Health inSite: Breaking the Fifth Wall

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A refresher on Alternate Reality Games, Transmedia Storytelling, and Engagement

While I highlighted the opportunities with Alternate Reality Games and Transmedia Storytelling in my last post, I wanted to take a moment to share a recent production that I’ve been looking into that really highlights how this format works: The Lizzie Bennet Diaries. The Lizzie Bennet Diaries (LBD) is a modern retelling of Jane Austen’s Pride and Prejudice.  The characters in the story have their own online presence within various social media outlets and interact with one another through Twitter, Tumblr, YouTube, ThisIsMyJam, Websites, and more (various examples shown).  The characters share their stories with one another through these dynamic media and oftentimes interact with the audience as well.

While this has engaged a pretty significant audience (fandom), what is really incredible is the way in which the audience has begun to participate with one another.  A recent update to the story included new information that Lydia Bennet (Lizzie’s youngest sister in the updated version) has been caught up in a sex tape scandal (remember, this is not meant to be perfectly along the storyline that Jane Austen wrote, but one that resonates with the audience of this retelling).  There was a huge outcry from the audience expressing dismay at this turn of events.  So much so, that that there was discussion the fandom should look for a hacker who would be willing to hack the website on which the video’s seller was collecting interested buyers with a countdown clock.  This created an immediate problem for the producers/writers of the story.  If the site indeed had been taken down, the team would have to develop a way to get around the change in the storyline created by the audience, and at great expense.  In this way, the audience collaborated to solve the problem of the character, rather than maintain their understanding that this was simply part of the story for consumption.

Let’s start with the Fourth Wall

In theater, the Fourth Wall is the theoretical veil between the audience and the stage.  Breaking the Fourth Wall happens when the players on the stage actively communicate directly to the audience.  There are countless examples in which the magic of the story playing on any stage (screen applies here too) is broken in this way, but the practice is increasing with evermore prevalent new media projects.  In my last post, I described Transmedia Storytelling and Alternate Reality Games as a way of telling a story through multiple media streams and its ability to engage an audience in new and immersive ways.  But breaking the Fourth Wall can be used to engage the audience in participating in the story through these methods to expand the value of the experience that the audience has.  For more on the Fourth Wall, check out Wikipedia for a quick overview, or TV Tropes for all kinds of cool information about the idea and the way that the  this device may be used.

Now, to the Fifth Wall

There is another proposed wall which has been less well explored, and often debated as to its name: The Fifth Wall.  The operational definition that I like is the veil that separates members of the audience from one another.  For a long time, the audience has been the passive observer of entertainment with notable exceptions of breaking the Fourth Wall.  But, rarely does a media experience really ask for members of the audience to work with one another.  This concept of the Fifth Wall could have significant implications in the sharing of narrative within an Alternate Reality Game with a true Transmedia Story backbone.  Consider the opportunities of having participants in the audience that can help guide the story cooperatively; sharing goals, pushing one another toward success, battling challenges together.  If your friends’ friends impact your health in positive and negative ways (see previous posts about link influence here), what about engaging a first node relationship more directly to change the perception of the second or third node to ripple back through the network to you.  In this way, the network then begins to course with change and as you make changes that influence others, their responsive changes come back to you.  In this way, helping others get healthier helps you get healthier.

The Walls and their implications within LBD

The surprising situation that happened within the LBD is that while the narrative has been so clearly billed as a story, with many instances of the Fourth Wall being broken (the producers actually have entire blog postings dedicated to talking about the production process as it is occurring), it turns out that the Fifth Wall nearly took down the production.  The audience reverted to a sense of belief as they interacted with one another.  The characters, then, are part of the audience – and the audience part of the characters.  This creates a shared experience where the audience felt that they were responsible for helping solve the problem for the character.

Summary

The investment of the audience in their shared experience (this includes characters, as mentioned above) has huge implications for health programming.  Imagine a story with so much motivation and movement as LBD written to achieve Salutogenesis by creating a shared landscape around health behaviors.  If we know that education, knowledge, and external incentives are not motivations for behavior change, is this the next landscape to try?  We think it is.

To our health,

Ryan Lucas
Marketing

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Health inSite: Gamification of Health

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In the 10th installment of Health inSite, we take a look at strategies of an up-and-coming way of engaging health through Gamification.  Gamification has recently taken to the health world via a veritable windfall of funding coming through venture capital firms to try to create platforms that encourage and incent people to take on everyday health activities.  While most of these have been fitness related applications and websites so far, a good number are starting to look at emotional resiliency, pro-social behavior, and more.  If you’ve not yet read Jane McGonigal’s book, Reality is Broken, or seen her TED Talk, I highly suggest them.  McGonigal suggests that there is value in creating unnecessary obstacles for people to achieve more and feel the power of their own success by creating fiero moments – moments of intense pride in one’s triumph over adversity.  These obstacles enrich our lives and add value to our, oftentimes, mundane daily activities.  As McGonigal mentions in her book, if the point of golf is to put the ball in the hole, why don’t we just pick up the ball and walk it over to drop it in the hole.  Yet, we spend a lot of time playing the game and add obstacles to make it more challenging.  It creates motivation to achieve for the sake of achievement, rather than the end goal.  This is the point of a game and it has a big role to play in the future of health.

There are a number of groups starting to use the concepts of gamification to encourage health promoting activities.  And, there is a lot of hoopla being created around using technology platforms to make gaming a part of employers’ health strategies, with 60% of employers planning to add gamified health strategies in 2013.  However, most of these groups are only using small pieces of the total package that gamification, and other psychological research, includes; and sometimes, are even using pieces that are inappropriate, such as financial incentives and gimmicks, which directly undermine the value of the game itself.  But maybe there are better opportunities to correctly use the concepts of gamification, as well as the many other pieces of psychological research that we’ve covered in Health inSite, to create a total population health strategy at work; the first wellbeing program that actually pushes employees to challenge themselves, and each other, to become more healthy, rather than less ill.  In fact, MINES is doing just that.

It takes more than a website to do this – including focus on using the resources available to a company’s natural habitat, the worksite, to engage employees during the 40 hour work week, and more, by creating a story.  As described in the burgeoning world of Alternate Reality Games and Transmedia Storytelling, the ability to tell a cooperative narrative – on and offline – among those with which you work is an opportunity to actively create health, the benchmark of Salutogenesis.  When you have many platforms for engaging in this storytelling, you increase the modes of access to actively engage all employees where they are, rather than forcing them into a platform that they may not be comfortable with, or is not ideal for their way of engaging in their health generating behaviors.  This is done by asking for participation in the developing story that is experienced, rather than simply viewed.  Imagine, rather than passively hearing or reading what someone needs to do to fight diabetes, or other chronic health condition, or even simply drop a couple of pounds, each person can create opportunities for their fellow employees to actively and interactively challenge one another in the course of an unfolding story.  This makes health promotion participatory and engaging.

We’re focused on creating the health generating plan of the future and want to share it with you.  In the meantime, maybe you’re already starting to embark on this grand adventure in your own ways.  What do you do at work that helps make people healthier?

To our health,

Ryan Lucas
Marketing

Health inSite: A Salutogenic Workplace

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Let’s dig a little deeper into the concept of Salutogenesis and what it might mean at your workplace.

The River

Antonovsky’s explanation of Salutogenesis was well depicted by a river.  His concern with the current model of health (Pathogenesis) is that it’s generally believed that we are healthy from the beginning but that because of environmental / circumstantial events, we become sick.  Antonovsky expressed this as a river, where all healthy people stand on the bank, safe from the raging river’s flow.  Once one stepped into the river – got sick – then something needed to be done.  Salutogenesis, however, sees all people already in the river; but at different distances from the mouth.  General resistance resources (GRRs), a term Antonovsky used as well, are the supportive mechanisms that make it possible to engage in their health generating activities.  These allow for someone to swim against the current or maintain a position against the current.  The result of thinking this way is the freedom to abandon the bias that one has failed at being healthy, but rather that they are always working at generating more health.

Sense of Coherence

Antonovsky’s continued his explanation of Salutogenesis as hinged on a Sense of Coherence.  Sense of Coherence is defined by three major parts:

  1. Comprehensibility (I get this).  The ability to understand one’s circumstances.  If you look back at some of my previous postings on Cognitive Bias, we are unable to fully comprehend our experience because, as Kahneman has pointed out in Thinking Fast and Slow, we are subject to a number of biases including base rate neglect (not having the ability to assess, objectively, where things are from the start before making an opinion of what is possible).
  2. Manageability (I got this).  The ability to assess resources for dealing with one’s circumstances.  “The right tool for the right job” comes to mind here.  To adequately meet the needs of Manageability, one must not only have the resources available, but the knowledge that they can be used.
  3. Meaningfulness (I’m good to go).  The ability to comprehend the anticipated results as helpful.  We oftentimes recognize that there is a change to be had, but taking that step can be difficult without a fire under your bottom.

Taken together, these three points sit at the nexus of the ability for any given person to be able to effectively engage with their health.  When all three are maximized for performance, individuals can effectively mitigate the potential of their circumstances.  Education obviously plays a big role in the process of becoming healthier, but education alone cannot make people healthier.

Your role as a benefits provider

As someone that is providing benefits to a group of people, you have a key role in the ability to help those covered to become healthier; to actually create health.  It’s easy to provide a benefit that is available when it’s needed and provided by an external vendor, but that doesn’t have to be the end.  Visionary organizations are engaging their population in small, but every day, ways.

What can be done

Engagement is key.  First off, you have to take on an organizational wellbeing plan in earnest.  If you’re willing to put in the effort, your population will be more likely to stay engaged.  If you’re not behind it 100%, they probably won’t be either.  But what can be done to engage in health more actively in the worksite?

Let’s look at some of the GRRs that Antonovsky identified and where they may occur in the workplace.

Money: Money enables us to purchase services and products that can enable health generating activities.  It can also be used to incentivize or disincentivize activities – the so-called carrot and/or stick approach.  But, money also has some significant impact on engagement.  When individuals make a purchase, they are actively exchanging the value of their dollar for the value of what is being purchased.  If you’re familiar with the concept of Behavioral Economics, this might include devaluation of a certain program because it is provided for free.  Instead, incentivizing purchase of products or services that help in the generation of health means personal investment in its use.

Knowledge: You know that conference or meeting room that is usually set aside for meetings with clients, or teams within your organization?  It may also be a great location to have a training or two related to health generating activities.  Including helpful information in your break room, like healthful recipes, may be a continual reminder of what your population is putting into their bodies.

Commitment: Commitment may be especially easy to generate in the workplace because you’re already showing an investment in those you provide benefits for.  Showing your commitment to the program can help create mutual investment, as well!

Social Support: Encourage people to support each other in your health generating activities by rewarding employees who provide assistance or encouragement in the health of other employees.  This creates a social structure for engaging in health, and we know that community is the key to health.

Taken together, this is a powerful recipe for getting the kind of motivation needed to stay actively engaged in your population’s health.  And, the long-term benefit of a healthier and happier workforce is what drives productivity and profitability.

To our health,

Ryan Lucas
Marketing

Health inSite: Transformations as the Future of Healthcare

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Have you read the book The Experience Economy?  To explain it very quickly (and not do true justice to the ideas proposed in the book), there are various levels of economic offering that warrant different valuations, and thereby ability to generate revenue.  The levels of development discussed in the book are elegantly displayed in the graph below by Pine and Gilmore (the authors of the book):

This progression has expanded over time with new levels being added as the market strives for differentiation.  Many of the examples brought up are clear and concise, such as Starbucks as a purveyor of coffee (a commodity) that really charges the market at the level of a Service.  Pine and Gilmore stop at the level of Service in their description of Starbucks, but I would readily argue that they reach towards the level of experience.  Starbucks actually refers to this in their training materials as creating “The Third Place;” it’s not your work, or your home, it’s that other place where you can unwind a little bit.  Even though the customer isn’t actually brewing their own coffee, as is a hallmark of many experiences, they are engaging with the sounds and smells of the coffee shop in a very intentional way.

The book spends a great deal of time discussing offerings that are on the level of Experience but certainly takes a moment to tip its hat toward Transformations, a burgeoning new market offering.  Transformations are marked by the engagement of the customer in a way that enables that person to learn or grow, exactly to Transform, themselves in a way that is truly valuable to the customer.  It includes giving the customer the skills and motivation to make changes that will both provide some immediate value but also cascade down into further value down the road.

In healthcare, this understanding of the market is significant and valuable.  As we, as an industry, discuss Accountable Care Organizations, capitated care models, and participatory medicine, it’s important for us to keep in mind where value is derived in the typical marketplace.  Healthcare, while arguably different in many ways from other industries by its virtual necessity in every citizen’s timeline, still must compete under the same rules as many other industries.  Many times, in healthcare, we present ourselves on the level of Service – that is that we are doing something for someone, for a fee.  As we look at these new systems, it is time for us to consider what the future of healthcare delivery will require under a population health model of delivery.

Eschewing the fee-for-service model opens up the possibility for the healthcare industry to reconsider offering the long-term value of teaching individuals how to keep themselves healthy, at least in terms of the 80% of healthcare costs that are mediated by behavior.   This decreases the time and services that must be provided creating new forms of cost savings.  As we move further up the economic offering ladder, it will become more necessary to move our industry into the Transformation realm.  In fact, there is no other industry more suited to it.

To our health,

Ryan
Marketing

Health inSite: Wellbeing or Wellness?

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We provide wellness sessions for a number of our clients, integrating the wellness component into the overall Employee Assistance Program (EAP).  To recap what MINES considers an EAP to be:

  • An employee benefit: Free-to-the-client counseling or coaching sessions for the employee and their household members on topics ranging from workplace to personal issues.
  • A management benefit: Supervisor / Manager training, work-performance referrals, and management consultations that help management work more effectively.  (For some of our clients, this is like adding a part-time HR assistant!)
  • A work/life component: Including access to an online behavioral health portal with articles on all aspects of work/life balance, concierge referral services for help in finding and accessing resources like college planning, legal and financial coaching, and trainings related to interpersonal, stress, and other wellbeing topics.

This layering of benefits is more robust than a typical “embedded” EAP that is offered as part of a health plan.   These do not usually provide heavy promotion and oftentimes do not extend to the many management benefits that MINES includes in our EAP.

But a few months ago we were preparing for a presentation of this more integrated model and discussing the unique selling proposition of this program and how we wanted to position it in juxtaposition to our other Employee Assistance offerings.  When we charted out the program, we found that we had two very large changes that were being considered under this new program proposal: 1, we were looking at a more holistic approach to the health of the employee that honed in on outcome-focused behavioral change, rather than just incentivizing program participation (meaning that we were giving employees the opportunity to affect many dimensions of their health from the emotional to the physical to the financial and occupational); and 2, we were offering a way for management to interact with their employees in a way that was much more integrated than many wellness programs typically do.

By creating an offering that was integrated into the social fabric of the company, rather than simply proposing a commoditized offering, we uncovered a significant change in the way that we wanted to present this program.  We changed the program from an EAP with a wellness component to an Organizational Wellbeing System.

To distinguish these two terms from one another, and why we thought we needed to change our language for the proposal: wellbeing is differentiated from wellness, as defined by Merriam-Webster, by the former term’s incorporation of total prosperity.  Prosperity, we thought, had the added quality of openness to more dimensions than wellness had available to it.

We believe that this difference is significant, especially when considering the future of healthcare in the United States.  Regardless of what the Supreme Court decides about the legality of the Affordable Care Act, there are changes coming in the landscape of health and we at MINES believe that we are moving in the direction of a more integrated, network-based HEALTHcare as opposed to single person SICKcare.  As we’ve mentioned in some of our other postings recently (PPACA Roundup: Part IICommunity is the Key to healthHalo effects and Link Influence), the brief therapy model has significant implications for treatment adherence in more than just substance abuse and mental health issues and we’re prepared for a more involved role with the whole wellbeing of the individual, their social network(s), and the population as a whole.

To our health,

Ryan
Marketing

Health inSite: Halo Effects and Link Influence

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In a recent article published by NPR, Gain Together, Lose Together: The Weight-Loss ‘Halo’ Effect, two studies were mentioned that suggest that our social networks have a significant effect on our overall health and well-being.  Since weight is oftentimes affected through behaviors (exercise, diet, smoking, drinking, etc.), those with whom we engage in those behaviors have a direct impact on the outcome.  It’s pretty simple when you think about it, but certainly, easy enough to miss.  We do know that your friends’ friends make you fat.

However, the article highlights another very interesting second-node response to those receiving treatment for obesity. While there may have been behavioral changes that were enacted by family members (first degree of separation) as they complied with the treatment plan for the patient’s (first-node) benefit, the article suggests that there may have been another influence on the weight of the patients’ family members – additional education.

This does add a new layer of influence that might create additional change.  If you are engaged in the treatment, even just on the education level, what possible changes might that make to your cognitive approach to the subject.  Said differently, even if your behaviors aren’t initially, directly adhering to the treatment plan, is it possible that through continuous education on the subject, you might potentially change your behaviors simply through thought pattern change? We do know in psychology that simply logging what you eat will result in weight loss. Where your mind goes, the energy goes.

Of course, the way Psychology views the Halo Effect – a cognitive bias that involves one trait influencing others in one’s judgment of another person or object – a little different than what is described in the study – but it would be interesting to see if perception of success of the patient had an influence on the outcomes of the family members.  In other words, if there were a Halo Effect regarding the overall interpretation of the composite qualities of the patient by the family members adhering and discovering success with a treatment plan, if that in turn could create the opportunity for a cognitive reframe of self-perception – a sort of, “they are doing it and maybe I could/should too.”

If anyone knows of an interesting article or study that has delved into the topic, we would love for you to share it.

To our health,

Ryan
Marketing

Health inSite: Community is the Key to Health

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Alternate title: Your friend’s friend makes you fat.

When it comes to your health, it’s important to realize that the decisions you make do not exist in a vacuum.  In fact, it may be even more the decision of your peer group than yourself as to what you eat, how you exercise, and what other habits and behaviors you engage in.  Recent studies have shown that your social network (and we’re not talking about facebook here, although that may be one depiction and/or part of your social network) has a greater impact on our overall health and well-being than we knew (or, in some cases, would like to think!).

An excellent, recent article posted by Mark Hyman, MD on the Huffington Post explains: “Much can be done with a little help from your friends.”  Creating a community around health topics, especially related to health behavior changes, can be critical to instituting new or better habits that have an impact on your total well-being.

At MINES, there are a couple of us that get together for lunch every day.  In the course of the meal, we may talk about the Broncos, the latest political debate, technology, and so on.  But one thing that we do every meal is discuss what we are eating.  We come together and discuss new recipes we’ve discovered and why we’ve chosen to eat as we have.  I recently (and at the time of this posting, currently) tried to eat only whole foods for a month.  This meant no salt, no sugar, no cheese, sweetening my coffee with honey, and very little pasta / bread.  It has been difficult to fully 180 turn around on a diet that had previously heavily relied on enriched cereal grains and pre-processed foods.  But, the reason I was able to make the shift, I believe, was that I was positively influenced by this group that was interested in, shared similar views on, and regularly engaged (daily) in the topic.  In behavioral health, we would say this created a support resource for treatment adherence.

Healthy behavior is not dependent on what payment models, medical technology, or other innovations come about in the healthcare debate.  We know that your friend’s friend has a great impact on what you do – and vice versa.

Today, you could:

  • Discover new friends
  • Decide to impact your friends
  • Ask for support from your friends
  • Be influenced by your friends

Today, make a decision about one habit that you want to change and find someone who wants to make that change with you (or even better, a group of people) and you’ll find yourself much more likely to achieve it.  If you’re not sure how to decide what changes to make or need some ideas on creating your own wellness plan, one of our Affiliates, Cecelia Keelin, recently hosted a ChooseWell webinar for MINES that might help.

To our health,

Ryan
Marketing