From compliance to engagement. Using Gamification to promote "Quality and Risk culture" in a University Hospital

Continuous professional development is essential but often limited by heavy workloads and low motivation, especially for transversal topics such as clinical risk management and quality systems. Gamification has emerged as an effective strategy to enhance engagement in adult education. This study describes the “Campus Game 2022,” a gamified training program implemented in a University Hospital in Rome to improve knowledge and awareness of quality and safety practices. In 2022, 18 teams (145 participants) competed weekly in a digital quiz featuring multiple-choice questions on hospital policies and safety protocols. Drawing on Social Comparison and Reinforcement Learning theories, the program included leaderboards, feedback loops, rewards, and “badge challenges” that encouraged hands-on learning in areas like hand hygiene, emergency evacuation, and data protection. Engagement remained high over 25 weekly rounds, with 15 teams completing all challenges. The average participation rate was 76.8% (p=0.0012). ANOVA showed significant differences in participation between matchdays (F=36.57, p<0.0001), and a decline was noted in the second half, likely due to external factors such as the summer break and scoring dynamics. Gamification proved to enhance motivation, collaboration, and active learning in healthcare education, particularly for cross-disciplinary, non-clinical topics. Further research should explore its long-term impact and scalability.