Points and Badges ≠ Gamification


Gamification is more than points and badges

 by Michael Fergusson

Gamification is a term for which I have very mixed feelings, especially when it comes to health care applications. On the one hand, it should mean something good: the recognition and incorporation of an all-too-often ignored but fundamental aspect of human behavior into Maler_der_Grabkammer_der_Nefertari_003 applications that have been starving for a touch of humanity. On the other hand, it’s come to mean something closer to the opposite of that: the process of layering the outward appearance of fun and games onto applications which have no fun and games in them, seemingly in order to somehow trick the user into thinking they are enjoying themselves. Some people have taken to calling this oversimplification of game design “pointsification.”

This may be a worthwhile approach to consider (or maybe not) if you want a quick and dirty way to get somebody back to your website a few times. But we don’t just want more persuasive, effective short-term rewards (commonly known as “bribes”). What we want is a feedback loop that bolsters intrinsic motivation.

The reality is that points, in and of themselves, are not very engaging. I like to say that points are to games what page numbers are to literature. That’s not to say they’re irrelevant: they can help you keep track and provide a convenient shorthand for progression and mastery; but an incrementing number alone exerts minimal influence on the motivation to move forward. Try thinking of a game as a kind of economy, with satre8218050435inputs (effort, time, information), industry (the mechanics of playing), and outputs (emotional satisfaction, physical prowess, social status). Points are like the currency of the economy. They’re only meaningful to the participant insofar as they represent value created in your game’s economy. If they don’t represent some value to the participant, then they’re, well, pointless.

Gamification, therefore, is not about layering points and badges on top of your program to reward participation. It is about using the behavioural psychology of play to help the participant make a psychological/emotional commitment to the program itself. So how is that done? Like many things, this is not a trivial question, and I’m going to risk the ire of knowledgeable people everywhere by (over-) simplifying it for the purposes of fitting it into a blog post:


These five things must be integrated into a gamification strategy for the system to be properly called “gamified”: Agency, Challenge, Uncertainty, Rules, and Outcomes.

Agency: There must be real, meaningful choices the participant can make at every important junction.

Challenge: A real conflict or difficulty must be engaged or overcome; for longer-term engagement, the challenge should have a good progression curve (which is a subject for a different post).

Uncertainty: If the result is certain, there is no game. I’m constantly mystified at how often “gamified” systems seem to be designed to eliminate all uncertainty for the participant. There must be some legitimate, meaningful uncertainty in the system somewhere in order for the participant’s decisions to matter. If your decisions don’t matter, why care?

Discovery, or constraints; not just in the sense of a rulebook. You can read the rulebook for ice hockey from cover to cover, but you must discover 640px-Wgretz_edit2some of the most important rules of all, like “go where the puck is going, not where it is.” These masterable rules, discoverable through the course of play, are crucial to emotional engagement and generating flow.

Outcomes: There must be meaningful, recognizable outcomes. This doesn’t have to just be win/lose/draw at the end. Within the game itself, each segment of play should have a recognizable outcome for the participant. Think of how frustrating it is to watch a sport you don’t understand: “why are they stopping? What just happened?”

Of course, it’s very challenging to apply these principles in a sensible way to health care applications. Challenging as it may be, a growing body of literature and successful applications in the field are speaking to our progressive understanding of this aspect of human psychology and our expression of that understanding in effective software. In subsequent posts, my colleagues and I will walk through ACUDO model, and present some case studies demonstrating its usefulness in gamifying  health care programs.

  • Influencing the patient’s self-concept by having the the player pose challenges to him/herself which bolsters the player’s intrinsic motivation. e.g. “Talking about why I am playing this game.” “Making a commitment to someone in my family that I will walk every day.” etc.
  • Bolstering intrinsic motivation by using a game context to introduce social connections who will supply positive peer pressure
  • Building an effective game economy by making progress in the game feel representative of progress in managing the condition, so the two are unified.


Michael is the CEO of Ayogo Health Inc., and can be reached at @fergusson

If you find the psychology of games interesting, read the latest thinking on Playful Design by downloading Ayogo’s White Paper:

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