by Maria Chesley Fisk

Leighton Read promotes games and ideas from games as tools for improving people’s health and the design of health care jobs and other jobs. The key is well-designed games that engage and motivate patients and employees alike to change their behavior.

When he was an academic internal medicine physician at Harvard in the early 1980s, J. Leighton Read channeled his interest in computer-aided decision support into the creation of the Original Boston Computer Diet, a text-based adventure game in which players could work to make positive changes in diet, exercise, and lifestyle. To design the game, Read brought together a team of providers who knew what it took to develop a healthier lifestyle: a behavioral psychologist, nutritionist, and exercise physiologist. Working with able designers, they created a game in which players selected a simulated counselor, set goals, and received feedback in the form of text, graphs and animation. Read describes the Original Boston Computer Diet as an “early attempt to combine what we knew about what was engaging and motivating in video games with what we knew were effective tools for behavior change.” The game, at $79.95 for the IBM PC and a little less for the Commodore 64 and Apple IIe, saw some success, and Leighton Read was captivated by the power of games.

Better known in Silicon Valley as a successful biotech entrepreneur and investor, Read is now Executive Chairman and co-founder of Seriosity and Chair of the Health Games Research National Advisory Committee. He remains passionate about the potential power of games to improve people’s health. He says, “In a wealthy country like the United States, the leading causes of mortality have a large lifestyle and behavioral component.” Read continues, “Whether it’s teenage driving and sexual behavior, or diet and exercise, there is a massive opportunity to impact health and health care costs by finding better ways to engage people so that they exercise more and have healthier lifestyles.”

And Read thinks games will play an important role because they can motivate people to change their behavior. Read believes we are now in the early days for health games, and he is convinced that we will see games with large numbers of followers in the future. Perhaps slowly, but he predicts surely, games will become useful and popular tools in our slow-to-change health care system.

Research on the effective design and efficacy of health games, including the studies now being conducted by Health Games Research grantees, is critical to moving health games into the mainstream. Read says, “The exciting thing is that Health Games Research is building a basic science to help us understand which design principles and game elements work and in which settings. Research is the way we can advance the field systematically—the only other way is inefficient trial and error.”

But Read does not believe that every game is worthy of inclusion in a study— researchers have to earn the right to study how a game works by first proving that it does work. As he puts it, “There’s little we can learn from games that don’t work. First, you have to have a game that produces a desirable health outcome.” Player participation should be voluntary. The game has to be engaging enough for people to play before it will have an opportunity to change health behaviors. In other words, Read says, “You need engagement before you can even get to efficacy. Then, we want to know how a game works, why it works, for whom, and under what circumstances.” He adds, “We want valid, legitimate health interventions that are safe, both physically and psychologically.”

Read asserts that lessons from today’s technologies, combined with guidance from research on successful health games, will allow us to create better and better games that can be scaled up and reach more patients interested in changing their behavior and improving their health.

Not only can games and ideas from games impact individuals, they can also help create other important changes in our health care system. Read maintains that improving the health care system requires thinking about the employees who keep the system running. He and co-author Byron Reeves have written a book that applies to health care and other business systems, Total Engagement: Using Games and Virtual Worlds to Change the Way People Work and Businesses Compete. Their thesis is that “the psychological power of games can be applied with the objective of improving productivity for employers and job satisfaction for employees.” Read explains further, “The common theme between improving health care and employee engagement is engagement. When someone is engaged, you have their attention. They are activated; they are in a better position to make choices and take action consistent with their own values and their own wishes.”

Read suggests that health care work be analyzed with a game developer’s perspective and infused with engaging game elements. Features of multiplayer games in particular can be highly motivating: inspiring narratives, opportunities to explore and build a trusted reputation, a need for productive teamwork, appropriately timed feedback via multiple senses, and explicit rules that help players (or employees) internalize a “can-do” attitude.

Imagine the job of the medical service provider who fields questions and complaints from patients: phone call after phone call requires polite responses that demonstrate understanding of the patient’s situation and the correct decision to resolve the issue or transfer the call to a manager. Reimagine this job set in a virtual world, say a visually rich pirate world, where points and status are earned for individual employees and their teams based on number of calls completed, complete call log entries, quality assurance ratings, real-time analysis of language and voice stress, and more. Employees can see their teammates’ rankings, aid and encourage them via on-line chat, and spur more quality work. Read calls on this example, similar to one in Total Engagement, to illustrate how many health care workers’ jobs— even those of administrators, doctors, and nurses— could be partially or completely gamified to increase engagement, productivity, and job satisfaction.

Games engage us and can motivate us to change our behavior. Leighton Read wants to use games to change health and healthcare by promoting healthy lifestyle behaviors for patients and productivity and effectiveness for employees. Let the games begin!