# Building games into multicenter clinical trial systems to boost trial engagement

## TL;DR

This paper shows how adding game-like elements to clinical trials can boost team engagement and performance.

## Contribution

The paper introduces gamification guidelines tailored for clinical trial systems to enhance team motivation and performance.

## Key findings

- Gamification was successfully applied to start-up tasks of seven trials and enrollment tasks of nine trials.
- Customized gamification strategies improved engagement during trial activation and patient recruitment phases.
- The approach aligns intrinsic motivators with trial infrastructure and performance metrics.

## Abstract

Workplace gamification refers to the translation of ordinary work tasks into a fun thematic framework—using game design elements such as points, competition, and recognition—to enhance engagement and motivation. Clinical trials are lengthy and operationally demanding, leading to low enthusiasm and disengagement. As a trial coordinating center, we successfully put gamification to work as an engagement tool in a series of multicenter clinical trials.

We combined trial metadata with gamification and concepts around motivation to enhance how we engaged site teams responsible for trial activation, patient recruitment and retention, protocol compliance, and data quality. Using metrics routinely captured within trial data platforms, performance indicators were extracted and converted into point-based scoring systems. Gamified strategies were integrated into start-up and enrollment phases of each clinical trial, as both phases had measurable tasks with defined timelines.

We successfully gamified the start-up tasks of seven trials and enrollment tasks of nine trials. As start-up tasks were similar, one game fits multiple trials. Gamification was customized, however, for enrollment processes and further adapted to address protocol-specific challenges and periods of suboptimal performance. Drawing from these experiences, we present a set of guidelines that outline key principles and gamification mechanics, serving as instructions for game development in this context.

Gamification guidelines afford a novel approach to align intrinsic motivators for achievement with existing trial infrastructure and performance metrics to enhance trial team engagement across diverse trial settings.

The online version contains supplementary material available at 10.1186/s13063-026-09498-6.