Cognitive Design

Recently asked a group of cognitive design students to tackle the texting while driving problem.  I know a few are still working on it. Check out the excellent article in the NY Times, Drivers and Legislators Dismiss Cell Phone Risks.  They confirm it is as bad as DWI and that going hands free does not help. More interestingly, they put cognitive science right at the center:

“Scientists are grappling, too, with perhaps the broadest question hanging over the phenomenon of distracted driving: Why do people, knowing the risk, continue to talk while driving? The answer, they say, is partly the intense social pressures to stay in touch and always be available to friends and colleagues. And there also is the neurological response of multitaskers. They show signs of addiction — to their gadgets.”

Serious clues for the cognitive designer.

Also check out this game that measures your change in reaction time while distracted.  Would such a device be useful for changing the mental model of texting drivers?

From time to time I blog about the role of design, especially cognitive design, in resolving the US healthcare quality/cost crisis. My basic argument is always the same – most costs flow from otherwise avoidable health behaviors (poor eating/drinking habits, inactivity,  ineffective self-care, etc.)  and so solving the problem means designing programs for achieving and sustaining individual behavior change.  

One firm that seems to be making impressive progress along these lines is Safeway. Check out the post,  Incentivizing Health Behaviors, on the Healthcare X Prize Blog.

“Safeway’s plan capitalizes on two key insights gained in 2005. The first is that 70% of all health-care costs are the direct result of behavior. The second insight, which is well understood by the providers of health care, is that 74% of all costs are confined to four chronic conditions (cardiovascular disease, cancer, diabetes and obesity). Furthermore, 80% of cardiovascular disease and diabetes is preventable, 60% of cancers are preventable, and more than 90% of obesity is preventable.”

Very similar finding to Halvorson’s argument  in his book Healthcare Reform Now!.

The Safeway program uses the same model as auto insurance which has been very successful in changing driver behavior via financial incentives.  At Safeway, the cost of health insurance to employees is behavior-based (tobacco, weight,  blood pressure, cholesterol) and achieving top scores can mean a reduction of $1560 in annual premiums for a family. They offered this level of incentive and achieved a 40% reduction  in cost (at the same premium level) over four years.

Lesson for designing behaviors change: Link real $$ to vital behaviors to create value for all parties.

Something about realigning incentives that changes behavior almost every time.

A major theme in cognitive design is that we don’t design things to fit how we think-and-feel very well.  The lack of cognitive fit generates some serious problems and creates major innovation opportunities. But sometimes it can be extreme.  

Many of the extreme cases (see above) are caused by the fact that my brain function evolves at a much slower rate than culture does.  The brain of a hunter gatherer does not fit the cognitive task environment of a knowledge worker.  The classic example is the inappropriateness of the fight-or-flight response we experience while disagreeing with our boss over a performance review.

Books, articles and posts that illustrate this extreme lack of cognitive fit abound. Two recent examples (thanks to Gina Farag) are given below.

An article in the New York Times, Yes Looks Do Matter,  on how stereotyping has evolutionary roots:

  ”Eons ago, this capability was of life-and-death importance, and humans developed the ability to gauge other people within seconds.”

And an opinion piece in LiveScience, Losing It: Why Self Control is not Natural, claims lack of self control may have had an evolutionary advantage:

Apparently, it’s human nature to be out of control. Imagine our early ancestors roaming the savannah looking for food. They might bring down a gazelle, but that meat was probably not enough for some of the group. As soon as they wiped their mouths, those lacking self-control were probably off again on the hunt because they could not deny themselves anything. 

Of course many brain functions, the so-called higher brain functions, have evolved specifically for the purpose of adapting to the modern information age. Right? Well it seems even the nobel function of reason has come under the assault from an evolutionary perspective. Take a look at the book Kludge: The Haphazard Construction of the Human Mind as an example.

Flight-or-fight, self control, stereotyping and reasoning are powerful forces in society today.  Yet in many ways, our hardwired approach to these is wildly out of step with the cognitive task demands of today’s culture.  The effects are quite visibile – a tsunami of unwanted behaviors – discrimination, poor health choices, workplace violence.

Our technology-fueled culture will continue to advanced at an accelerate pace. It seems clear the only way our poor old slowly evolving brains will manage is via excellence in cognitive design.

A slogan in an advertisement for potato chips that has burrowed its way into our culture.   A great slogan from a cognitive design standpoint but according to a new book by David Kessler (Harvard trained MD and head of the Food and Drug Administration) there may more powerful forces at work.

His new book,  The End of Overeating, argues that food scientists have learned how to tap into our brain chemistry to stimulate our desire to eat more even when we are not hungry.  If you don’t want to go after the book, check out the review, How the Food Makers Captured our Brains, in the New York Times.   Here is a taste (pun intended):

“When it comes to stimulating our brains, Dr. Kessler noted, individual ingredients aren’t particularly potent. But by combining fats, sugar and salt in innumerable ways, food makers have essentially tapped into the brain’s reward system, creating a feedback loop that stimulates our desire to eat and leaves us wanting more and more even when we’re full.”

This is an important perspective for anyone designing weight management programs.  You will have to design interventions that can overcome visceral effects far more powerful than normal hunger. Yikes.

Our inability to make behavior changes is driving health care costs through the roof. Employers have responded by ramping up wellness program around the US.  This makes the research, completed by Kori Lusignan a recent graduate of the Masters in Learning and Organizational Change Program at Northwestern University, very timely. She identified seven factors that are key considerations in the design of organizational wellness programs aimed at improving individual health. These include:

coaching,  self-efficacy, group/environmental support, convenience and automation, stress reduction, self-regulation and company satisfaction. 

A powerful blend of organizational and individual factors and specific enough to guide program design.  For an executive summary of here capstone research project click here.

Seed and the Council on Competitiveness recently convened a diverse group to discuss the future of innovation. It is an interesting read.   A sample for cognitive designers:

“Mullainathan said that this “last mile problem”—where people have all the information to act in an effective way but fail to do so—can be solved through innovations that adopt lessons from the social science of human behavior. As an example, Mullainathan used Clocky, a motorized alarm clock that jumps to the floor and rolls away while ringing, ensuring that users get out of bed to turn it off. An alarm clock has one piece of information to convey; adding wheels makes that information much more difficult to ignore. That kind of lateral thinking could be applied in many different contexts and at much larger scales, such as global health or poverty. “There are high returns to innovation in this kind of area because there are a lot of low hanging fruit—situations where behavior change can drive a huge return,” Mullainathan said.

Just in case you wonder what Clocky looks like,  I’ve include a photo. It is also interesting to note that “design” is an explicit part of the discussion on the future of innovation. Ten years ago that would not have been the case.

For some first-hand insights into the cognition of cults and deprogramming check out this TED video on how cults rewire the brain. It is about 6 minutes long and contains some graphic images. Deprogramming, now that’s a truly hard cognitive design challenge!

Washing your hands, especially if you are clinician caring for patients in a hospital, is serious business. It is a key for avoiding the spread of infection and keeping patients safe. Yet it is hard to get 100%  compliance with established hand washing safety practices.   

A classic cognitive design challenge.

EurekAlert! reports on an interesting new approach developed at the University of Florida. Billed as  Soap-sniffing technology encourages hand washing to reduce infections, save money, here is how it works:

“The health-care worker squirts sanitizer gel or soap into his or her hand before passing it under a wall-mounted sensor. A wireless signal from a badge worn by the worker activates a green light on the hand-washing sensor. When the worker enters a patient room, a monitor near the bed detects the status of the badge, and flashes green if the person has clean hands. If the person has not washed, or too much time has passed between washing and approaching the patient, the badge will give a gentle “reminder” vibration.” 

This may seem like too much technology for a behavioral issue, but hand washing in hospitals has turned out to be a very hard condition to manage. The approach is called HyGreen  and it is important because it closes the loop electronically and provides an automated way to monitor and report on compliance. Something that is a known and powerful behavior changer.

Design for behavior change is a hot topic. And it should be. Nearly everyone looks to rid themselves of some unwanted behaviors. Products and services that promise to change health or money related habits are a multi-billion dollar industry. For the most part they don’t work as the engineers and designers that develop them fail to draw on the science of behavior change. 

As a cognitive designer I am always on the look out for scientific insights into how to change behaviors while respecting individual autonomy.   That’s why the recently published meta-analysis of the effects of web- and computer-based smoking cessation programmes caught my eye.  

EurekAlert! news service has a nice summary of the study and reports for example,

“When the results of the trials were pooled and analyzed, individuals assigned to use computer- or Web-based programs were about 1.5 times more likely to quit smoking than those assigned to control groups. “

The evidence supports including software as a feature/function in the design of behavior change products and services. 

Learning the basics of how to manage our personal finances is an area that has cried out for reinvention for sometime. We don’t learn or practice the basics well in the US.  Given the level of consumer credit card debt and the recent sub-prime mortgage meltdown it is clear we are in trouble.

As much of the problem has to do with poor cognitive design – that is, financial products and services that ignore how our minds really work, I am always on the look out for innovations that seem to get it.

Take for example, EverFi, a start-up that is focused on teaching Generation Y about personal finance. There offering has two powerful innovations from a cognitive design perspective.

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