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Saturday, May 21, 2011

CoHealth Recap - Designing Incentives for Health and Engagement

A Recap of the CoHealth Tweetchat (#co_health) from May 18, 2011
We were joined this month by Paul Hebert (aka @incentintel). Paul is the managing director and lead consultant for I2I. he’s been interviewed by the BBC, quoted in USA today, and writes for various blogs and HR publications. he’s also a member of the cohealth community, chiming in with wisdom on incentive design from time to time.   As it turns out, there is no shortage of opinions in the CoHealth community about incentives and rewards programs in wellness ... which kept Mr. Hebert very much on his toes!!  This turned out to be one of our most engaged chats ever - and we're grateful to Paul for guiding us through the tricky business of wellness incentives.  

We started the chat (with Fran - @femelmed - driving the @co_health account) asking the group their favorite thing about spring ... turns out that there are a lot of baseball fans in the wellness business.  Who knew?

Q1: @incentintel, give us a sense of you. What’s your general incentive philosophy?

Quoting Paul directly, "incentives should be used sparingly and with great care.  They don't "make" folks do anything - simply give them choices. Incentives are blunt instruments - be careful... incentives in wellness are tough - we want quick results for breaking long-term habits - not always possible"

Our friend Janet McNichol (@jmcnichol) also chimed in: "I have a @incentintel quote on my wall, "a good incentive program involves many behaviors rewarded quickly in small amounts over time accompanied by genuine recognition & demonstrable progress toward the goal."

With that as a "warm-up", we dove right in to the meat with Q2: Knowing that, what’s critical to make an incentive actually do what you intend it to do?

There was a general sense that "rewards" and "recognition" serve very distinct purposes, and we began to explore that theme.  Our group agreed by-and-large that incentives work first (and perhaps best) as attention grabbers:


"incentives should peak interest - get ppl to listen and pay attention - then you drive the changes in behavior thru education"
- Allison Kohler (@amkohler)

"incentives break inertia (because they are so strong) recognition maintains it (because it's more subtle)"
- Paul Hebert (@incentinel)

We also started to broach the subject of control and empowerment, with both Paul and Carrie from Ergotron (@giveafig) recognizing that 1) it's best to focus incentives on things your subjects can control; and that b) a sense of control over one's own space and time can actually be an incentive in and of itself.

We then decided to get a little bit more specific, and look at Q3: Lots of companies and partners are using financial incentives to get people participating. What are the risks?

Bob Merberg (@WellWork) shared a nice resource article from an unusual source (for this group, anyway!): Money over Matter: Can Cash Incentives Keep People Healthy?: Scientific American http://ow.ly/4Xu29

Paul introduced an interesting concept here ... the danger of using cash as an incentive creates a relationship that becomes transactional (in an escalating fashion over time).  This can be powerful, as people "do the math" and think about "is this worth it to me?"  But that kind of transactional relationship almost never touches the more significant and lasting psychological triggers associated with behavior change.  

@DialDoctors characterized the role of cash incentives as a "front end" of behavior change as follows: "Incentives should act like the 1st 5 lbs you lose. They keep you pumped to maintain a healthier lifestyle."

And Paul, in making the point about the kind of incentives people really respond to, introduced an analogy that resonated with a lot of people (including me): "think of asking you buddy to help move you - offer them 6-pack vs. offering them $12 - one would insult them right?"  That's a subtle difference, and also brings into question the nature of the relationship between the rewarder and the rewardee: Is it paternal or fraternal?  The indication seems to be that a fraternal (perhaps more accurately, collegial) will be more effective in terms of actually producing desired behaviors.

Paul also introduced another important concept: that of timeliness of rewards ... noting that we tend to discount rewards that are further out in time. Today's reward now has much more value than a (less tangible) reward later - e.g., a burger today -> health tomorrow.

Q4: So, getting a sense that money isn't great for all. Where does it work and where should we use non-financial incentives?

Ray Goldberg (@raygoldberg) framed the question as one of gratification - and the power and challenge of delaying gratification.  And it prompted one of our really interesting side conversations, concerning individuals' motivation for change.  It started with a quote from Janet (@jmcnichol), 
"Nothing tastes as good as skinny feels. -- A fav delayed gratification quote."  A lot of folks chimed in that this was a favorite quote from them, but there was another (smaller, but noticeable) group that felt turned off.  [Personally, I think a cheeseburger tastes awesome, and can't even remember what it feels like to be "skinny" ;-)]

Another idea that divided the group was about competitions (a la Biggest Loser).  They are certainly popular in corporate wellness programs today, and some of our members swear by them (@dialdoctors is training every day after work and maintains a "challenge board" in the office).  But I always found them a little uninteresting ... especially since (in my experience) when they get big enough, people always cheat.  Paul (@incentinel) also noted that competitions have a dangerous side effect: They have losers.  And we don't want to create losers.

We closed out by getting to the heart of the matter. Q5: What would you advise companies considering their incentive design? About outcomes and design?

An important debate sprang up about reward and incentive programs being based on behaviors vs outcomes.  In the short term, focusing on outcomes seem both better and easier for the company ... if a company is trying to contain costs, for example, they might want to reward people who have a BMI in the "normal" range ... or for dropping X number of pounds.  This has the added benefit of reinforcing norms as "goals."  HOWEVER, this approach is fraught with difficulty, and many felt that outcomes-based incentive programs are eventually doomed to fail.  

Behaviors are much better as a basis for incentive programs for several reasons:
- You can reward in a more timely basis, associated with seeing and reinforcing new, healthier behaviors
- The reality is that there is no "norm" and health looks different on different people.  Focusing on outcomes is going to alienate or render ineligible a significant portion of your population.

Timeboxing incentive programs is also a fairly well-established best practice ... in other words, don't plan on having incentive programs that are open-ended and just go on forever; programs need to be evaluated for success and refreshed regularly.  This is a lot easier when you know up front that you're operating a 90-day program, for example.

Another important element of incentive design is that it can't stand alone ... it has to be associated with recognition and support programs, training, and some level of company support.  [Re: support, some in our group felt that having senior staff "bought in" and demonstrating wellness behaviors was critical, while others felt that it was a "nice to have."  What we all agreed on is that that company at the very least needs to not put up obstacles to healthy behavior in the workplace.]

There were a TON of questions posed on that chat that the group (and especially Paul, in spite of Herculean efforts) wasn't able to get to, so look for follow-up next week on Fran's blog (http://www.freerangecomm.com/).

WRAP
While @incentintel massaged his weary typing-fingers, Fran wrapped us up, and reminded us about the next chat.  As always, it'll be on the 3rd Wednesday of the month at noon EDT ... and in June that happens to be June 15.  And we are incredibly excited to be featuring the program that IDEO is running with chef-turned-health-activist @jamieoliver, "Cooking & Company."  Not to be missed!

Thanks again to Paul Hebert (@incentintel) and to all of our participants for a lively, envelope-pushing discussion ... and I'm sure it won't be long before incentives make another appearance on the show.  If you have ideas for an upcoming show, just let Fran (@femelmed; fran@contextcommunication) or I know ... we'd love to hear from you.

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