Cognitive Design

The placebo effect is powerful and widespread in medicine. It involves patients getting better when they take a medication or therapy that has no clinical value or active ingredients.  Often used as a control to test the efficacy of other treatments, the impact of placebos demonstrates the power of perception and belief in creating change. Indeed,  the placebo effect is one reason I am high on cognitive design, a think-and-feel can have as much functional impact as a hammer and nail. It is the real thing not frosting on the design cake. It turns out we all have our placebos. 

Leveraging placebos outside of clinical trials involves deception and raises ethical issues. But do you have to deceive people for placebos to work? According to a recent study by the Harvard Medical School,  Placebos Work – Even Without Deception, the answer is no. They found that nearly twice the patients with irritable bowel syndrome that knowingly took placebos experienced symptom relief.  The control or comparion group took nothing.

It was very clear that placebos were being used:

“Not only did we make it absolutely clear that these pills had no active ingredient and were made from inert substances, but we actually had ‘placebo’ printed on the bottle,” says Kaptchuk. “We told the patients that they didn’t have to even believe in the placebo effect. Just take the pills.”

If this effect can be reproduce in other contexts it signals an important development for cognitive designers.  It illustrates the importance of ritual (in this case the clinical ritual of taking medications) in creating change.  This may support arguments claiming prayer, teaching and leadership communication involve placebo-like effects.

It is the belief in positive outcomes amplified by the psychology of authority-led rituals that is doing the work not the science of the intervention!

How might leaders and mangers driving behavior and organizational change put this to use?  Can we label a change technique or management idea a placebo and generate results?

The world of work has change radically but the world of management has not. Work is now service not product, network not hierarchy, intangible value not cash flow, open not proprietary, crowdsourced not outsourced and untethered not done in the corporate office.  What customer, employee, value, organization and strategy mean has fundamentally changed over the last 25 years.

Nearly everyone admits that our management theory, much of what we teach MBA students and certainly what managers practice on a daily basis is out of step.  Some argue that this accounts for the steady decline in return of assets across most industries for the last 40 years!  Management needs to be reinvented.

One attempt to do that is the Management Innovation Exchange or MIX.   As described in the McKinsey Quarterly:

“The Management Innovation eXchange (MIX) is a Web-based open-innovation project dedicated to catalyzing the creativity of thinkers and practitioners interested in reinventing management. That’s not an undertaking for any one individual or organization—it’s everybody’s problem, which is why the MIX is designed as a collaborative platform both to surface bold ideas and make progress on a set of make-or-break challenges.”

Check out this 3 min video by Gary Hamel, MIX’s founder. They held the first ever M-prize early in the year. It produced some interesting result but did not (as far as I could tell) lay the seeds for a management revolution.

Two more prizes are currently active including the Human Capital Management Prize (What’s your bold idea or radical fix for transforming human capital systems and leadership practices? ) with a deadline of January 20, 2011 and the MBA Prize, open only to graduate business students offering $50K in funding to test bold ideas “ aimed at redistributing power,unleashing human capability, and fostering renewal in our organizations.” with a deadline of February 28, 2011.

I strongly encourage readers to check this site out and ”join the MIX” as relevant.  Cognitive design has a big role to play in reinventing management for the 21st century.

I am preparing a submission for the Human Capital Management Prize.

Social media provides unprecedented opportunity for patients to help other patients in the management of chronic diseases.  From a cognitive design perspective we need to understand what type of information sharing has the biggest impact on improved health behaviors as well as improved compliance with medication schedules and treatment plans.

Found an interesting recent study (sponsored by CVS Caremark and conducted by Harvard) of the 15 largest communities on Facebook that focus on diabetes. It  provides some insights for cognitive designers.  The total membership in all 15 communities was just over 9,000 and the researchers looked at 690 posting from 480 members and found:

- 66% of the posts described personal experiences with diabetes

- 29% included one patient providing emotional support to another

- 27% of the posts were product promotions or requests to complete surveys or participate in trials

- 24 % covered experiences that would likely not be shared with a healthcare professional

- 13% of the posts were responses to specific requests for information.

Sharing personal experiences and providing emotional support is what we expect social media to do.  Meaning and emotion can help immensely when it comes to self control and the regulation of behavior. The fact that some of the content would not normally be revealed to a health care professional (e.g. comments about alcohol consumption) is interesting.

It is not clear how this type of information sharing impacts outcomes but:

“To the best of our knowledge this is the first study to analyze in detail the quality of the information that people with diabetes are sharing with each other through Facebook,” said William H. Shrank, MD, MSHS, senior author of the study. “There are certainly public health benefits that can be garnered from these sites – but patients and doctors need to know it is really the Wild West out there.”

You can access the full article, Online Social Networking by Patients with Diabetes for free. There is definitely a need for more research. One surprise to me was that there is so few people on Facebook that are part of communities focused on diabetes.

Instead of begging friends, chasing a grant, pitching a VC or making a presentation to the board for funding you can use crowdsourcing to get capital for your brilliant idea.  Crowdfunding uses a internet-based microfinancing approach to pitch the crowd collecting many small promises to fund.

Many crowdfunding sites have sprung up. Some focus on specific types of ideas, for example RocketHub funds projects in the creative arts, while others such as KickStarter are general purpose.  Some sites extract a fee for funded projects (5-7%) but otherwise there are no costs.  Amounts raised seem small but often happen quickly. For example, Diaspora raised $10K in 39 days.  The model is even being tested as a funding mechanism for scientific research – see FundScience.

From a cognitive design perspective the micro financiers  are getting a kick (intangible value or mental energy) from helping to fund an innovative idea.  You can select the projects to fund, monitor its progress and in many sites have to pay nothing unless it is fully funded.   For little to no financial investment you can have the pleasure and satisfaction of supporting dreams and make the world a better place through innovation. A good deal. But the effects go deeper. As Lawton and Marom point out in their book: The Crowdfunding Revolution:

 ”Even as exciting, is that crowdfunding links funding with the social dynamics and affinity groups which naturally surround efforts that resonate with our many motivations. That alone, is enough to cause a monumental shift in the way business and organizations operate.”

Interested to hear from readers that have used crowdfunding.

I am just starting a small project focusing on students sending and receiving off-topic text messages during class. This came about in part because of the series of posts on the Cognitive Design Blog about the topic. 

MSNBC posted the results of recent 269 student survey that had some interesting findings:

- 90% of the students text during class

- 50% claim it is easy to do

- 10% do it during exams

- 3% use texting to cheat

Some professors have instituted a no-texting policy resulting in a “zero” if caught. At least  one professor leaves the room when he detects texting. In another approach instructors ask students to bring phones and use them as a polling technology during the lecture. The resulting text messages are displayed on a screen and used to faciltate discussion.   This may or may not minimize off-topic texting by the same student group.

There is an important related issue.  Working adults frequently text, email or IM during business meetings.

How can we use cognitive design to approach texting off-topic during class?

I am often asked by clients and students how cognitive design can be used to improve the effectiveness of coaching.  Or more specifically, what findings from cognitive science can help us coach employees in the workplace, patients in healthcare and students in the classroom more effectively?

These are important questions as coaching programs have sprung up everywhere, are deeply entangled in cognitive needs (intellectual, affective, motivational and volitional) and don’t always produce the outcomes we want.

So I am always on the look out for good scientific studies that have designable insights for improving the coaching process. Take for example, the work at Case Western Reserve University that clearly demonstrates Coaching with Compassion can Light up Human Thoughts.  Researchers are using brain scanning to study the neural signatures of different coaching styles and their impacts on outcomes.  A key finding:

 ”Boyatzis, a faculty member at Weatherhead School of Management, and Jack, director of the university’s Brain, Mind and Consciousness Lab, say coaches should seek to arouse a Positive Emotional Attractor (PEA), which causes positive emotion and arouses neuroendocrine systems that stimulate better cognitive functioning and increased perceptual accuracy and openness in the person being coached, taught or advised. Emphasizing weaknesses, flaws, or other shortcomings, or even trying to “fix” the problem for the coached person, has an opposite effect.”

Perhaps not so surprising to folks that are good at coaching.  But the fact is we normally coach using a Negative Emotional Attractor by focusing on what is wrong and trying to “fix” the person.

Coaching, according to this study, tends to produce the best outcomes when the person being coached feels inspired and compassion flowing from the person doing the coaching.

“By spending 30 minutes talking about a person’s desired, personal vision, we could light up (activate) the parts of the brain 5-7 days later that are associated with cognitive, perceptual and emotional openness and better functioning,” Boyatzis said. 

You still provide corrective suggestions as a coach but you must do so from a genuine sense of compassion versus critical judgement.  Coaching is framed in terms of making changes to achieve the individual’s dreams and ambitions. It is grounded in a caring, empathetic and emotional intelligent interaction between parties. It is not technical compliance with the duties of some formally specified coaching process.

Our minds open to influence in the presence of an informed, caring voice that has our best interests at heart.   Compassionate coaches, just like compassionate leaders, doctors or teachers, will be the most effective in changing how we feel, think and behave.

To tackle coaching from a cognitive design perspective we must first discover, cultivate and unleash compassion for helping others. Without that, what follows will fail to light up our brains.

The design community should be on fire. 

As part of the Affordable Care Act (health care reform bill), a Center for Medicare and Medicaid Innovation (CMMI) has been established to create more effective ways of delivering healthcare services in the US. The idea is to  improve the patient experience, clinical outcomes and radically lower cost or “bend the cost curve”.  This will include improving patient safety. The center has $5B in start up funds and is promised another $10B over the next 10 years.

The economic claims in the Affordable Care Act depend critically on the CMMI’s success.   Failing disruptive innovation, US healthcare costs will spiral out of control even faster.

We need new service delivery models.  Old ideas and improvement methods won’t work. For example, it takes 7 years for the Center for Medicare and Medicaid Services to do a demonstration project.  It needs to happen in seven months.  Ideas already in the pipeline (e.g. improved care coordination, alignment of incentives, etc.) while important are far from sufficient.

What is needed is our best effort in service, experience and cognitive design for health, wellness and the delivery of ambulatory and acute care services.

Fortunately, design thinking has started to take hold in healthcare (see for example Transform) but the CMMI opportunity affords an entirely new level of involvement.

The CMMI is doing a conference call on November 29th to provide an overview and get input. I urge readers to participate and make it clear that design thinking is a key enabler for creating the new health care service delivery models we need in the US.

I am also interested in hearing form readers that have ideas on how to mobilized the design community to work with the CMMI.

Doing cognitive design for employees is an excellent way to approach workplace effectiveness.  The key is to understand how employees think-and-feel about work. What psychological (intellectual, affective, motivational and volitional) needs do employees have in the workplace?  How do your HR and management services and policies satisfy these needs better than competitors? These questions are intensely important when it comes to talent management.

There is not likely one answer for most firms. Indeed, how employees think-feel-and-do work seems to differ along generational lines. Most large corporations have intergenerational workforces. So I am always on the look out for generational workforce studies that provide scientific insights into the cognitive needs of employees. For example, a new study just published in the Journal of Management, Generational Differences in Work Values, provides several designable insights.  They analyze the intrinsic and extrinsic values that three generations attach to work. Generations include Boomers (1946- 1964), GenX (1965 – 1981) and GenMe (1982 -1999).  

Big shifts are in the works.  Most notable is the decline in the intrinsic value of work and the rise in importance of leisure time.

Boomers live to work and GenMe works to live.

This graph summarizes some of the details of the shift nicely: 

On an HR blog I also found an interesting contrast of the motivational differences between generations. While the time frame on the cohorts are slightly different and GenMe = GenY the two studies paint a similar picture.  

I do see important differences. For example, is the best reward for GenMe leisure time or meaningful work? Also, I suspect text messaging is the key communication mode for GenY.

Interested to hear from readers that have seen other empirical studies that shed light on the shifting psychographics of work.

Creating new ways for people and machines to interact that stimulates supercharged levels of decision-making, learning, creativity and other knowledge production is a major innovation trend.  Powered by technologies such as the internet, social media and smart phones and enabled by clever “architectures of participation” that satisfy deep psychological needs we witness the emergence of raves, flash mobs, prediction markets, match-making markets and mass collaboration.  Sometimes the participation is so well wired that a form of cognition emerges that goes far beyond the capacity of all the individuals and anything normal group interaction can produce.  We temporarily get authentic networked intelligence or an emergent mind.

As a cognitive designer I am always on the lookout for new architectures of participation that have the potential to create emergent or networked levels of mental performance. For example, I am currently studying the unconference.   A new way of stimulating a group of intelligent and creative people to interact and share ideas.

Here are initial thoughts on some key features.

- Offer a general theme to select, attract or allow participates to self select. Do not create an agenda. An agenda should emerge from the participants. The design of invitations is important as it conveys the what and why that draw the right participants or not.

- Keep the group small but not tiny. 300 is a magic number for a maximum as any more and the human capacity for intense interaction between all members breaks down

- Bring participants together physically in a stimulating environment in a “get to know you experience”. Let topics, talks and schedules emerge from the group interaction in a self-organizing fashion.  Topics that don’t get critical mass die out.

- Keep talks short (TED style or even lighting style of 5 minutes), hold many sessions concurrently and let things go until people run out of mental energy.

- Planted facilitation using affirmative inquiry, open-talk agenda creation and other group techniques can make or ruin an unconference.

For a good second hand experience check this blog post on SciFoo 2010 an unconference at the Googleplex.  For some how-to tips check out Unconference a blog by Kaliya Hamlin, an experienced designer and facilitator of such events.

I am looking for evidence that the unconference is producing interesting cognitive results beyond what happens at a normal conference or organized meeting.

Effective disease management programs are a cornerstone for any serious attempt to improve the cost and quality of healthcare in the US. These programs target chronic conditions such as congestive health failure and diabetes and provide services to insure compliance with best practices by clinicians and patients alike. The goal is to improve outcomes, avoid hospitalization and eliminate unnecessary cost.  As most of our healthcare dollars are tied up in chronic conditions, effective disease management programs are a must have.

But how do you design an effective disease management program (DMP)? That question was asked and answered in a recent article in the McKinsey Quarterly.  The researchers studied programs that worked and programs that failed in several countries and found:

“Five traits seemed to be the most important in ensuring that DMPs meet their goals: program size, simplicity of design, a focus on patients’ needs, the ability to collect data easily and analyze results, and the presence of incentives that encourage all stakeholders to comply with the program.”

Although these traits seem basic (and they are), there  are some details especially relevant for cognitive designers.

For example, decreasing cognitive load is key. Under simplicity the cognitive load is decreased in the program by avoiding complicated care pathways that have been customized for multiple sub-groups of patients.  While under the patient need trait it is lowered by avoiding the use of complex technologies to monitor and report results.  Also under patient needs care was taken to support the cognition of self-regulation:

“The patients are given ongoing, disease-specific coaching to maximize their ability to care for themselves”

A careful reading of the article reveals other cognitive factors that help drive the success of disease management programs.   It is not surprising that cognitive factors play a key role but it is very useful to see the details revealed in a empirical study.