Gamification Ramifications With Michael Fergusson

BlackBoxPhD Checklist92.001Gamification Ramifications With Michael Fergusson

Michael Fergusson

Michael Fergusson

Small changes in behavior can make a huge impact, especially in health. One way to get people to make small changes is to make it fun for them to change, by using games and gamification. Most of us know what games and video games are, and many people have heard the word gamification, but what does it really mean? Michael Fergusson is the CEO of Ayogo, a company that integrates social networking and gaming to help improve patient health behaviors. His work is at the cutting edge of mobile health applications, and both he and Ayogo have received national awards in this area.


 Michael, please tell us about your background and how your interests with medicine, social networking, and games have come together.

I started my career in technology in the mid-nineties, just as we were all starting to realize the impact the internet and the web were going to have. Right from the beginning I was working with social software – some of my earliest projects were converting dial-up bulletin board systems to web-based discussion forums – so, right from day one I was fascinated by the social aspect of that technology. In 2001, I founded a company called Enfolding Systems to develop enterprise collaboration tools and in the course of that work noticed that the process that go through to (for example) collaboratively edit a paragraph of text looks a lot like, well… play. There are rules, both implicit and explicit, there is cooperation, competition, and a final “win” state. I became increasingly interested in how to use that insight, that much of what we consider to be “serious” work can be thought of as a kind of social play. When Paul Prescod and I were founding Ayogo, we wanted to use this insight, together with a lot of great work we had done building successful social games on Facebook in the meantime, to create something important and solve serious problems. We began to experiment and develop the business plan, and ultimately saw that we could have a significant impact on the enormous problem of patients simply not doing the right things for their health.


How can the technologies you work with be used to help improve people’s lives?

Healthcare, quite rightly, is delivered by highly qualified people using very precise language in very controlled environments that value dispassionate reasoning as the best way to determine how to act. This is roughly the opposite of real life. In fact, if you were going to design an environment guaranteed to have a minimal impact on the behavior of ordinary people, it would look a lot like that. Just to pick two aspects of Ayogo’s technology: our specialized social networking system delivers social proofs that help a patient feel empowered, our gamification framework helps them feel a sense of mastery that keeps them engaged and active.


 People throw around the world gamification, but it’s unclear how you make something gamified. For example, do you use points, badges, leaderboards, etc? Is there a recipe for gamification?

Points, badges and leaderboards are not gamification any more than page numbers and chapter headings are literature. That’s just making something look like a game, and won’t be any more successful that trying to ride something that only looks like a bicycle but has none of the underlying mechanics that make a bicycle work. To think about this another way, I can tell you that my high score in Ms. Pac Man is 185,211 and that may not mean anything to you, but to an avid player of that game it will tell them a lot about how good I am, how well I have mastered that game. The points are only the outward expression of my mastery. If I just put quarters in the machine and got a random score assigned to me I would feel no emotional connection to it. You could call that “gamifying” the process of getting quarters from me if you like, and you may even be able to get me to put in a quarter or two, but ultimately anyone who saw that would agree that it is not a game.


Gamification is creating systems that express the essential qualities that make a game, but have a serious purpose. Those essential qualities are: Agency, Conflict, Uncertainty, Discoverability, and (meaningful) Outcomes. I call it ACUDO for short. I’ve got a short paper on this published on the Ayogo blog for anyone interested in learning more.

 What are some of the “coolest” games you have created? Did “cooler” games work better in changing behavior?

Everybody’s idea of “cool” is a bit different, so it’s hard to answer that question. We’ve certainly built games that were a lot of fun to play, regardless of health or educational outcome. That’s usually not a primary goal of our work, as we’re quite focused on healthcare outcomes. Having said that, we built a really fun game called “T Cells Attack!” which models some interesting immune system functions in a sort of bubble-shooter hybrid

T Cells Attack

T Cells Attack

( We built a 3D board game for the Provincial Government to help kids learn about alternative careers in different regions around our home Province of British Columbia. In those cases, the visual aesthetics and clear “win” states served a purpose and weren’t an end in themselves.


 What are the biggest challenges is your work? How have you overcome them?

There are so many, it’s not possible to choose a single greatest one. Explaining to people what gameification really is (and isn’t) is a real challenge, as is working with the very long sales cycles and stifling bureaucracy of large healthcare companies. Just as they say, though: every challenge is an opportunity in disguise.

 What do you believe is most important in keeping people engaged, especially with their health?

Understanding that people make decisions emotionally and justify those decisions intellectually. If you’re focused on educating and rationalizing, you’re missing the key decision point.

 What are three key pieces of advice you have for people who are struggling to keep on top of their health regimens?

Don’t be hard on yourself. Everybody struggles with this. The worst thing you can do is punish yourself just for being human. Put your misstep behind you and get right back at it. As the chinese proverb goes: the best time to plant a tree is 20 years ago. The second best time is right now.


For more information on Michael Fergusson, check out the Ayogo blog


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