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: Welcome back once again to the outcomes rocket podcast where we chat with today's most successful and inspiring health leaders. I really thank you for tuning in because today I have an amazing guest in healthcare. Her name is Anna Sort. She's from Barcelona, Spain. The beautiful country, beautiful city. She is expert in engagement and design. She's the CEO and founder at PlaBenefit gamification. She's an entrepreneur, a nurse, a professor in various universities. She specializes in health gamification. She's intrigued by video games, human behavior and positive psychology. Her motivation is to bring what makes us happy playing games into taking care of our wellness and health. I'm so excited to have Anna here on the podcast because she really brings forth her passions and a lesson that you don't have to solely be passionate about health care to be successful in health care and bringing solutions, you could bring forth other passions such as game design to do that. So I really want to just give a warm welcome to the podcast Anna welcome.
: Hello. Thank you for having me Saul.
: It is a pleasure Anna. So did I leave anything out of your introduction that you want to share with the listeners?
: No. It was impressively true.
: Thank you. Thank you. Well you know Anna, we've had a chance to connect before the podcast but I didn't get the story about why you got into healthcare so maybe you could share that with us.
: So I wanted, I ended up studying nursing and I think my deter was more like how does someone that the nursing or the health care sector end up in the technological sector, maybe. So for me, my turn away is I want to go back to France to study because I did an Erasmus there which is an exchange program for student. So I find a job in Paris where I went and it was on the media sector. So you have a company that's over 600 employees in Paris, you need to have a nurse full time and that request me.
: Wow. Very interesting.
: So I was at a company called Blizzard Entertainment. You might know it from games that just will work rapter Overwatch.
: Oh yeah.
: Do they have like 21 million players just to over what..
: Very big company,yeah.
: Exactly. It's very very big. So I was there. I'm a gamer myself as you describe. I actually was playing World of Warcraft at the time.
: So to be in a company where people actually does the game, it was a little experience for me.
: So after a while you know I was working there for a while until one of the guys I mean these company was super young like the average was probably 30 or something like that I was really really young. So after a while I was doing a lot of prevention because there were people that were sitting in the chair all day, went home had a pizza at SUTS again in the computer play games so lot's of prevention to there. So one time, one of the guys had a pulmonary embolism between the other things.
: Oh boy.
: An undiagnosed diabetes yet that's a very serious medical problem. And it was like 24 hours before it was not reversible so that was very lucky.
: So anyway so he came back and when he came back from the hospital it was up to me to give him his diabetes introduction and medication. Right. So I did as I was told at university. I sat him down on the table talk to him for about an hour about diabetes with questions and everything and that gave him a pamphlet and said see you in two days. So what happened. So after two day he came back and it was like they hadn't like pulled him like..
: Same thing.
: He like remembered about 10 percent of what we talked about. And this is he, this is I mean this is important.
: Super important.
: So I will play what happened here. Try to analyze what happened because I knew this guy was really smart because he was playing World of Warcraft at the high level. And let me tell you, World of Warcraft is way more complex than diabetes.
: You've got to be on your game. You got to be on A game to be at that highest level of World of Warcraft.
: Exactly. This is way more complicated. So it is definitely not a you know he's got smart type right.
: So like should I do diabetes more like they'd do World of Warcraft?
: To have people learn more about what it is.
: Yeah. So here was my turning point that my moment of realization that someone asked me who had a passion for helping people and a hobby that were a video game that I had to put them together in order to make help fun so everybody would want to do it.
: That's awesome.
: So I came back to Barcelona. I did masters. I mean at the time there were no masters we're like digital and health connected. So I ended up being one of the Masters that had like a health branch but you need to be a programmer like I was with programmers and with designers and it was me. The only one that had ever been there. I had to take a course on programming you know in the summer because I couldn't get it if not.
: Yeah yeah.
: So I did these masters and they talked about really cool things actually from the five pieces that they offered, three of them were had to do with health care because there were like things to help with rehabilitation and platforms to help encourage exercising through the games, right? And stuff like that. So that was interesting. Like what has this to do with health care.
: Yeah, interesting. So I learned about serious games which are games that are designed to actually learn something beside just being fun. I learned about a gamification which is what I do mostly nowadays which is how can you have people getting into these gaming mindsets in real life with real challenges. And I also learned about executing platforms which are the platforms that you do exercise through games. So I thought this is an amazing world that I wanted to get in. So I started after awhile, after I started Play and Fit which is my company. And we do consultancy for hospitals and pharmaceutical companies and any other company that designs digital solutions for healthcare that they want to have innovation as in gamification in them to have more engagement from their users piece a cake.
: Very cool. And thank you for sharing that story Ana. So anybody looking for if they have digital solutions if they're looking to add a a more jazzy or better gamification solution to it. You're the person they call?
: Yes definitely. And I've even had people from outside healthcare do it because I figured out that, if I wanted to do it like the proper way I would have to do behavior change on it. So we do like the basis of behavior change and then add gamification on top of that. So that's a really effective gamification approach to take. So people from outside they're like no, but we are convinced that you're going to help us better than other doctor you do the thing you know and I'm like Yeah but you know I'm a nurse right?
: That's too funny.
: So yeah.
: I love them.
: And another funny story. There's actually WoW diabetes add-on, so you can download an add-on for your World of Warcraft where your character from level 1 to level 10 have diabetes.
: No kidding? Are you serious?
: It's really furious.
: So your character in World of Warcraft could actually have diabetes?
: Yeah this.
: Was this you're doing? They do this because of you?
: Yeah this was one of my earliest achievements when games for health which is like a Congress here. And I was like I have an idea, I want to do this and then I like I was playing the game. I knew what you could do inside the game like how could you record exercise to put it this way and happened on your sugar in your blood. And like the game has tons of food so I knew I could use that to like having an impact on your chewer and your bod as well. So I guess so I like this I did the whole thing. And then Rochester Institute of Technology professor there called Steve he was like OK you know I see your thing. Let's do it. And we made it.
: That's awsome. Folks, there you have it. You know if you have an idea don't be afraid just go for it. And Anna saw this opportunity to introduce a very real problem of diabetes. You know a lifestyle condition that needs to be introduced even to the day to day gaming part of the world. So she just did it and that's what we have to do here you know in health care, it's about implementation, not just innovation. You've got to find out ways to make these ideas happen. So Anna you've done quite a bit in health care. Can you sum up what you think a hot topic that needs to be on every leader's agenda today?
: Yes. So what I think is most important and where we fail most of health care actually is health care prevention. So we know that a lot of chronic disease is just like where we spend most money in health care wise. We know they are preventable. But what are we doing about it. Because if you think about how the health care system is constructed, most health care prevention is done by nurses and then there's a little health prevention by doctors. But when do people find nurses and doctors when they have you know they're ill or when they have a problem and they actually go to see them. So right then and there you cannot do health care prevention because the people is focused on other things. So it is very inadequate and we do not do it very well because the other side of health care prevention is the TV ad saying hi a day which does not work either very well. So that's definitely on top of my agenda. And I think it should be an every every agenda. And I think it is quite general.
: Yeah, no, that's a great point Anna you know it's the difference between health care and sick care. And I think we all think of health care as really as sick care right when you're already sick. You see these people. Anna, tell us what you and your company are doing to address the health care space more than just the sick care space.
: Yeah we're actually work a lot with the healthcare space that we do also work with secure space specially at the consultancy when we have to develop platform for chronic diseases and whatnot. But my preference is in healthcare as you said it. So for example, some of the things that we do in consultancy like let me tell you about the last one for example that we put in. So this is a platform to help adolescents when they have been diagnosed with an STDs, so it's sexual transmitted disease, sorry. They have trouble telling their couples they made their friends that they have this if they've been you know sexually in contact with them. So we developed a game actually make them understand how important it is, and to actually help them contact this person and tell them you know pre sort of word semi design way. So they actually do it more. And this is because they have noticed that closing this communication issue the earliest the less spread you have. So it's having a really big impact versus what they do now which is giving them like a paper so they can give it to the partners that they've been with. So that is like it improves a lot, the system.
: And it goes back to prevention, right?
: Exactly. It does. And ourselves. We've just developed a product which is called, free energy we cheese and that helps people learn more about food, exercise, sleep, their digestive system, the environment how can that help them to improve and their mindset. And this app is actually all prevention like it's based on what we nurses have to tell or are told to sell or patients to actually help them with their health care prevention. So it's very scientific it's very medical. But we've made it funny in a way that we've made it that the information pills that are really straight to the point. One of the biggest failure that we do in health here is the following. It's actually what I did with my diabetic patients. So one thing that I've noticed games do very very well. It's like the autonomy and competence balance. So when you know very little about the game, you have very little competence so they give you a little autonomy like you have one or two buttons to push. And then as you grow more, your competence grows, you start having a little more to do with little more buttons to push it a little, They give you a few more spells or whatever. So it grows as you're growing with your competence the autonomy, right.
: So what happened with my diabetes patient. He had practically zero confidence and I gave him two full days of full autonomy to explore and through whatever so obviously the system was badly designed and he left the system. He was able to take care of it. So with this app what we're trying to do is like concentrate the information in very small pills like we try to tell you just one little thing like if we talk about food we talk about why do we say that we should be eating five times that day for example and we describe studies that point out this direction which is that normal standard. It's like if your studies that pointing to other directions but they are smaller studies or whatever but at least you find your where is it that you feel more comfortable with. And then we give you like a little quest to do for example for this one. So you can just learn something and now you have to do something with this information like right away. And exactly, if not you not able to just put it in your head. For example in this case it's like trading at five times a day on the next five day. So you have to put like that time that you commit yourself to trying to eat something and then the energy tells you give to your mind that signs and also you feel like a little tip suggests or you know it's 4:00 o'clock in the afternoon. If you have a little fruit remember that if you have a little nut is going to help you, absorb your vitamins better and stuff like that so yeah.
: That's very cool. That's very cool. Some great examples there Anna. And folks, if you're curious about what Anna is up to. Check out her website, it's www.playbenefits.com and if you want the English version just do a slash en for English. www.playbenefits.com/en. She's got a really great examples of the wonderful work that she's doing and the people that she works with solutions that she's created in her team so make sure you check that out. If you're looking to gamify your chronic disease strategy or the things that you're doing in health care. Anna, can you talk to us a little bit about a setback maybe something that happened where it didn't work out quite well and what you learned from that.
: All right so PlayBenefit has a little bit of a side story I guess all the companies that survive, log-it off half one of those, I'm going to guess here because I don't really know.
: You're right. You're right.
: So I started PlayBenefit with like a second hand like a second person on board them with me and we were together working for about two years when I managed to get some funding to create the energy and some private funding. And then what happened was that I got my team and everything to focus on energy. And he took care of that consultancy which know was working for a while then and basically I focused on the product and everything and he was focusing on that consultancy. So what happened was we got to January 2017 and I noticed that for about six months we had one the consultancy job done. And we were running out of money. We did not have the app. Yes it is. So we did not have the app finished and I was like oh my gosh this is really bad. So actually we invited this person who I had been working with for two years and you know almost three years by then we invited him to go and then I took in charge consultancy and the app. Obviously the app I have..
: Both sides.
: Yes I had to sort of put something a bit aside because you know I'm only human. I only have certain hours a day. But I did want to focus a lot of consultancy because whether you won it or not likely Playbenefit consultancy sort of what keeps as afloat and then..
: Was to help the app to like do better and bigger but later on obviously. So six months after its June and I run out of money I'm going to have to make the biggest decision had to fire everyone. I had put money in the company to actually make sure everyone must spade and everything. The last month and you keep that everything that we have here in Spain and it was a point where sort of..
: How do you feel that day, like that morning and you had to go tell everybody I mean what was the feeling?
: Actually no, the feeling was the worse is to come yet. So yes so it was stressed I was like everything but I had the feeling that the worst was still to come. So even though it was bad I did not feel like it was bad, bad.
: Ok. OK.
: No, I know what you mean. You felt like there is something around the corner still coming.
: Yeah I don't know. It felt like you know this is bad. But you know the worst is still to come and I just to take it easy and so forth. And then you know how things go. You sort of give something to big universe and the universe gives back,.
: Stuff like your own reason.
: I agree.
: And then in August I get the biggest consultancy job.
: So a month later one month later? Oh my God.
: So you..
: Talk about a roller coaster.
: Exactly. You have been calling to people and be like you know those vacations that we've talked about how about not being together again and we actually close the best year consultancy wise and I was able to get my money back and everything is been going well since then.
: Wow, what a story. And if you had to go back and share with the listeners what your key learning from this was what would you say it is?
: So there were lots of things learned there. But I think one of the biggest once was keeping things in check as with metrics twice. So you don't feel like you're asking you're number two or you're equal to put it this way. You were demanding from them anything it's just like OK so we have this meeting where we do the metrics and the metrics and numbers. And so I'm not subjectively telling you something I'm objectively, where objects following a process exactly putting a process in place that is metric, that it's not emotional that everyone feels comfortable and everyone agrees in.
: I love it. What a great share of that accountability. Like the great Ronald Reagan said Trust but verify.
: Exactly. I don't saying not trust your partners. It's not like the good thing to say. I think..
: Exactly it's business. It's something else and it should not be. Yeah it should be metrics and should be.
: I love it.
: If that makes sense.
: And what a great share. Wow. I felt like I was there with you. I was like oh my gosh we're losing everything we have to fire everybody. Next thing you know you got the biggest contract and then everybody is working with you again. Wow. And so folks what a great share by Anna. Don't assume that things are getting done. It's always good to have redundancy. It's always good to have systems and processes that are going to guarantee that you're getting the information. The optics that you need to have a successful business because that's what your car has a fuel gauge. You know when your car is running out of gas you've got to have the same thing in your business. Great share Anna.
: Thank you.
: So what would you say one of your proudest medical leadership experiences has been to this date?
: So I think I've been quite lucky to feel many of these moments throughout my career because for once I was a pioneer. And that means it's a very cool word but actually means that it's extremely hard. And you feel like quitting many, many times. So I think the peak of it all was when this year I've received the Youth Talent for nursing prize from the Nursing Association in Catalonia.
: Thank you. And I it was one of the peak because for us nurses who were hard to recognize each other. I don't know why it's something that's been there for a long time like we are aware of it. We know it.
: And for your kin to tell you there's and sort of honor me this way was like wow this is the best experience I could ever got.
: That is so awesome.
: So yeah.
: That is so awesome. Congratulations and so did they have a ceremony and?
: Oh yeah there was a lot of that of that and there were like long dresses and stuff like that.
: Wonderful. That's awesome. And you were honored at this event by your peers by your kin. Sort of like a homecoming right like this.
: Because as I said it's so hard for other nurses to actually be aware of each other. And for me I've been always sort of recognized but as see health care professional from a technological part so I had never been recognized from my peers. I was always the odd one you know the ones that's weird. But I know it sounds probably other people would look at my eyes and say Oh you would have to say you know this medical achievement or these other one are being able to participate in these steps or having the first mhealth corps in the whole world which was you know in Stanford and what not for me, my biggest one, is this one.
: I love it and that's what spoke to your heart right. I mean it's what drove you it's why really made you feel alive.
: Exactly. I mean I'm here for this.
: That's so great. How about now, you know you guys are working on a lot of different projects Ana. What would you say one of the more exciting projects that you're focused on today is?
: Well definitely be energy. I would say like with the consultanty we have quite some exciting projects like we have one with that ICU. Sorry. No that's not the, that's a Spanish word. It's intensive care and stuff like that which is really cool. But I would say be energy the one that touches my heart. And the one that I am it's probably the one that's going to get most attention because I really want to get the IUS data out and we have some studies that we want to start. We have studies with the two hospitals here in Spain and one hospital in Columbia and the studies are super different like we have ones that want to give the application the app to the patients and see how they're doing. They're improving their lifestyle, if they find some improvement this way. There are some studies that is like they have surgery patients they just have surgery patients and see the app let's you look at your..
: Bowel movement?
: Bowel movement there you go, I have it written somewhere. Anyway, it allows you to log your bowel movement and with the metric like a scientific metric and what not. So it's very useful for them, if they and they want to see how that works. And then there's another one the one in Colombia. What they want to do is give the app to nureses and see if the nurses themselves learned from the app enough to actually translate this information into their patients like and help them with these tool be more proactive in the prevention and help them if the present. So those are super exciting things that I have in the future. And I really want to start them.
: That's that's super exciting Anna. And with the focus and the drive and the passion that you have for it I'm so sure you're going to take this project and turn it into a successful application and health care so we wish you the best of luck on those.
: Thank you.
: So this is closer to the now now let's pretend you and I are building a medical leadership course on what it takes to be successful in healthcare gamification. Let's call it the 101 of Anna Sort and we're going build the syllabus here. I've got four questions for you lightning round style followed by a book that you recommend to the listeners are you ready?
: Ok I'll try to do my best?
: And let's do it. What is the best way to improve health care outcomes?
: I would say focus on users and when I say users, it doesn't mean the treatment. It means the patient the family the health care professionals whoever is going to use your app. And just a quick tip, we know that patients are the most underused tool we really need in health care.
: Absolutely. What's the biggest mistake or pitfall to avoid?
: You assume you understand like I am a nurse and with the ICU for example experience that was telling you about just need to go and be a nurse there for a while before I understand who the patients are because they can't tell you things but since I know I mean I need to know who is there, what the mobility they have and what they can do what they cannot do. Like to be suspected, I mean you can assume you know something because I'm a nurse and I know about this because I've been told about it in university and so on. But I think the biggest mistake is to assume that you know.
: what a great great piece of advice there. How do you stay relevant as an organization despite constant change?
: Oh that's very good one. I think the biggest mistake you could do here would be to focus on technology. If you focus your organization in technology you'll be always out of a good decision. But as the technology, nursing has been relevant for over 150 years If I portrayed is in my organization and my organization is seen as a digital nursing for example. Then it will definitely stay relevant no matter what technology changes.
: Love it. What's one area of focus that should drive everything in your organization?
: I think I would say prevention probably in healthcare. That's what interests us all and what we try to do.
: Awesome and what book would you recommend to the listeners, Anna. So one of the first books that sort of had helped me or inspired me to be in the course that I'm taking today in my life was from Jane McGonigal who a scientist and a video game designer. And it's called Reality is Broken.
: Reality is broken.
: Yeah and it was on that time that I was that Blizzard Entertainment. And I knew and I saw all these people playing these games because life is much less rewarding. You are not rewarded for your efforts in games, you are. So we need to make life more like a video game.
: I love it. I love it. What a great recommendation listeners if you want to get a hold of the things that we talked about the transcript, everything that we've discussed, links to the book that not recommended just go to outcomesrocket.health/playbenefit and you'll be able to find all that there. So don't worry about writing it down. Anna, this has been a lot of fun. I've really enjoyed our time together here. You've shared so many interesting things that I'm sure the listeners are taking notes on. So Anna, this has been a lot of fun. Before I conclude I'd love if you could just share a closing thought. And then the best place where the listeners could get in touch with you or follow you.
: Yeah. So this is not much of a closing note but I think it's relevant because I've just told you about Jane McGonigal's book, Reality is Broken and I actually tweet some and I wrote up myself which sort of tries to portray what we do in healthcare and how important and how it's playing with video games, how we could improve doing that. Do you know that I told you before about balancing competence and autonomy.
: That's right.
It's like a lesson learned from video game industry because that's exactly what they do and they did very well to keep users and gate. So how can we keep patients engaged or users engaged through their health in a scientific matter. And there's a lot of scientific findings in this book and I try to always relate back to how this world so the book is called, From Games to Health: Lessons learnt from the games industry. Find it on Amazon on eBooks. Some Pretty much anywhere I think we have been all plugged from discover I think.
: That's amazing. So folks what we're going to do here is just add a link to Ana's book as part of the show notes. So if we go to outcomesrocket.health/play benefit. We're going to have a link there. So if you're curious about this, I think you're going to want to pick it up because is definitely a lot of lessons learned that Anna shares in this piece for you is so I know this is a great share. Thank you for that.
: Thank you.
: And what would you say the best place for the listeners to get ahold of or follow you?
: Yes I'm on Twitter. Most of the time, I check it every day. You can find me as @lostnurse because at one point in time I was like a lost nurse. I didn't I don't know how to, say I could have stuck and I'm still the lost nurse, say I'm right.
: I love lot.
: And If not, I'm definitely researchable on LinkedIn in Anna Sort just Anna Sort in LinkedIn, where you found me actually. Yeah, I respond to that as well.
: Fantastic. Well, there you have it. Listeners, Anna Sort from PlayBenefit. Anna, this has been a blast. Truly fun interview and I'm excited to stay in touch with you.
: Thank you. Thank you.
Thanks for tuning in to the outcomes rocket podcast if you want the show notes, inspiration, transcripts and everything that we talked about on this episode. Just go to outcomesrocket.health. And again don't forget to check out the amazing healthcare Thinkathon where we can get together took form the blueprint for the future of healthcare. You can find more information on that and how to get involved in our theme which is "implementation is innovation". Just go to outcomesrocket.health/conference that's outcomesrocket.health/conference. Be one of the 200 that will participate. Looking forward to seeing you there.
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