Cognitive Design

Wellness programs are a key application area for cognitive designers.   These programs seek to shift employee health behaviors in an attempt to lower employer costs and improve workplace productivity.   Wellness is big business as over 90% of larger employers have some plan in place and there are many provisions in the Affordable Care Act (aka Obamacare) that focus on health, wellness and prevention in the workplace.  So I am always on the look out for scientific studies of what works in wellness.

For example,  Rand just released a must-read report that provides a Review of the US Workplace Wellness Market.  They examine 33 studies and outline core elements in a program, itemize interventions used, provide uptake and participation statistics and draw some important conclusions.  It is clear that wellness programs have passed the “proof of concept” phase but we don’t have a clear evidence base for interventions that work.   The key conclusion on impact:

“Based on the available literature, we find evidence for a positive impact of workplace wellness programs on diet, exercise, smoking, alcohol use, physiologic markers, and health care costs, but limited evidence for effects on absenteeism and mental health. We could not conclusively determine whether and to what degree the intensity of a wellness program influences its impact.”

The report is quick to point out most wellness programs are not even assessed and those that are often lack rigor in assessment.   From a cognitive design standpoint we know that without frequent assessment and feedback at the individual level it is nearly impossible to do the learning from experience necessary for lasting behavior change. And this must go far beyond the individual health risk assessments wellness programs use. Same for the program level. Without frequent assessment and feedback at the program level it is not possible to do the continuous improvement  and organizational learning needed to optimize a wellness initiative.

More bluntly, you won’t get deep, broad and lasting behavior change at the individual and group level unless your wellness program is designed to measure and provide frequent feedback on physiological, activity, process, participation and financial measures.  The more transparent (shared) and real-time the better.

There are big opportunity for cognitive designers in wellness!

A placebo is a substance with no medicinal properties that can nevertheless have therapeutic effects on some people.  Sometimes called sugar pills or sham medicine, they produce real changes in our psychology, bodies and well being.   How and why they work is a bit of a mystery but recent research  led by the University of Michigan Medical School suggests personality factors play a role.

Researcher tested a dozen healthy subjects for a response to a pain placebo. They found angry or hostile type subjects showed little response whereas those that were resilient, trustworthy and altruistic showed the best response. To quote:

“We ended up finding that they greatest influence came from a series of factors related to individual resiliency, the capacity to withstand and overcome stressors and difficult situations. People with those factors had the greatest ability to take environmental information — the placebo — and convert it to a change in biology.”

The change in biology here refers to the fact that they are generating natural pain killers at multiple sites in their brain.

While this study needs to be replicated on larger groups the fact that adaptive personality traits make the best use of placebos will catch some by surprise.

As we have reported elsewhere on the Cognitive Design Blog placebo effects are widespread and real. They even work with processes or rituals that don’t involve pills, injections or clinical equipment.   The door is wide-open for some creative cognitive designers to develop ethical uses of the placebo effect to address any number of organizational and individual challenges. How about a pill or ritual that accelerates organizational change or doubles my creativity?

The answer is yes, at least according to a recent meta-study that reviewed five projects including some 9000 smokers.   More specifically,

“… smokers who used mobile messaging interventions were twice as likely to make it six months without smoking than those who didn’t.”

Messages included scheduled motivational statements, hints for managing  temptations and rapid response to texts about cravings. Motivation, skill and help from someone else when you are about to fail  is powerful cognitive design for making any type of behavior change.  Unlike many other health apps this solution  reaches out and engages the smoker acting as a nudge, reminder and coach.

Changing the behaviors of people that have problem with drinking and driving or drinking and violence is tough.  An interesting sobriety program in South Dakota claims to be having success with six years of data and an independent RAND study to back them up. Key features of the program include:

“…frequent alcohol testing with swift and moderate sanctions for those caught using alcohol reduced county-level repeat DUI arrests by 12 percent and domestic violence arrests by 9 percent.”

Frequent testing means two breathalyzers daily ( morning and evening)  and those that fail or don’t participate get a day or two in jail, no exceptions.   This supports the idea that daily crisp measurements that drive immediate and modest corrective feedback can reprogram even drug-based habits.

We are hardwired to finish what we start. That is, unfinished tasks will bug us until we complete them. More formally:

“The Zeigarnik Effect is the tendency to experience intrusive thoughts about an objective that was once pursued and left incomplete (Baumeister & Bushman, 2008, pg. 122). The automatic system signals the conscious mind, which may be focused on new goals, that a previous activity was left incomplete. It seems to be human nature to finish what we start and, if it is not finished, we experience dissonance.”

The effect is named for the Russian psychologist that first noticed it at work with waiters in a restaurant. The waiters were able to remember complex orders until they were served. Once the order was complete the waiters lost all memory of them. An incomplete task is remember far more often than a completed one.

From a design standpoint this means we can use incomplete tasks to create specific cognitive effects. The PsyBlog suggests that we can use it to help beat procrastination and the BBC has an post that uses it to explain the psychological punch of the wildly popular game of Tetris.

“Tetris holds our attention by continually creating unfinished tasks. Each action in the game allows us to solve part of the puzzle, filling up a row or rows completely so that they disappear, but is also just as likely to create new, unfinished work. A chain of these partial-solutions and newly triggered unsolved tasks can easily stretch to hours, each moment full of the same kind of satisfaction as scratching an itch.”

If you don’t believe it try it out.

I’m interested to hear from readers with ideas on how else to apply the Zeigarnik Effect to interesting design problems.  For example, how can we use it to improve change or innovation efforts?

Roberto Verganti has some important insights into how innovation works for cognitive designers.  If you don’t know his work check out, Design Driven Innovation. He emphasizes innovations produced by changing the deep psychological and sociological meanings we attach to products and services rather than more traditional technology/capability or market driven innovation methods.  Examples include how Artemide reframed the meaning of lamps from something beautify that casts light into something that lifts your mood and makes you feel better. Likewise Sony’s Wii reframed playing video games into a full-body social experience. In both cases these new meanings were proposed to customers rather than crafted in response to perceived needs.

Creating new meaning is one route to psychological impact and is therefore very relevant for cognitive designers.   Instead of turning to a scientific understanding of how minds make meaning, Verganti focuses on the designers approach and stresses listening, interpretation and addressing.  I  especially like his discussion of design circles where a small group of like minded individuals work together and support each other to nurture truly innovative approaches.   To quote:

“Within this environment members are more likely to survive skepticism and criticism of the dominate culture. They realize they are not alone and they sustain each other in the early experiments through frustration and failure.”

An example of an innovation nurtured in a design circle is Slow Foods. Focused on small-scale sustainable food production (good, clean, fair food). the organization:

“….was founded in 1989 to counter the rise of fast food and fast life, the disappearance of local food traditions and people’s dwindling interest in the food they eat, where it comes from, how it tastes and how our food choices affect the rest of the world. “

Definitely a meaning-driven innovation.

What new and compelling meaning can you propose?