Healthcare is not just about the people who work in HealthIT, it’s about everyone…

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Special thanks to the many influences that have contributed, directly or indirectly, to my questions leading into this #HITsm chat: @leonardkish @ochotex @avantgame @gzicherm @connected_book @paullikeme @robertamines @kellymcgonigal @joepine @hankgreen

Intro

I’ll be moderating the #HITsm chat on August 28th at 10am MDT and wanted to put together a couple of thoughts related to the topic before going into the chat. Maybe you’ll find these useful. Also, feel free to join us if you are interested in the topic. The more the merrier! Toward that end, let’s have a discussion about what we, in #HealthIT can do to make sure that we’re meeting the needs of those who are our end-users.

Considerations should include #EHR & #App design from #Payer, #Provider, #Patient, and #Peer per this posting on #4PHealth.

It’s the convergence of all four P’s (Provider, Payer, Patient, and that Patient’s Peers) that will allow for greater healthcare reach. When the Payer and the Provider are able to engage the Patient’s Peers, then true health generation is possible and the benefits of one’s social network can then be fully leveraged.

People:Person Design

We have historically looked at healthcare (and by extension, #HealthIT) as though it exists outside the “natural” world, or as though health is outside the realm of our social experience. Yet, we know that health is not divergent from our health reality or our everyday lives.

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.

How do we reconverge these two realities knowing that what we do in our daily lives result in healthcare outcomes? Framed differently, how do we leverage the way we make decisions every day in considering how #HealthIT is designed?

Our health is not our own. We are bound to others, near and far, and by each decision and every sharing of those decisions, we birth our health.

#HITsm T1: Knowing that #health is dependent on daily life, how do we design #HealthIT in consideration of the larger, social world?

Cognitive Bias, Iterative Decision-making, Behavioral Economics, Game-Theory

Considering the depth of our knowledge related to cognitive bias, are we considerate of this branch of psychology in design? Knowing what we know about iterative decision-making (that decisions have to be made in sequence, often after new or different information) how do we prepare adaptive #HealthIT that responds to new information as it becomes available, like it does for Human Beings? For details on Cognitive Bias and Decision-making, see here and here. For Game Theory (including iterative decision-making), see here.  

So what does a salutogenic framework look like?  Mindfulness, resilience, focus on daily health-promoting activities that increase our ability to get healthier, rather than fend off illness.  Of course, a fee-for-service model doesn’t bode well with this concept, so unless you’re enrolled in a highly visionary health promotion healthcare system, you’re probably on your own – for now.  

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.

There are some obvious benefits to these advances in Health IT, but one of the things that may not be fully clear yet is the application of Watson to understanding more about human behavior. While Watson can absolutely tell a clinician the likelihood of a set of symptoms’ association with a given disease, I’ll bet Watson can’t tell you how the patients’ family impacts their overall wellbeing through behavior reinforcement. If Watson knew who the patients’ workout buddy was, Watson might be able to help identify with a high confidence whether that workout buddy was a statistically-sound partner in the overall health management of the patient. Further, Watson would be able to weigh in on the evaluation of treatment adherence based on real-time data pouring into the health record for the given individual.  This is the game state evaluation of the health of the individual in a real and meaningful way.  With this, a total and complete understanding of the long-term treatment of chronic conditions (and even more important to the salutogenic framework that I’ve discussed previously in this blog series, total health production) through the understanding of actual human behavior devoid of the clinical separation from reality is the “social human” version of epigenetics that will become more useful in the coming years.  This is where the data comes to life.

#HITsm T2: How do we achieve #patientengagement over time considering that a one-off solution can’t fix #health?

Gamification

A recent post mentioned that Gamification is failing due to a lack of accurately applying the concepts of gamification; in short, supplanting “badges” for increasing levels of difficulty appropriately. If Gamification is going to solve the #engagement problem, why can’t we quite figure this out? Gamification in health, generally, see here.

Whether we admit it or not, it is the promise of the potential emotional pay-off that lures us into working ridiculous hours already. But unlike gaming environments where we are totally immersed, our modern work environments seem contorted — almost criminally — to keep us from feeling blissfully productive. And once we give up hope that epic wins are possible, our careers turn into drudgery.

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.

 #HITsm T3: What game mechanics in #HealthIT are currently being used appropriately? Which are not?

Integration with the larger #healthIT world

Specifically looking at the #payer and #provider perspective, how can we ensure that the same #psych principles are being used to ensure adoption of #HealthIT throughout the Healthcare continuum? When we consider #wearables and #IoT, what do we focus on in terms of integration versus simple cataloging?

#HITsm T4: What should be made usable by #enterprise #healthIT to ensure the #Human element does not get lost?

Free-for-all on Design

#HITsm T5: What design considerations have you seen that work well in #HealthIT / #mHealth?

In review:

#HITsm T1: Knowing that #health is dependent on daily life, how do we design #HealthIT in consideration of the larger, social world?

#HITsm T2: How do we achieve #patientengagement over time considering that a one-off solution can’t fix #health?

#HITsm T3: What game mechanics in #HealthIT are currently being used appropriately? Which are not?

#HITsm T4: What should be made usable by #enterprise #healthIT to ensure the #Human element does not get lost?

#HITsm T5: What design considerations have you seen that work well in #HealthIT / #mHealth?

To our health,

Ryan Lucas
Manager, Engagement & Development

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Health inSite: #4PHealth

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Each week I take an hour to join with a few colleagues and thought-leaders around the world on twitter to discuss all kinds of interesting topics related to where healthcare is going, what to expect in the intersection between Health and Technology, and how we might play a role in that changing landscape. These TweetChats are an opportunity to learn, share, and ultimately understand how social media, technology, and the role of various players in the healthcare world might better work together. Often, we turn to the topic of patient engagement. This is focused on what tools, technology, and other needs might help to get patients more involved in their own health. This can come in the form of tracking various metrics (see the Quantified Self movement) to making sure that individuals on medication are staying on top of that treatment to ensure their continued health improvement. While in our last TweetChat, which emphasized Patient Engagement and Experience specifically, we discussed that it was important for us to focus on what the patient could do, yes, but also what the provider and the payer could do. This is a common picture of the players in the healthcare world. Someone needs the service (patient), someone provides the service (provider), and someone pays for the service (payer). It looks sort of like this:

#P3Health

But that’s not really the whole picture, now is it? The truth is that this is the model of a sick-care system. As I’ve mentioned in blog postings beforehand, in order to keep people as healthy as possible before they need to access the healthcare system, the system must account for one more “P” in this proverbial puzzle (or pie, if you’d like!); one’s Peers:

#P4Health

It’s the convergence of all four P’s (Provider, Payer, Patient, and that Patient’s Peers) that will allow for greater healthcare reach. When the Payer and the Provider are able to engage the Patient’s Peers, then true health generation is possible and the benefits of one’s social network can then be fully leveraged.

With that, I submit a new hashtag for the consideration of a community that continually strives to make the very complicated healthcare system a little simpler as we move towards greater total health and wellbeing of the individuals that have to access this system. #4PHealth represents the four core stakeholders in healthcare that ultimately are responsible for the health of the patient and responsible for keeping that patient out of the hospital, involved and engaged in their total health and wellbeing, and always striving to improve one’s total health picture. When the Patient, Provider, Payer, and Peers come together, total wellbeing is possible.

This doesn’t have to be limited to the TwitterSphere, though. Take a moment and think about the real-world applications of this for you in your life. What can you be doing to help those in your peer group become healthier? What opportunities are there for you to help generate greater health for yourself and for your friends, family, and coworkers? What can you ask of your peers to help you with to create better health for yourself? The 4P model may not be the easiest thing for us to accomplish in our current healthcare system given the disjointed nature of care models, but you still have the ability to start working on the fourth “P” today. What will your first step be?

To our health,

Ryan Lucas
Supervisor, Marketing
(illustrations assembled myself!)

Health inSite: Decision Support, Games, and making people healthier

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I’m a bit of a trivia nerd. In fact, I play trivia with a group of friends every week. We do alright, and obviously there are good weeks (I mean, we keep going back) and then there are bad weeks. I play team captain for our group. The responsibilities of team captain are to record our progress (each question gets a wager based on our confidence in our answer) and recording the success or failure of each question in a running total, and helping to marshal the resources of the team (points, knowledge bases of the players, ranking answer likelihood, etc.). The final trivia question of the night is a challenge. Each team is given the question that requires four answers in rank order, usually. When turning in one’s response, a point value between 1 and 15 is assigned to the answer. If any part of the question is wrong, the wager is subtracted from the team’s total score. If the answer is 100% correct, the team gains the wagered points. So it’s no surprise that I would be really intrigued by Watson, a supercomputer that was able to best two of Jeopardy’s greatest champions in a tournament back in 2011. Research into Watson is really interesting.

Confidence

Watson was trained to respond only when a certain threshold had been met in the likelihood that Watson was correct in its assumptions. This confidence was determined based on cross-referencing the available answers and identifying the highest scored answer based on a number of algorithms. While Watson is not right 100% of the time, its significant domination of the final score ($77,147 vs. 2nd place’s $24,000) is no small feat for a computer responding to natural language, searching natural language information, and culling a response to an “open-domain” question.

Game State Evaluation

Part of the programming behind Watson required not just an understanding of the likelihood that Watson was right, but also what the potential for gain or loss in relation to the other players might be. Because Jeopardy includes wagering for daily doubles and Final Jeopardy, Watson had to strategically wager in relation to the likelihood not only that it was right, but also what it would mean if the other players were right or wrong. This is well-illustrated by the final wager that Watson placed in response to the final jeopardy question, which was $17,973. This is a statistically-determined wager based on total game state evaluation at the time of this final question using the above variables.

Thinking

While there is plenty of room for argument as to whether or not Watson is thinking, there is absolutely no question as to whether Watson is logical. As I’ve mentioned before in a couple of articles related to the work of Daniel Kahneman, (if you haven’t, make sure to check out Thinking Fast and Slow) human rationality is very rarely very rational. This is due to a number of intervening variables that interrupt our ability to make rational decisions all of the time. These “biases” can be intentionally or unintentionally applied during the decision-making process. While Watson has a number of heuristics, no-doubt, built into its logical processing, it is probably not as likely to respond to cognitive biases such as anchoring, duration neglect, and certainly curse-of-knowledge as seen in its commanding performance in the Jeopardy games.

Decision Support Systems

Watson is now being used in a number of healthcare applications assisting in the support of clinicians as diagnostic support. Watson is not making decisions, but it is able to cull the plethora of information available in the medical field to provide confidence-rated responses to data that is provided regarding a patient. This marks a big step for the advancement of Health IT as we can standardize clinical response to symptoms, and stabilize health information as it is consolidated into big data stores. And because Watson is able to learn as it answers and receives feedback as to success and failure based on those responses, Watson can only get better at diagnostic prediction and likelihood of treatment success or adherence based on the results of those treatments.

What does this mean for making people healthier?

There are some obvious benefits to these advances in Health IT, but one of the things that may not be fully clear yet is the application of Watson to understanding more about human behavior. While Watson can absolutely tell a clinician the likelihood of a set of symptoms’ association with a given disease, I’ll bet Watson can’t tell you how the patients’ family impacts their overall wellbeing through behavior reinforcement. If Watson knew who the patients’ workout buddy was, Watson might be able to help identify with a high confidence whether that workout buddy was a statistically-sound partner in the overall health management of the patient. Further, Watson would be able to weigh in on the evaluation of treatment adherence based on real-time data pouring into the health record for the given individual.  This is the game state evaluation of the health of the individual in a real and meaningful way.  With this, a total and complete understanding of the long-term treatment of chronic conditions (and even more important to the salutogenic framework that I’ve discussed previously in this blog series, total health production) through the understanding of actual human behavior devoid of the clinical separation from reality is the “social human” version of epigenetics that will become more useful in the coming years.  This is where the data comes to life.

To our health,
Ryan Lucas
Supervisor, Marketing
To stay ahead on topics related to this, follow me on Twitter @dz45tr

Health inSite: Placebo, by any other name, is just as effective?

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The Placebo App

A review of a year and a half of Health inSite research and how I think one group is probably more on target than some might think.

I’m going to start out by laying out a couple of concepts for review.

Placebos and psychology

A placebo is defined as “a simulated or otherwise medically ineffectual treatment for a disease or other medical condition intended to deceive the recipient.”  This causes what is called the placebo effect.  A patient is said to have experienced a placebo effect when the intended deception manifests experienced results.  While the research indicates that there is a small range of people that are susceptible to the effect, that range hovers at around 30% of the population.

Rationality

One might ask, “How is it possible that the effects of a non-drug could be experienced as having the results of an actual drug that has the intended, or actual, impact on a patient?”  This is explained as the product of self-fulfilling prophesy, or a form of expectation bias.  If you recall the previous posting on Thinking Fast and Slow, one of the difficulties we face as human beings is both our difficulty in matching up experience and memory, as well as overcoming biases that tint our understanding of rational data.  In a word, we are not always rational beings and sometimes our understanding of an experience or idea is subject to our memory and cognitive constructs that allow us to think fast.  We respond the way that our mind has told our body it expected to experience the event.  The concept, “Where your mind goes, the energy goes,” has been mentioned extensively by my colleague Dr. Mines in his series on Psychology of Performance, beginning with his first posting.

Hysteria (or mass psychogenic illness)

If you happened to miss the events in Le Roy, NY, where 18 people experienced Tourette’s-like symptoms for an extended period of time, there were many that identified the cause of the experience of these individuals as mass psychogenic illness.  Mass psychogenic illness has been largely attributed to situations in which individuals are experiencing similar physical effects (tics, for example) without any clear physical reasons (e.g., environmental toxins, viral or biological triggers, etc.).  Historically, this has been referred to as mass hysteria.  The complexity of the condition has led many to write it off, but the core assumptions of mass psychogenic illness are sound given what we know about social influence.  Oftentimes in mass psychogenic illness, an index case is discovered in which someone’s conversion disorder acts as a catalyst to the development and spread of the illness through the network.

Assuming that this is the way in which mass psychogenic illness works, index cases could be used to induce behavior change in a network towards a positive outcome. In this way, it is not mass psychogenic illness, but mass psychogenic salutogenesis (widespread generation of health through the influence of the mind over the body within the social structure of a network).

CBT and treatment adherence

Critical to adherence to any health maintenance or treatment protocol plan is the ritualizing of new behavior.  In the chemical dependency field, we’ve known this for a long time.  By creating new routines that positively impact our behavior; we are able to more easily overcome the many triggers that previously caused our substance use.

Triggers are defined in the substance abuse field as events, emotions, or thoughts that trigger the addiction response.  They are a major focus in many treatment protocols and are especially important for recognition in the cognitive behavioral therapy (CBT) model.  The goal in CBT is to identify why it is that we respond to thoughts, emotions, and events and then to develop, for ourselves with the help of a therapist, ways to counter the effect of those triggers.  In this way, it’s not the abolition or avoidance of triggers so much as a rational understanding of the trigger and building tools to overcome that trigger’s effect on the coached patient/client.

Network theory, social comparison, and braggadocian behavior

If you’ve read all of the links to other blog postings in the Health inSite category, but missed the posting on braggadocian behavior, the concept is very simply that social media has enabled us to engage in bragging around the things that we are doing and that this activity can influence the way that others perceive us – and we do this to intentionally accomplish that change in perception.  This gives us the ability to influence the way that others behave as they engage in responses which may include trying to match our behavior (wittingly or unwittingly)  or rejection of our behavior as a method of coping with one’s own deficiency in the category of behavior being expressed.  This has a powerful impact on the social network in which agents operate as they can directly and indirectly influence the behaviors of individuals that are proximally or distally connected to them.

In their book ConnectedChristakis and Fowler explore the significant effects that our social network has on our health and health behaviors.  Social networks, of course, are not just websites like Facebook or Twitter, but all forms of interaction that we have with various people in our lives, including our family, friends, co-workers, neighbors, and even the people at the grocery store.  The power of individuals to have an effect across a network based on their location within the network is a clear and well-documented reality.

Suspension of disbelief

As I mentioned in an earlier blog posting on the fourth and fifth wall, suspension of disbelief is critical to the effectiveness of theater.  Without the audience allowing suspension of disbelief, a presentation falls flat in its ability to engage the audience emotionally.  Think back to a PowerPoint presentation that was particularly awful because the speaker failed to actively paint a picture that the audience could connect with.  Similarly, engagement strategies are starting to use these concepts to create thick tapestries of story that immerse the audience in the story-line, and even sometimes ask them to co-create the story, as in the case of the Lizzie Bennet Diaries spin-off series, Welcome to Sanditon.

New technology

Recently, an IndieGoGo campaign was started for a new project that would create a placebo app.  You might think to yourself, “How the heck could a placebo app affect someone’s health?”  The app, which leverages the power of mirror neuron activity and the placebo effect by creating positive thought-feelings in the brain, could actually override the systems in the brain that cause us to act irrationally in terms of triggers and cognitive biases by leveraging suspension of disbelief.  Further, the app allows individuals to interact with their social network around their use of the placebo app, creating a unique opportunity for mass psychogenic salutogenesis.  Now all we need are some index cases to start the process toward a tipping point.

It will be interesting to see the resulting data from this project as we would expect that there is a real opportunity for this to be leveraged to significant effect, not only for those directly accessing the placebo app, but also those that end up interacting with those users.  But the rest of the story is still to come.

Whew, that was quite a round-up of research, huh?  Comment or send questions!

For more…

…check out a G+ Hangout from HuffPost on placebos and their effect.

Ryan Lucas
Supervisor, Marketing
To stay ahead on topics related to this, follow me on Twitter @dz45tr

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

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