boring content. This oversimplified “gamification” strategy overlooks the profound psychology embedded in game design, resulting in superficial enhancements that miss the core benefits.
To illustrate this contrast between game design and gamification, let’s walk through a thought exercise. What if, instead of this approach, we chose to “gamify” the Hunger Games? The “gamified” Hunger Games book would be relatively straightforward. At the end of the book, there’d be a link to an online quiz. The reader would earn a digital badge for completing the quiz.
What would the engagement improvement be for the “gamified” Hunger Games? We’d go from four hours of engagement reading the book, to four hours and five minutes. These are similar to the single-digit improvements one can expect from gamification in healthcare.
In contrast, by employing expert game designers, using the toolbox of real game design (e.g., social mechanics, competitive dynamics, interactive storytelling, game loops, reward/challenge balancing), we were able to increase engagement by an order of magnitude—from hours to hundreds of hours.
Sam Glassenberg has flown spaceships for LucasFilm, led Emmy-award-winning game platform teams at Microsoft, and built multiple game companies in Hollywood and beyond. At Level Ex, his team unleashes video game technology and neuroscience on healthcare. They work with the world’s leading medtech and life science companies (and NASA) to accelerate adoption of medicine’s latest products and techniques.
Let's delve into what drives that behavior change.
Behavior Change
The Obama administration allocated a substantial $2 billion to $3 billion (2009-2017) to combat the U.S. obesity epidemic. The investment was designed to drive engagement in an epic struggle to get overweight Americans to simply “Get Off the Couch” and go for a walk.In a surprising turn of events in 2016, all of these meritorious efforts were eclipsed immediately—by a single video game. Thanks to Pokemon Go, over 40 million Americans got up and started walking (for miles). It was a game unbounded by age—half of its players were over 21. Hitting the streets, this game transformed metropolitan downtowns into “zombie apocalypses,” showcasing the transformative power of video games.
While we may perceive Pokemon Go as an isolated phenomenon, it isn’t. Every successful video game does what Pokemon Go does. Every. Single. One.
Video games are, hands-down, the most effective tool to drive behavior change. Usually, that behavior change doesn’t manifest as a walk around a strange neighborhood. Instead, it’s motivating players to return every day, to share with their friends, to engage with sponsored content, and so on.
Tens of millions of those players can name 50 Pokémon characters, but they can’t show you where Switzerland is on a map. That’s because video games are exceedingly good at driving learning as an unintended consequence of play.
Ever wondered why you remember endless information from “Where in the World is Carmen Sandiego,” but almost nothing from history class? It’s all thanks to an incredibly deep discipline steeped in cognitive neuroscience: game design.
Video Game Design
Over the past three decades, video game designers have reached billions of players through games like Call of Duty and Wordle. While doing so, they have distilled the neurochemical recipe for changing behavior and driving learning among any audience. They’ve honed this recipe repeatedly through testing on more than 3 billion subjects.Expert video game designers have mastered the delicate equilibrium between reward and frustration, challenge and skill, to maximize the release of neurochemicals in the brain at the right moment. Chemicals like dopamine increase neuroplasticity and reinforce neural pathways to ultimately maximize learning.
This is why it takes you several tries to beat Level 1 of Angry Birds—and within an hour, your brain has become expert at predicting parabolic flight and is firing that bird between two narrow obstacles at 50 yards (and why you’re still playing, 30 hours later).
These methodologies are equally effective on all humans, including surgeons.
Physicians are challenge seekers—a primary motivator for pursuing their field. The challenge(s) they seek may be a hand-eye coordination challenge, clinical challenge, or diagnostic challenge. Some resemble physics puzzles (advanced endoscopic maneuvers), strategy games (surgical/trajectory planning), hidden object games (find the polyp), or reductive reasoning puzzles (complex disease diagnosis). Medical professionals use these advanced cognitive skills daily in their practices, and these are the same skills honed by core game mechanics used in successful video games.
When these neuroscience-based design approaches are applied to medical device marketing/sales/training, the results are equally impressive. Doctors understand product benefits faster, and experience rapidly accelerated learning curves that spare days in cadaver labs. Efficacy studies continually demonstrate that these approaches notably improve physician performance over didactic methods.
Of course, it’s also important to note these games triple foot traffic at conference booths.
This is the result of deliberately applying game design methodologies. In other words, unleashing real game design experts on specific business challenges offers unique benefits. They can achieve tasks such as recreating the “Aha!” moment of a particular device, designing a game that allows the player to use the standard of care and then play again with the improved device, or designing a game that empowers a novice to develop the mental model of an expert without practicing on hundreds of live patients.
For example, an intubation game that allows players to struggle their way through performing a direct intubation on a difficult airway, immediately followed by the same procedure being performed with a video laryngoscope that allows them to perform it in a fraction of the time. By scoring the player based on procedure time, the player discovers the benefits of the product through their own actions. This is the benefit of game design over gamification.
Gamification Misconceptions
In the healthcare industry, the term “gamification” is often thrown around by consultants who lack any genuine experience in commercial video game development. Their pitch goes something like this: “We will take your video/lecture/text/web content and we will gamify it for you. We’ll add a quiz and some badges—and we will take your boring and non-interactive content and make it FUN!”Newsflash: Quizzes aren’t fun. They weren’t fun in 5th grade, and they aren’t fun now. And badges? The videogames industry didn’t even invent those. We stole them from the Girl Scouts.
Gamification, as it has been applied in the healthcare industry, involves naive opportunists taking advantage of well-meaning trainers and marketers to scrape the most shallow and obvious features of video games and slap them (ineffectively) onto boring content. This oversimplified “gamification” strategy overlooks the profound psychology embedded in game design, resulting in superficial enhancements that miss the core benefits.
The Real Power of Game Design
In my prior role, I ran one of the leading independent video games studios in Hollywood. Our Hunger Games video game amassed over 30 million players. The average player online would spend a couple of hours watching a Hunger Games movie, and then play the game for more than 100 hours. How? Deliberate application of proven game design methodologies.To illustrate this contrast between game design and gamification, let’s walk through a thought exercise. What if, instead of this approach, we chose to “gamify” the Hunger Games? The “gamified” Hunger Games book would be relatively straightforward. At the end of the book, there’d be a link to an online quiz. The reader would earn a digital badge for completing the quiz.
What would the engagement improvement be for the “gamified” Hunger Games? We’d go from four hours of engagement reading the book, to four hours and five minutes. These are similar to the single-digit improvements one can expect from gamification in healthcare.
In contrast, by employing expert game designers, using the toolbox of real game design (e.g., social mechanics, competitive dynamics, interactive storytelling, game loops, reward/challenge balancing), we were able to increase engagement by an order of magnitude—from hours to hundreds of hours.
Conclusion
Harnessing the decades of expertise in the video games industry necessitates collaborating with individuals possessing such knowledge. Only by intentionally designing experiences to drive targeted behavior change can the transformative potential of game design be fully realized; anything less merely scratches the surface of what is achievable.Sam Glassenberg has flown spaceships for LucasFilm, led Emmy-award-winning game platform teams at Microsoft, and built multiple game companies in Hollywood and beyond. At Level Ex, his team unleashes video game technology and neuroscience on healthcare. They work with the world’s leading medtech and life science companies (and NASA) to accelerate adoption of medicine’s latest products and techniques.