How many doctors does it take to make a game? Graphics PhDs put your hands down, I’m not including you!

BioWare Co-founders, each has a medical degree. We'll leave them out too

Last month I had the privilege of presenting at the Games for Health Conference.[1] It was a big gathering of people that want to use games to positively change the world. However, most of attendees were from the the education or healthcare space. While everyone knew they were on to something powerful, there were also a lot of misconceptions on how gaming works as a motivator.

The “G” Word

One way to apply games to real life

I heard the word “gamification” many times during the three day conference. While the term has been around for a while, Jesse Schell popularized this concept in his DICE 2010 speech.[2] A lot of attendees used it to describe adding points systems, social web interactions, and other extrinsic rewards to get people to do healthy and educational tasks. In their minds, the “game” was all about getting the reward. However, extrinsic rewards in and of themselves aren’t good replacements for intrinsic motivations.[3] Those presenters didn’t understand what it means to make a “game”. True conventional[4] video game design is about finding the enjoyable parts of a process and exemplifying them while skipping over and minimizing the parts that aren’t fun.

The Points Don’t Matter

Whose Line Is It Anyway

As Drew Carey would say at the start of “Whose Line is It Anyway?” the points don’t matter. A lot of presenters focused on the extrinsic rewards we give players (points, achievements, badges, etc.) because its the part of making games that’s most visible. What they don’t realize is that good games use these rewards as an icing on the cake of an inherently compelling experience. Kendra Markle, founder of and another presenter at the conference, used a powerful metaphor of the rider and the elephant.[5] The rider is our rational mind which reacts to things like money and tweets. The elephant is our emotional side where it takes a lot of effort to do something we don’t want to do. When there’s a disagreement about which way to go the elephant almost always wins out.

Good game designers understand that while we need to convince the rider to pick up and start playing the game, we should spend most of our time getting the elephant to not want to put it down. That’s why we spend so much time on polish, usability, and getting players into “flow”[6]. Being fixated on the things which most people don’t consciously notice is what separates designers from the rest of the world.

Let’s take Stack Overflow for example. It’s a popular question and answer forum used by programmers. Stack Overflow uses a system of upvoting the best answers and keeping track of how good members are at answering questions. On its surface it sounds the same as the forums and mailing lists coders normally go to for answers but with a score added. But just like “Who’s Line Is It Anyway” the points in and of them self don’t matter. It’s the fact that they act like filters, making sure the best answer is easily found at the top and that trusted posters are easily identifiable, that has made it the go to site for coding questions. And this in turn feeds into founder’s bigger intentions: to get programmers writing more.[7]

Stack Overflow: More useful than English classes?

Bad Teacher

The problem with trying to target intrinsic motivations is that not everything can be “gamified”. There are things in life that are necessary and are fundamentally not fun. “Games” implies being able to voluntarily start and stop at any time. Let’s take a hypothetical doctor that doesn’t like to fill out forms. We can use game design skills to try and streamline the process and make a better connection between filling out forms and the health of patients. But at the end of the day doctors have to do it or patients’ health will be compromised. When you also take into account that what’s considered fun changes from person to person, leaning on “games” as a primary teaching method becomes really tricky.

What happens when you force people to play games

Good Willed Propaganda

The take away is that games are a great way to have people voluntarily reinforce a set of behaviors. Truly inspiring change should be about getting players to exercise the right behaviors on their own instead of relying on a carrot which won’t always lead them. We should be focusing on embedding our intent in what makes the game fun, even if the player has to go outside the game to get the specifics of the message. Good luck elephant handling!

Control the elephants, control the world!




Note 3: There’s a lot work in the social psychology space about how motivation works. For example, there’s the
overjustification effect where people will start aiming for the rewards instead of for the behavior you were trying to instill in them.

post on not games



sneakily teach programmers how to write. Jeff wanted to help programmers become better writers and he knew the only way to do that was to well… write. Blogging would seem too insurmountable to people who aren’t used to it. So they honed in on two things every programmer wants: quick, reliable answers and the ability to show other programmers how smart they are.

Picture of Ray Muzyka and Greg Zeschuck from:
Picture of “Reality: Worst Game ever.” from:
Picture of Whose Line Is It Anyway from:
Picture of Stack Overflow logo from:
Picture of bunny from:
Picture of baby elephant from: