Skip Navigation LinksHome > May/June 2013 - Volume 17 - Issue 3 > Optimizing Work With Play: A Gamification Primer
ACSM'S Health & Fitness Journal:
doi: 10.1249/FIT.0b013e31828cb82b
COLUMNS: Worksite Health Promotion

Optimizing Work With Play: A Gamification Primer

Sintek, Natalie J. M.A.; Pronk, Nicolaas P. Ph.D., FACSM, FAWHP

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Author Information

Natalie J. Sintek, M.A., is a communication consultant for Aon Hewitt and a certified expert in gamification design. She holds a master’s degree in New Communication Technologies from the Annenberg School of Communications at the University of Southern California. Her experiences in the field of health communications include work for the United Kingdom’s National Health Service at Northamptonshire Primary Care Trust and consulting work for large multinational companies in the United States. Ms. Sintek is a regular presenter at national and international communications events on topics ranging from gamification to motivational speaking.

Nicolaas P. Pronk, Ph.D., FACSM, FAWHP, is vice president for Health Management and health science officer at HealthPartners in Minneapolis where he also is a senior research investigator at the HealthPartners Institute for Education and Research. Dr. Pronk is an adjunct professor of Society, Human Development, and Health at the Harvard University School of Public Health, where he teaches and conducts research in worker health protection and promotion. He is a past president of the International Association for Worksite Health Promotion, an ACSM Affiliate Society, the editor of ACSM’s Worksite Health Handbook, second edition, and an associate editor for the ACSM’s Health & Fitness Journal®.

Disclosure: The authors declare no conflicts of interest and do not have any financial disclosures.

“In every job that must be done, there is an element of fun. Find the fun and SNAP! The job’s a game.”

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-Mary Poppins

Many may consider the eccentric and imaginative credo of Mary Poppins beyond the scope of health improvement and wellness. But that’s just Chim Chim Chiroo! In the last few years, a new paradigm in engagement design has evolved to not only testify to the accuracy of Mary’s assertion but also explain why a spoonful of sugar does indeed help the medicine go down. It is called “gamification.”

Although the sound of “gamification” may be simply quite atrocious, it is the use of play and game design to optimize processes, systems, or programs. It uses behavioral economics, loyalty studies, and game design to align business objectives with users’ wants and needs. Leveraging gamification to achieve better outcomes is not just a smart play — it is very much a central component of the future of health and wellness improvement and a key factor in controlling health-related costs in the most delightful way.

So, as a worksite health promotion practitioner, how can you get in the game and level up your health improvement programs? It starts with understanding the appeal and impact of games, then recognizing what gamification systems are, how to optimize work with play, and considering what this all means for you and your future health improvement programs.

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Even if they’ve never picked up a video game controller, kicked a ball, declared “check mate!,” or flung an Angry Bird, every human at every age is a gamer. People love to play, even when they don’t know they’re playing. Play is an essential trait of evolutionary success and one of the strongest drivers of human behavior (4). Games are the first ways children experience and interact with the world around them. Later, this operant conditioning becomes a strong, but subtle, force in their adult lives. As a result, “Fun seeking is not a compartmentalized area of our cultural fabric. Rather, it is constituent to almost every aspect of our daily lives” (1, p. 197).

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Today, there are more than 100 million active gamers (7) playing more than 215,000,000 hours gaming everyday in the United States (8). But before you assume that there is a “type” of person who qualifies as a gamer, consider that more than 29% of gamers are older than 50 years. In fact, the average gamer is now a 37-year-old woman (8).

These numbers and behavioral trends have not gone unnoticed in consumer and enterprise markets. Fortune 1000 companies, such as Nike, Delta, Cisco, P&G, NBC, and Dell, are rolling the dice and reaping the rewards of gamification in improved employee productivity, health, and training. Consider some of these recent examples of gamification applications:

* The software engineering firm NextJump saw employee participation in regular weekly exercise increase from 5% to 80% in 2 years (6).

* Google’s gamification of its travel expense process translated into 100% compliance within 6 months of its launch (5).

* Blue Cross Blue Shield saw 80% of employees participate in at least one of its gamified Wellvolution programs, which translated into a 50% drop in smoking and a similar increase in regular physical activity. In addition, the incidence of hypertension has fallen by two thirds, and disability claims are down among participating workers (5).

And this is just the beginning! According to a 2012 study by Gartner, Inc., by 2014, more than 70% of Global2000 organizations will have at least one gamified application, driving 50% of all innovation (3). Obviously, people and employees are not just primed for games — they’re already seeking them!

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In theory, gamification’s ability to translate people’s love for games into predictable measurable results sounds like a Candy Land of opportunities with very little Risk. But it can be puzzling to try to implement this tactic into The Game of Life without it becoming some kind of Trivial Pursuit of fun. Gamification is more than points, badges, or Balderdash. In fact, some of the best gamification systems don’t immediately look or feel like games at all. Instead, many of them use game design to expedite learning, drive socialization, and reduce Aggravation. Fun is a by-product of a well-designed system — it’s not the whole Operation. In other words, you don’t need a Monopoly on fun — you can simply use game design to better communicate business objectives and — Bingo! You’ve got gamification. So, what are some Clues that you can look for as you begin to un-Scrabble the Chutes and Ladders of this Twister? How can you Guess Who is a gamified system versus who is just a Charade?

Table 1 compares and contrasts programs, gamified systems, and games across a variety of factors. However, what really separates these concepts is the impetus for usage, the outward perception or impression, or — at its most basic — whom it was designed for.

TABLE 1: Characteris...
TABLE 1: Characteris...
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A Program’s Emphasis Is on Function

Programs are primarily oriented toward outcomes, results, simplicity, predictability, and repeatability. A program generally gives the impression of a transaction or a tool kit. It may be said that such an emphasis on the destination and not the journey suits clients or businesses best.

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A Game’s Emphasis Is on Fun

Games, with their focus on fun, are only concerned with enjoyment, diversion, socialization, and play. A game generally gives the impression of a narrative or an overall emotional experience. This emphasis on the feeling of use, rather than the outcome of use, means that this design is geared primarily toward users.

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A Gamified System’s Emphasis Is On Functional Fun

A gamified system’s design bridges the gap between client wants (outcomes, results, predictability, and repeatability) and user’s wants (personalization, simplicity, socialization, enjoyment) by recognizing and considering the importance of both sides. In other words, from a client’s perspective, it’s a program; from a user’s perspective, it’s a game. This can make the gamified systems harder to identify but captures the results and benefits of both games and programs.

Gamification’s balancing act between the two major audiences (clients and players) means that most programs could — with the effective use of game mechanics, reward systems, and/or socialization — become gamified systems. The opposite is true as well; if the game’s mechanics, reward systems, and/or socialization are repurposed effectively, most games also can become great gamified systems! However, finding the balance between fun and function can Boggle the mind.

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Consider the first paragraph under “iSpy Gamified Systems…Do You?” above. Chances are you identified at least some of the board game puns in the text. Although this word play did not alter the message or the meaning of the paragraph, it made the experience of reading different. Suddenly, you, as the reader, experienced a level of interactivity with the content as you identified the game titles. Whether or not you know it, your brain switched from a passive receiver into an active participant in the language and message. This is the very premise of gamification: make the act, or experience, as important as the outcome.

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What Are You Playing With?

The following three concepts — game mechanics, rewards, and socialization — may be considered game design ingredients that, combined in the right way, can create a unique, engaging, and enjoyable experience.

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Game Mechanics

These “make up the functioning components of the game. At their core, they allow a designer ultimate control over the levers of the game, giving her the ability to guide player actions” (2, p. 36). In other words, these are the elements of design that feel like games to a player and help channel behavior and outcomes for designers. Although there are literally hundreds of game mechanics, the most common examples are points and badges, levels, leaderboards, challenges/missions/quests, and feedback systems.

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Gamification designers and systems prescribe to the rewards hierarchy of status, access, power, and stuff — more commonly referred to as SAPS. This is a reward system that ranks different types of rewards/prizes/incentives in order of user’s perceived worth and importance (2). The SAPS reward system changes the paradigm of incentives, concluding that “…by reevaluating what constitutes a reward, marketers may be surprised to note that what prompts people to (play) is rarely the promise of that shiny new car but rather the overarching enthusiasm for the experience of playing the game itself” (9, p. 25). Table 2 presents an overview of SAPS.

TABLE 2: SAPS  Statu...
TABLE 2: SAPS Statu...
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Perhaps the most important and most often overlooked aspect of games and gamified systems is socialization. Gamification should directly or indirectly facilitate either competitive or cooperative social interaction. Why? Because people have a different emotional and cognitive relationship to other people than they do to programs or computers. If nothing else, consider the ability of a program to motivate or reprimand versus a person. The person will know how to communicate effectively and will, most likely, not be received with distrust, annoyance, or apathy. Instead, the person’s message is more likely to reengage, excite, or prompt action. Not to mention recruit! If your game allows for coworkers, friends, families, or acquaintances to share an experience or connect, then suddenly your game is more than a game: it is an emotional common ground and pathway. That makes it addictive, attractive, and worth sharing.

To illustrate how these three concepts of game mechanics, rewards, and socialization may be used in gamification, Table 3 outlines them in the context of a frequent flyer program.

TABLE 3: Game Mechan...
TABLE 3: Game Mechan...
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Absolutely! If gamification is ineffectively implemented, it can create a lot of problems. So before you assume that gamification is the answer to everything, take a moment to consider some of the common pitfalls.

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Not All Systems Should Be Gamified

There are certain instances where gamification is not an appropriate or even an advisable solution. This includes, but is not limited to, scenarios where:

1. A behavior is not difficult or unappealing: if you gamify something that is already high functioning, you run the risk of making it more complex and annoying.

2. A system doesn’t require a behavior: if there’s nothing for a player to do, then it can be very hard for them to play.

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Not All “Gamification” Is Created Equal

As the discipline of gamification is very much in its infancy, it is important to consider definitions, expectations, and context. There are a lot of theories and definitions and interpretations of gamification available in the market — some interpret gamification as merely slapping badges and points on every action or idea; some see gamification as a waste of time and energy. If you’re looking to buy or build gamification, look for partners who share your definitions and expectations.

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Not All Games Are Self-Explanatory

Play is an inherent hardwired behavior, but sometimes applying it to new contexts, such as the worksite, can feel strange or uncomfortable. For employees to see games as legitimate, you must take the time to communicate and ensure that the context of the gamified system is appropriate.

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Now that you’ve jumped into the Mary Poppins’ chalk drawing of gamification, here are a few ways to hone your skills and continue your journey.

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Become a Big Game Hunter

Once you begin to recognize games and gamified experiences, start studying them. Figure out the purpose, audience, and mechanism of the game. It is easy to say something is “fun,” but it’s much harder to figure out what is triggering that response. Look for the mechanics, the rewards, the social dimensions, and the overall narrative or context that these things fall into.

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Find Ways to Play

Because gamification doesn’t have to be an advanced, online, avatar-based system, you can use it almost anywhere. Try it on yourself with a task or a chore that you find difficult or unappealing; use game mechanics, rewards, and/or socialization to develop a bigger experience that you do enjoy. Get creative!

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Keep Learning

Because it is so multidisciplinary and so new, this field and the theory within it are constantly evolving. Keep reading, learning, and interacting with the ideas within gamification to better your understanding of where the market is at, where it’s going, and how you can use it to your advantage. See the Recommended Reading resources in the reference section for some great places to start!

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Ultimately, gamification is changing the way individuals view and experience systems. This, in turn, is altering how systems are designed and operate for individuals. In other words, it’s a total game changer. Moving forward, literacy in the language of gamification will become a necessity in the health and wellness conversation. Although it is our hope that this article will serve as a catalyst to deeper conversations and the development of best practices of gamification, for now, it is merely a gateway. Welcome to the Supercalifragilisticexpialidocious world of gamification.

Let’s play!

(Answer to Word Play! 21. Blackjack! OK, 22.)

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1. Bryant CD, Forsyth CJ. The fun god: sports, recreation, leisure, and amusement in the United States. Sociol Spectrum. 2005; 25 (2): 197–211.

2. Cunningham C, Zichermann G. Gamification by Design. Canada: O’Reilly Media, Inc.; 2011.

3. Gartner, Inc. Analysts discuss the future of gamification. In: Proceedings of the Gartner Portals, Content and Collaboration Summit; 2012 Mar 12–14: Orlando (FL); 2012.

4. Groos K. The Play of Animals. New York (NY): D. Appleton and Company; 1898.

5. Herger M. Enterprise gamification workshop. In: Proceedings of the Gamification Summit; 2012 Jun 19: San Fancisico (CA); 2012.

6. Kim C. Enterprise gamification of fitness. In: Proceedings of the Gamification Summit; 2012 Jun 21: San Francisco (CA); 2012.

7. Meloni W. Gamification in 2012: Trends in consumer and enterprise markets. In: Proceedings of the Gamification Summit; 2012 June 20: San Francisco (CA): 2012.

8. PSFK Web site [Internet]. The future of gaming (White paper). New York (NY): PSFK; [cited 2012 Jun 9]. Available from:

9. Zichermann G, Linder J. Game-Based Marketing. Hoboken (NJ): John Wiley & Sons, Inc.; 2010.

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Recommended Readings and Resources
Zichermann G, Cunningham C.Gamification by Design. Canada: O’Reilly Media, Inc.; 2011.

Radoff J. Game on: Energize Your Business With Social Media Games. Indianapolis (IN): Wiley Publishing, Inc.; 2011.

© 2013 American College of Sports Medicine


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