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From Silos to Progression: Gamification in Healthcare Fundraising
- 2 days ago
- 5 min read
A little over a week ago, I had the opportunity to present at the AAMC Conference for Institutional Advancement. Our session focused on gamification—specifically, how it might be used to strengthen patient and family engagement (often referred to as grateful patient programs) and support movement across the donor pipeline. But what stayed with me after the session wasn’t just what we presented. It was what I kept hearing—across sessions,
conversations, and case studies—regardless of institution, size, or structure. Different approaches. Different terminology.
But the same pattern kept emerging:
Moments matter.
Identity matters.
Progression matters.
Not always explicitly stated—but consistently present. And it reinforced something I’ve been thinking about for a while: We don’t have a lack of activity in fundraising. We have a lack of visible progression. In earlier pieces, I’ve explored how behavioral economics and nudging influence individual donor decisions—how people give, what motivates them, and how small shifts in design can guide action. What I’ve been thinking about more recently is what happens between those decisions. Not just how we influence a single moment—but how we design the experience over time.
The Structural Challenge: Silos vs. Experience
In healthcare philanthropy, we are structured for clarity.
Annual giving. Mid-level. Major gifts.
Each area has its own strategies, metrics, and teams. And those distinctions are necessary—they help us manage portfolios and define goals. But donors don’t experience our work that way. From their perspective, giving is not segmented into tiers or departments. It’s experienced as a series of moments:
a first gift tied to care, a follow-up (or silence), an update, another gift (or not).
What we track internally as movement—retention, upgrades, recurring giving—doesn’t always translate into something the donor can see or feel. And when progression isn’t visible, momentum stalls. Not because donors aren’t interested—but because they don’t know where they are, or what comes next. This is especially true in patient and family engagement programs, where the initial connection is meaningful—but the long-term pathway isn’t clearly defined. At the same time, we’re being asked to build stronger programs, develop mid-level strategy, and grow major gift pipelines. But if the pathway between those stages isn’t clear, progression becomes something we hope for rather than design.
What We Actually Mean by “Gamification”
“Gamification” is often misunderstood in fundraising. It’s frequently associated with points, badges, leaderboards, and short-term participation tactics—and in certain contexts, like Giving Day or time-bound campaigns, those elements can be effective in building momentum and shared participation. But in healthcare philanthropy, the application requires more care. When engagement is rooted in personal experiences of care—often tied to vulnerability, gratitude, or loss—those same mechanics can risk trivializing the very connection we’re trying to honor if they’re not applied thoughtfully. In this context, gamification is better understood as intentional, progressional design. It means making progress visible, reinforcing milestones, recognizing movement, and clarifying what comes next. It is not about making giving feel like a game. It’s about making progression feel real—without losing meaning. This aligns with what we already know across the field, including principles emphasized by the Association for Healthcare Philanthropy and the Association of Fundraising Professionals: donors are motivated by connection, identity drives sustained giving, and recognition should reinforce meaning—not just activity. When viewed this way, gamification becomes more about experience.
Internal vs. External: Same Principles, Different Application
One of the clearest distinctions that emerged is how differently these ideas show up internally versus externally. Internally, gamification often appears as structured challenges—shared goals, timelines, visible progress, and rewards – we shared examples of that in our presentation. These can build alignment and momentum. But even internally, what matters most is not the reward (well not always, right?)— for me it was the clarity, visibility, and shared movement. Externally, with donors, the application must shift. What motivates staff does not translate to what motivates donors. Donor engagement is relational, rooted in trust and identity. Recognition must feel personal and dignified. Milestones must feel meaningful. Progress must connect to impact. When misapplied, gamification risks reducing giving to participation rather than deepening connection. When applied well, it helps donors see their role in something growing.
The Gap: Tracking Movement vs. Experiencing It
Internally, we track movement well: first gifts, repeat gifts, recurring commitments, loyalty, expansion. But donors don’t experience those as milestones unless we make them visible. Without that visibility, giving feels episodic, recognition feels generic, and engagement feels reactive. This is where pipeline development breaks down—not because movement isn’t happening, but because it isn’t felt.
From Pattern Recognition to Pipeline Design
What began as observation has shifted into design. Not just recognizing progression—but building for it. Key milestones—first gift, recurring giving, sustained support—become signals and opportunities. Recurring giving signals commitment. Sustained giving signals readiness. Milestones become moments that guide relationships forward. This doesn’t require building everything at once. It starts small—one milestone, one intentional moment, then layering over time. That’s how progression becomes visible—and how pipeline becomes intentional.
What This Is Not
This is not about points, badges, or rewards. Not about competition. Not about urgency without follow-through. Not about treating donors as behaviors. And not a shortcut. There is no “cheat code” to pipeline development. This is about designing for long-term engagement.
A Shift in Perspective
We are very good at creating activity in fundraising. But we are still learning how to design progression. In healthcare philanthropy, where relationships begin in personal moments, progression matters—not just for pipeline, but for how donors experience connection over time. Donors don’t need more touchpoints. They need a clearer sense of movement. When we move from transactions to relationships, moments to momentum, and silos to progression, we build something more sustainable—not just gifts, but a pathway. This shift—from understanding behavior to designing for progression—is still evolving. In future pieces, I’ll explore how this thinking can begin to translate into practical application—starting small, and building intentionally over time.
References & Suggested Readings
Abdullah, A., & Kuşakçı, A. O. (2025). A systematic literature review: Success factors and gamification impact on donation-based crowdfunding campaigns. International Review of Management and Marketing, 15(5), 18–34.
Aaker, J. L., & Akutsu, S. (2009). Why do people give? The role of identity in giving. Journal of Consumer Psychology.
Behl, A., Sampat, B., & Raj, S. (2023). An empirical investigation of repeated donations on crowdfunding platforms during COVID-19. Annals of Operations Research.
Gong, X., & Ye, S. (2025). Not just the game: The impact of structural gamification on charitable donations. Acta Psychologica, 260, 105521.
Disclaimer
The views and opinions expressed in this article are solely those of the author and do not reflect the official policy, position, or endorsement of any organization with which the author may be affiliated. This content is intended for educational and informational purposes only. Any references to specific organizations, programs, or approaches are included for illustrative purposes and do not imply endorsement. Readers are encouraged to conduct their own research and consider their institutional context when applying these ideas.
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