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The Senior Fellow to the Chief Executive of NHS England looks at the healthy phenomenon that has couch potatoes everywhere getting fit without realising it:
With over 50 million downloads in its first month, more than 20 million returning players, and more daily users than Twitter, blast-from-the-past Pokémon Go has swept smartphone users off their couches, into the streets, hunting for virtual creatures night and day.
At first, it seems illogical. The app doesn’t make you money, doesn’t make you look good, doesn’t taste nice or sound particularly pleasant. Whether its nostalgia or simple enjoyment, there’s a hook in the game that’s even led some to quit jobs and become fulltime Pokémon hunters.
Beneath the veneer of Pikachu fun however, is a complex behaviour-changing machine from which healthcare can learn.
The game is a success because it sweats assets: users’ smartphones, surrounding buildings and environments, well known characters and inbuilt mapping software. Users can play the game, anywhere, any time, using a device they already own and are comfortable with.
This should ring a bell with with the health sector. We speak of assets that could be better utilised or deployed, such as NHS estates or even certain arms of the workforce, but seem to ignore our most game-changing asset: the smartphone.
The majority of the population owns one, yet while they have access to NHS services online, single digit percentages of the population use smartphones to interact with the health service.
Hospital-based IT systems are a start, but they represent technology catch-up, not the future. If medical records aren’t built to run off patient’s smartphones, we’re missing a trick, developing inconvenient platforms that won’t be used when they’re inevitably retrofitted to phones in five years’ time.
Pokémon Go blends offline with online, real with virtual. Users seamlessly permeate from walking on streets in the real world, to having virtual teams and battles, all underpinned by their smartphone’s screen and camera. The result is a highly engaging experience that turns almost any environment, be it stores, parks, streets or homes, into a popular game.
A lot of these lessons can be transferred to healthcare. Indeed, in some cases, augmented reality (AR) is already in use. At the Royal London, colorectal surgeon Shafi Ahmed has pioneered the use of Google Glass in surgery to teach students and trainees. In the Netherlands AED4U is an App that shows you the location of nearby defibrillators using your phone. This, however, is just the beginning.
From putting people off smoking and junk food, to turbocharging diagnosis, to helping surgeons identify cancers in the operating room – AR is a revolution we can’t afford to miss out on – it’s what digital was five years ago, and if we don’t think about it soon, it’ll be too late.
Last month in California two Pokémon Go players were rescued by local police after falling off a cliff trying to catch Pokémon. 5% of Android users in Australia and the USA play the App daily; and 70% of those who download it, use it the day after.
The most important characteristics of Pokémon Go aren’t just its viral spread, but rather, its “stickiness”. While we shouldn’t perhaps encourage patients to visit every A&E in the country and “catch ‘em all”, there is still much to learn. In the same way that Pokémon Go has increased physical activity over summer, the NHS must crack how to reduce attendances this winter.
The addictive nature of the platform’s behavioural engine is multifaceted:
- It’s social – from sharing tips, tricks, rumours or battles, the offline-online social processes allow people to build relationships and consolidate existing ones.
- It’s motivating – the game fosters achievement, catching Pokémon, levelling up after successful battles and giving rewards for progress. It’s easy to track and compare as you collect more and more Pokémon.
- It’s unpredictable – from the location you find a Pokémon, to the type of creature you come across, or the time you receive a reward, the slot machine-like nature of the game instigates arguably the strongest form of psychological conditioning, with random, unpredictable reinforcement.
But how can we apply this to healthcare? The relevance to behaviour modification for physical activity and lifestyle change are clear, as modelled by the game itself, but we can go a step further.
Gamification and stickiness factors, similar to those in the App, could help us engage and reward patients for self-care, and A&E avoidance – we just need the platform.
NHS Choices, the UK’s biggest health website with over 40 million unique visitors per month, is an excellent factual resource, but how could this be converted into a behavioural change interface akin to Pokémon Go? One that helps users navigate the system, manage minor ailments and receive the right care, at the right time, in the right place, rather than getting lost in the current alphabet soup of urgent and emergency care.
Pokémon Go has provided plenty of creatures to catch and plenty of food for thought. Healthcare has classically lagged behind other sectors when it comes to technology – it’s time to learn and get ahead of the curve, instead of always playing ‘catch up’.
Augmented reality, Pokémon-like behavioural theory and better use of our assets may hold the key to a better A&E, a safer Winter and a more sustainable NHS.
Dr Mahiben Maruthappu is a practicing doctor and Senior Fellow to the Chief Executive of NHS England. He advises on NHS England’s innovation, technology and prevention portfolio, co-founding the NHS Innovation Accelerator and the NHS Diabetes Prevention Programme.
He has advised a range of organisations, from start-ups to multilaterals, including the Swiss government and the Experiment Fund and the WHO.
Mahiben has a strong interest in research with over 80 peer-reviewed publications and 50 academic awards. His work has been featured by BBC News and the international press.
He is Chairman of the UK Medical Students’ Association (UKMSA), and has written three medical books. Mahiben was educated at Oxford, Cambridge and Harvard universities and was the first person from British healthcare to be included in Forbes’ 30 under 30.