The Behavioral Design Podcast · Samuel Salzer and Aline Holzwarth

Healthy Gamification with Mitesh Patel

·45 min·4 clips

How did a single checkbox in electronic health records save $32 million in medication costs?

This episode of the Behavioral Design Podcast features hosts Samuel Salter and Aileen Holsworth interviewing Mitesh Patel, a behavioral scientist and healthcare leader. Patel founded the Penn Medicine Nudge Unit and now leads behavioral insights at Ascension, focusing on applying behavioral design to improve health. Patel shares a foundational example where his team redesigned an electronic health record system to default prescriptions to generic medications, increasing the prescribing rate from 75% to 99%. He explains that defaults are powerful but cannot be used when clinical guidelines are unclear or patient data is incomplete, citing lung cancer screening as an example where poor smoking history documentation is a barrier. For situations where defaults are unsuitable, Patel advocates for well-designed active choice prompts that reduce clinician effort, such as pre-populated statin orders. He describes a strategy where medical assistants handle these prompts to prime patients for preventive screenings before doctor visits. The conversation uses gyms as a product deep dive to explore encouraging exercise. Patel suggests reducing friction through location, integrating temptation bundling with entertainment, and leveraging social accountability. He proposes a gym could offer expiring "friend passes" to book classes together, creating a social commitment and potential new members. For personalization, he envisions a system offering tailored workout maps, class recommendations, and post-workout feedback based on member data. Patel defines effective gamification as using game elements to make activities more engaging without adding user friction. He criticizes apps requiring manual logging, instead favoring automated systems that harness social incentives like competition and collaboration within existing networks. In his research, starting participants at a middle "silver" level in a step-count game created a sense of endowed status to lose and made the top level seem more achievable. Patel notes dropout rates in his trials were below 3%, attributing success to simple daily text messages and explaining game rules progressively rather than in one overwhelming email. The tone is conversational and educational, blending academic research with practical, scalable applications. The hosts and guest exchange ideas in a collegial manner, posing hypothetical scenarios to explore design concepts. Listeners interested in applied behavioral science, especially in healthcare, workplace wellness, or product design, will find concrete strategies here. Those seeking highly narrative content or debate on behavioral ethics might find the discussion too focused on mechanistic solutions.

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