How Gamification Increases Hand Hygiene Performance

By Madison Pittman

Gamification – the process of adding games to a task to encourage participation and enhance motivation – can effectively boost all kinds of healthy behaviors, including hand hygiene.

Since Nick Pelling, a computer programmer, coined the term “gamification” in the early 2000s, game designers, healthcare professionals and scientists have experimented with using game concepts to encourage healthy behavior. Humans’ fascination with video, board and role-playing games has proven that people enjoy completing engaging, challenging missions with other people, so why not harness that interest to power positive change?

Games Proven to Facilitate Positive Behavior Change

American game designer Jane McGonigal created the game Super Better after suffering a concussion in 2009. That game, which includes classic game elements like quests, “power ups” and allies, has since been shown (via a NIH-funded clinical trial) to facilitate healing from concussion while also promoting optimism. Another randomized controlled trial found that people with depression who played Super Better at least 10 minutes per day for one month experienced significant relief from depression symptoms as well as decreased anxiety and increased life satisfaction, self-efficacy and social support. 

Another game, the smartphone-based Mission: Schweinehund, has been shown to increase physical activity in inactive, overweight people with Type 2 diabetes. The game has a gardening theme; players complete real-world physical activity to earn digital building materials and “water” they can use to restore a decayed digital garden and attract pixelated animals. According to a 2019 study published in JMIR Serious Games, 83.6% of all in-game workout reminders led to a completed workout on the same day, and previously inactive players averaged 143 minutes of physical activity per week. 

Why Rewards & Fun Work Better Than Punishments & Shame 

If you’re a parent – or were once a teenager – you already know that punishment and shaming rarely change behavior for the better. Taking away a teen’s driving or internet privileges might make it more difficult for that teen to stay out late with friends, but it won’t diminish the teen’s desire to spend time with friends. Instead, that teen will probably exert a tremendous amount of creativity trying to figure out how to connect with their peers anyway. Your punishment won’t keep your teen from his friends, but it will catalyze resentment and distrust. 

According to Tali Sharot, a professor of cognitive neuroscience at University College London, punishments are rarely effective in motivating positive action, as they tend to create fear and anxiety, which may lead to withdrawal and disengagement. In contrast, rewarding desired behavior creates a positive feedback loop in the brain. The reward triggers the release of feel-good neurochemicals, which reinforces the behavior and increases the likelihood that the behavior will be repeated. 

The research, Sharot wrote in a 2017 Harvard Business Review article, suggests that “we need to consciously overcome our habit of trying to scare people into action, and instead highlight the rewards that come with reaching our goals.” 

How Games Work for Improving Hand Hygiene

Games don’t have to be complex or app-based to motivate positive action. According to a 2012 article published in Clinical Infectious Diseases, a 17-bed intensive care unit increased hand hygiene performance more than 70% by using an electronic board to publicly reward appropriate hygiene. When an employee washed their hands, the board displayed a positive message and the team’s hand hygiene score would increase. Within four months, hygiene rates went from less than 10% to nearly 82%. Hand hygiene rates remained in the 83-92% range during the 75-week maintenance period. 

The Clean Hands-Safe Hands Hand Hygiene Acceleration Pathway uses gamification as a central component to improve hand hygiene. Our staff work with hospitals to set up competitions and incentives to positively reward teams. Creativity is encouraged, and games can be customized to the interests of employees. (We’ve already thrown a Halloween-themed competition and a March Madness-style tournament.) Teams compete to earn rewards, so team members encourage and support one another in adopting excellent hand hygiene habits. We have seen that not only is this more fun for the hospitals, but we get better clinical outcomes. These games consistently drive hand hygiene performance rates higher by taking advantage of the competitive spirit that exists in almost all areas of healthcare. 

Want excellent hand hygiene rates? Skip punishment and shame and have some fun instead. 

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