Cognitive Design

Or so argues Todd Park the chief technology officer (really the chief innovation officer) of Health and Human Services.    He makes his case in this video and suggests changing incentives (from volume based to value based) and the democratization of all types of health data are acting as “rocket fuel” for entrepreneurial activity in healthcare.  An interesting argument especially since many of the opportunities involve improving health behavior change, care coordination experience, decision making by patients and caregivers and other cognition-heavy challenges. This means:

Cognitive design and engineering sit right at the heart of  many entrepreneurial opportunities in healthcare.

In a recent study of how labels effect school children’s food choices researchers found:

“that by naming plain old carrots “X-ray vision carrots,” fully 66 percent of the carrots were eaten, far greater than the 32 percent eaten when labeled “Food of the Day” — and the 35 percent eaten when unnamed.”

Other behavior changing labels include power punch broccoli, tiny tasty tree tops and silly dilly green beans.  These are names the students created.

Vegetables can be transformed into cool new foods with the right labels.  New labels invoke a different set of mental models that bias our perception of the food in new ways. The effect appears robust  as it works on different age groups and ethnic backgrounds over an extended period of time.

For other evidence-based suggestions on how to nudge health food choices by children check out the Smarter Lunchroom Movement.

Yes, claim the authors of  God is Like a Drug: Explaining Interaction Ritual Chains in American Megachurches,  a paper being presented today at an American Sociological Association Meeting.   According to the authors churches with 2000+ members (a megachurch) create a powerful emotional experience using charismatic leaders, stagecraft, small group dynamics, sensory rich pageantry and environments  and deeply positive and consistent messaging.  All key elements of cognitive and experience design. To quote:

Many participants used the word “contagious” to describe the feeling of a megachurch service where members arrive hungry for emotional experiences and leave energized. One church member said, “(T)he Holy Spirit goes through the crowd like a football team doing the wave. …Never seen it in any other church.”

I am interested to hear from readers that attend megachurches. What can they teach us about cognitive design?

Over 75% of the healthcare spending in the US goes to chronic conditions.  One reason for the high cost is that they are not managed well.  Recent studies show the ability to keep chronic disease in check is very difficult when patients have multiple conditions.

Keeping chronic conditions in check, and better avoiding them in the first place, requires a range of patient behaviors and choices. This point is dramatically illustrated in Living Not with One, But Six Chronic Conditions:

“It’s estimated that 80% of heart disease and stroke, 80% of type 2 diabetes, and 40% of cancers could be eliminated if Americans were able to do three things: stop smoking, eat a healthy diet, and get regular exercise. These same behaviors may also prevent exacerbations of existing chronic conditions.”

Fortunately, we don’t lack the science needed to manage these diseases well. What we do lack are programs that deliver the required evidence-based care in a cost effective and psychologically compelling way. We need programs that deliver a think-and-feel experience with enough power to shift smoking, eating and activity behaviors as well as support learning new condition specific self-care routines. Such programs must be based on understanding and meeting the cognitive needs of patients as they manage limited self-regulatory capacity and struggle to learn from experience which routines will fit-and-stick-with their personal circumstances.

In short we need a cognitive design initiative focused on managing multiple chronic conditions.

And the audience for such an effort is fairly well defined.  One report emphasizes how concentrated healthcare costs are.  The sickest 5% of citizens account for nearly 50% of all healthcare costs. More dramatically, just 1% (3-4 million people) account for 22% of the cost! Most suffer from multiple chronic conditions.

I am interested to hear from readers that have insights into deeply-felt and unmet psychological needs (cognitive, affective, motivational, volitional) of patients that are failing to manage multiple chronic conditions.

Nearly 40 million people in the US suffer from intractable and chronic pain at a cost of approximately $600 billion (yes billion) a year. Chronic pain is intractable when the injury is not enough to account for the continued pain.  There is something else at work – a brain state or psychological process. But what?

Researchers at Northwestern University might have an answer. After 10 years of work they now have compelling evidence that

… chronic pain develops the more two sections of the brain — related to emotional and motivational behavior — talk to each other. The more they communicate, the greater the chance a patient will develop chronic pain.

This means that if two people develop a similar injury, say a back injury, the person with higher levels of activity between two brain regions  (frontal cortex and the nucleus accumbens) will be more apt to develop chronic pain.  They also found:

“The more emotionally the brain reacts to the initial injury, the more likely the pain will persist after the injury has healed”

Both these findings are important for cognitive designers working on chronic pain applications.  A brain/psychological state versus an injury is a proximate cause in longer-term chronic pain. This means improvement is possible through psychological design and therapy versus just clinical medicine.  Ideally, the brain will be able to unlearn the pain.

Understanding and meeting deeply-felt psychological needs is the primary goal of cognitive design.   So I am always on the look out for studies that reveal how we think-and-feel in everyday situations in enough detail to have implications for designers.

Take for example, the recent research done at the University of Alberta on  Pleasure, pain and the satisfied customer. They studied emotional reactions to  service experiences and purchases and found significant difference between consumers that are primarily promotion-focused or pleasure seeking and those that are prevention-focused or pain avoiding. The bottom line:

Pleasure seekers have a stronger emotional reaction when things go well or bad while those that avoid pain have a more muted emotional response.

This has clear implications for experience and service designers looking to leverage emotional energy. Focus on pleasure seekers!

While over generalized, the researchers go on to suggestion that men and younger people tend to be pleasure seekers while women and older people tend to try and avoid pain.  They offer some practical advice for service recovery and word-of-mouth marketing:

“To some extent, they can tell front-line people that, as older people approach them, they’re going to be more prevention-focused, they’re not going to be as extreme either way,” said Murray. “But when something has gone really wrong with that 21-year-old’s game console, they’re going to be a lot more upset and more likely to tell their friends.

“On the flip side, when they take it home and it works well and they really enjoy it, they’re more excited and happy, and more likely to tell their friends about it.”

The pleasure-pain psychographic is strong enough to warrant a review of your product designs, service processes and even internal employee programs.

In cognitive design we place primary emphasis on using features and functions to create thoughts and feelings.  Objects and artifacts are interesting only in so far as the mental states they create.  It is all about think-and-feel especially in domains where having psychological impact is the primary objective as in education, healthcare, communication, improving knowledge worker productivity, entertainment and many other areas.

We need to design and engineer products, services and even organizations so that they are optimized for how individual and group minds really work. While this statement is a given for regular readers of the Cognitive Design blog, is it far from broadly accepted.

So I am always on the look out for scientific studies that demonstrate the value created by think-and-feel. Take for example, the recent study reported in the Journal of Personality and Social Psychology that shows we place more value on experiential purchases than we do material purchases. More specifically, they found experiences such as vacations hold more value than products such as clothes.  Experiences are easier to integrate with our identities and can be savored and shared more flexibility than possessions. They require active participation and naturally tend to be more transformative than objects.

Importantly, the researchers:

“show that the tendency to cling more closely to cherished experiential memories is connected to the greater satisfaction people derive from experiences than possessions”

This reveals the primary importance of cognitive design.

Nearly everyone agrees that the K-12 educational system in the US is in trouble. High dropout rates, poor international rankings, high cost and an industrial age focus on teaching rather than a knowledge age focus on learning all signal the model has run its course.  A regulated, political  and fragmented market, K-12 has traditionally been closed to the normal forces of creative destruction that remake service/business models that go bad. All that may be changing.

According to the report Acceleration Innovation in Education Week, the pace of innovation in the K-12 market is seeing an unprecedented uptick.  Foundations and VCs have poured in a record amount of cash, incubators have sprung up and a small but diverse portfolio of start-ups are in motion. Key areas include hybrid charter models that combine online with face-to-face delivery and all facets of educational technology.

All of this is great news for cognitive designers that want to be entrepreneurs. After all,  successful innovation in K-12 requires a good deal of luck or a deep understanding of the cognitive needs of learners.

The psychology of money has many twists and turns.  The nuances may seem academic to some but they are fundamentally important for those of us that design incentives and rewards, financial products or educational materials about money management. That’s why I am always on the look out for new scientific research into how we think about money and wealth.

For example, Psychological Research recently reported some interesting findings:

“People generally like assets and dislike debt, but they tend to focus more on one or the other depending on their net worth,” says Sussman.  “We find that if you have positive net worth, your attention is more likely to be drawn to debt, which stands out against the positive background.” On the other hand, “when things are bad, people find comfort in their assets, which get more attention.”

These findings contradict our normal assumptions and are strong enough to guide design decisions. For example, a person in debt may take out a loan to buy a consumer item when a person with net worth may forgo it.

Experience is primarily driven by what we see and hear. Of course, the other senses – smell, touch and taste play a role but for the most part it is minor. This creates an innovation opportunity:

How to engage the sense of smell, touch and taste in experiences that otherwise lack them as a defining feature.

For example, we can enhance learning, gaming, shopping and night clubbing experiences by engineering the proper odors.  A recent article in Chemosensory Perception, Can Ambient Scent Enhance the Nightlife?  found:

“The three scents tested were orange, seawater, and peppermint. These scents were shown to enhance dancing activity and to improve the evaluation of the evening, the evaluation of the music, and the mood of the visitors over no added scent. However, no significant differences were found between the three scents”

Scents are powerful.  Olfaction is part of the brain’s Limbic system which supports long-term memory, emotion and behavior.

Odors elicit associations, emotions, moods and mental stimulation. They help form rich memories and can support savoring or other complex psychological states.  While we spend a lot of time and attention on eliminating unpleasant odors, the opportunities to enhance experiences by adding engineered odors has just started.

Interested to hear from readers that have examples of how to use odor to enhance experience.