From the frontline

A few weeks ago I went into my local Apple store to buy an iPad mini. It was my intention to get a discount on the list price, as I had read that Apple provide discounts for NHS staff.

I was thwarted. Apparently, it is down to local store policy whether or not to offer this discount, and my local store doesn’t.

My need for instant gratification was not so high that I was prepared to pay a premium for buying from an Apple store. So, being a hardened bargain seeker, I was prepared to purchase elsewhere for what I considered was the right price.

In the end I bought online through Tesco because, first, I got money offmy first online purchase and, second, I got extra club card points for using my Tesco Credit card.I felt I had got a good bargain and something extra as well: club card points.

Gaming goes everywhere

A few weeks later, I listened to Hardeep’s Game of Life on BBC Radio 4, in which Hardeep Singh Kohli investigated how “everything from brushing your teeth to filling out your income tax return may soon be turned into a game” – or have elements of gaming applied to it.

Having done that, I realised that I had been played. The elements that had steered me towards buying my device in the way that I did were a result of gamification.

For those of you, like me, who are new to this idea, here’s a quick 101. First from Wikipedia: Gamification is the use of game thinking and game mechanics (the rules that make a game work) in a non-game context in order to engage users and solve problems.

Any the wiser? Ok from Technopedia: Gamification refers to the use of game design principles to improve customer engagement in non-game businesses.

My definition of gamification is the means by which additional value is gained form a task that is routine and every day. By getting additional value, I may do that task more frequently, or I may choose to select a particular way of doing a task over another.

For example, how many of you choose to go to a particular coffee shop because you have a loyalty card which gives you a sixth cappuccino free? Would you walk extra distance to said coffee shop, rather than go to a competitor, because you are going to get a “free” cup of coffee… If so…you’ve been gamed!

Non-buyers’ remorse

One sure sign that you’ve been gamed is to find yourself experiencingregret on not completing a task; for example, for losing out on those club card points or missing a special offer.

A few weeks ago, it was suggested to health secretary Jeremy Hunt that an individual’s entitlement to free NHS treatment could be shown by using some form of identity card.

Now, there are all sorts of problems with this suggestion. Starting with the obvious, there is no UK tradition of ID cards, not least because there is no tradition of UK residents being asked to show that they are ‘entitled’ to universal services.

Lots of hard-to-reach users might object to the cards, or the information held on them, and not access services as a result. Even more people would find themselves without their card when they needed the NHS, or just lose it.

However, if a card was introduced, then it’s possible to imagine it being used for various forms of gamification. It’s often been suggested that patients could get points and rewards for following treatment plans or health advice; perhaps with the involvement of private sector organisations.

Because gamification of this kind is already rife in the consumer tech world. Google has revealed a prototype trainer that gives its wearer encouragement to remain active.

“Are we a statue or what?” the shoe remarks if you stand still for too long, while a prolonged period of energetic activity is rewarded with a “You’re on fire!”

This might get quite tiresome, but it’s easy to do; the shoe has a number of sensors attached to it that measure the wearer’s activity, and a Bluetooth connection uploads data to a mobile device.

More directly, Higgi aims to gamify health using a phone app and kiosks in more than one thousand pharmacies on the east coast of the US.

The kiosks measure weight and blood pressure and offer independent verification of progress. Cheating is harder but the bragging rights are greater! Extra health points can be gained by taking pictures of healthy food that users have eaten.

Back in the UK, the less fit and less fortunate users of the NHS might get points for free hospital parking or free hot drinks in the WRVS restaurant.

These could be collected when attending outpatient appointments. You never know, this could reduce the number of no shows in outpatient clinics. Equally, the NHS could give out extra points if a clinic over runs.

Winning is fun

The importance of identifying patients with un-diagnosed dementia is well recognised. My Emergency Department has a dementia assessment tool in its clinical documentation and has asked clinical staff to make an extra effort to complete this for all over-75s who arrive in the ED.

Using gamification strategies could increase the number of appropriate assessments. If all trusts had an electronic patient record with this kind of tool in it, from which the information could be extracted easily, then the performance of my ED could be compared with that of other trusts, to encourage some competiveness.

Or what about something along the lines of Amazon’s “customers who bought this item also bought x item”. In a healthcare context, this might be translated to “70% of clinicians in this trust who saw patients over 75 years’ old completed a dementia scoring tool”(strategies that ‘normalise’ behaviour are shown to have a big impact).

If your trust has an award for staffwho have gone the extra mile with patient care, which encourages other members of staff to emulate them in the hope of recognition, then that’s gamification again.

Andrew Carr

Andrew Carr is an emergency nurse practitioner working in the emergency department at Cambridge University Hospitals NHS Foundation Trust. Andrew has worked in emergency care for 25 years, and for the past four years he has been clinical IT lead for his department.

Andrew is passionate about delivering information technology to frontline staff enabling them to deliver safe, high quality care efficiently and effectively. He has recently developed ED clinical dashboards and waiting time information displays.

He is also participating in an eHospital programme that will see all clinical IT systems across the trust replaced by a single hospital information system in 2014. As a former head of IT once told him “if an IT system can work in the emergency department it can work anywhere!”