Popular Adherence: Long Haul Stickiness

Ok, so I've really been thinking alot about Adherence, which is case you aren't familiar, is really just a name for a combination of Compliance and Persistence. Adherence is a common word when we talk about medications, but what I thinbk alot of people don't consider is that Adherence is a process that is applicable to just about everything in our lives. And I don't mean obvious things like "adhering to a diet". I mean: teenage use of texting could be described in Adherence language. A drug addicts' use of drugs could be desrcibed as Adherence, taking the car for maintenance, getting your nails done. These all consist of protocols that are easily followed or not, and the length of time for which they are followed can be considered in terms of persistence. How about Religion? your job? same basic formula. There is a protocol that describes the methods that needs to be followed to maintain the prescription, and there is a length of time over which the protocol is followed. For almost every activity, adherence will wax and wane. This is true for drug addicts, teenage texters, religious folk, and everyone else. Which is interesting because when we talk about adherence, the conversation is almost always dominated by "negative adjustments" that must be adhered to. fine, we understand. people who don;t like to exercise, or who need to eat less junk food, need to make what they perceive as "negattive adjustments" to their lives. or in otherwords, they level of pleasurable activity they are accustomed to is being curtailed, and the perception of this requirement is "negative but necessary". But, lets now consider activities which are inherently pleasurable, and should not need to be curtailed(due to adverse effects) but demonstrate waxing and waning adherence. I just discovered Mafia Wars on Face Book. It failed to engage me, but it has succeeded with 5 million other people. These folks comply with the protocol: they press the buttons, do the jobs, make the money, etc. click, click, click. that site is stiiiiiiicky. And they persist. everyday, lots of times everyday....make the money, do the job, click, click. I could get into what motivates people to Adhere to this game, but that is a whole post on its own(extremely relevant and essential, but needs to wait). so now we have 5m people clicking away daily. all pleasure. they are not gaining weight, cholesterol is not going up, etc. but........after awhile.......game players stop playing. if this were not true, everyone today would still be obsessed with Pac Man. so what happens? why stop adhering to such an awesome protocol? boredom, popularity shift, competing games, who knows. What is important is tha even the most purely pleasurable activities see Adherence wax and wane. So, why should we be so shocked when negatively perceived activities have fluctuating adherence. Well you say, "health should always be the priority. for some its a matter of life and death. how can you not adhere to a protocol that will save your life?" I would wager that if you told a kid that me must follow a protocol daily that resulted in a daily ice cream cone, you would see adherence wane over time. How can this be? Well we need to know exactly why this is, in order to understand why Uncle Fred stopped taking his cholesterol meds(all things being equal such as ability to pay, negative sides, etc). Where we end up: Adherence Profiles. these can be constructed by gathering data that describes a patients lifelong performance in regards to a miriad of activities: from brushing teeth, to watching football, to mowing the lawn, religion, etc. The point is: we must accept that there are unique profiles that describe a persons track record to adhering to anything. Through the definition and analysis of this profile, we can then construct an Adherence program that will best suite the patient. In many ways, the programs can be exactly the same, BUT, we apply an "Engagement Skin", which is an overlay on top of a common infrastructure, designed to get all sort of people engaged in performing what is essentially exactly the same activity.(Ilearned this trick from the MafiaWars/Sorority Life folks). Stay stuned for more on Life Adherence Profiles

Immersion: What we know about Casinos and Hypnotists

I think the formulas exist already, no need to reinvent them. We will use Contextual Innovation to derive our Immersion formulas. I present two examples: Casinos and Hypnosis.
Casinos are all about immersion, further, they are also very much interested in “Sticky Immersion”. So lets show a couple of casino formulas:

Casino Immersion = Multi-sensory environment + elimination of “outside world” reminders + attentive needs fulfillment + “make me feel important”

Casino Sticky Immersion = Casino Immersion + Effective ability to meet expectations + Surpassment of expectations in an impactful way + delivery of services better than the next-best provider

Hypnosis is a blunt form of demonstrating Federated Reality(your awareness/mind are detached, but still in partnership with your body). Hypnosis may have its own goals, but the first objective is to shift patient awareness away from physical stimulation.

Hypnotic Immersion = patient willingness + effective tool(i.e. therapist)

VR must deliver the best of a Casino, and the willingness of a Hypnosis patient

VR Immersion = Union of(Casino Immersion + Hypnotic Immersion)
VR Sticky Immersion = Union of(Casino Sticky Immersion + Hypnotic Immersion)

Innovation in Education? Contradictory Terms?

In reading a post just now regarding the lackof innovation in education, there were a couple of examples provided, and this sparked a couple of my own observations from first hand experiences:
From the Article:
1. Great innovation coming out of universities is accomplished despite the university(Shawn Fanning/Napster is the example)
- I think this is a fair point, and we quite often see precisely the same thing happening in major corporations. A corporate employee who has a fantastic idea, will quite often leave the company to pursue the idea. Maybe this is for IP reasons, but it is also due to the lack of support within the organization for innovation. In many large companies, certain people on certain teams are the "designated innovators". If you are not part of that club, you are on your own.
2. Educators are focused on content, not mediums & methods
- I see this in universities as well as corporations. In each scenario, curriculum designers(sometimes overseen by compliance/audit) need to ensure that specific information is relayed to the student. Especially in corporations, the burden is to to ensure that you can document the fact that the student saw the content, and passed a quiz on the content. Sometimes as much as 80% of the educational effort is in tracking course completion, rather than ensuring the learner comprehended and can therefore deploy the knowledge
From my own Experience:
1. Education-lifers(those that studied to become teachers, and are currently teachers), tend to have a very different take on teaching methods then those current teachers who may have spent a career in Business, and then decided to become a professor.
- I will admit that almost all of my contact with educators is either at Universities or Corporations. I can generally tell almost immediately if an instructor was educated to teach, or whether the educator is teaching based on life/work experience. In my opinion, educators with a history of work experience inherently ensure that the information they are communicating is done so in such a way the learners are involved in understanding the implications for "knowledge execution". If you have lived/breathed knowledge-execution for 2 decades, you will almost certainly focus your teaching style on the end-objectives of having/using this knowledge. And in many cases, these educators will seek the best methods possible for communicating information. (don't get me started on the Pedagogy/Andragogy debate)
2. Quite often, education does not employ the same tools as business
- In my consulting practice it is not unusual to see a corporation using one set of tools to train employees, then see another set of tools given to the employees to do their job. We would not train car mechanics this way, why do we train corporate professionals this way?
3. Very often, educational software providers do not focus on what their customers(and the customers students) are asking for.
- This is my favorite so I saved it for last. I am presenting at an upcoming educational conference and the gist of what I am going to say is: we must educate the workforce of tomorrow(and today), using the tools that they will be using on the job. Now, depending on the industry, these tools will certainly be more innovative then asynchronous text messaging and powerpoint in a browser. I work with curriculum designers at Universities and corporations helping them understand what tools are available - and not just what their approved vendor has told them their product can do. There is a massive difference. I also have spoken to major LMS providers(for Universities and Corporate), and these folks have told me(and they believe what they say) that their customers only want what the vendor is currently providing. Hmmm, maybe the vendor only talks to procurement or IT? Because I get a very, very different message when I talk to professors and students. To the LMS vendor, the "customer" is the Payer. Who writes the checks? An LMS vendor must ensure that the check-writer is happy. And we should not assume that the check-writer is constantly communicating with the professor, or that the professor is always taking the pulse of student likes/dislikes. I suppose we could also argue that people won't want what they don't know exists. This however does not equal contentment. Students and Professors know what they like/dislike, regardless of whether they know about choices. Awareness of alternatives will however change how people respond to what they like/dislike(hope for improvement may spark action).

Big Pharma must go Deep, and Maybe not so wide

Pharma has changed considerably in the last decade. The days of Star-drugs mass marketed with an eye on volume seem to have come and gone. The holy grail now are super-premium drugs that treat special-case illnesses. They are expensive for sure, but if they work, they will be purchased. Pharma has always cared about patient outcomes, but now they must care even more. Adherence is the new mantra. Adherence to a drug that is effective has no choice but to boost Outcomes. A drug with the highest ranking Outcomes, will be the winner. So, if Adherence = Compliance + Persistence, investment must be in not only Promotion, but Compliance as well..

VR has its place, and its place is not Everywhere

I was just checking out the following Survey conducted by Forbes Magazine. How frustrating.


http://www.linkedin.com/news?viewArticle=&articleID=65560894&gid=1391417&srchCat=WOTC&articleURL=http%3A%2F%2Fwww%2E3dtlc%2Enet%2F2009%2F09%2Fforbes-survey-concludes-against-virtual-meetings%2Ehtml&urlhash=drEr

I really don't think that Forbes needed an elaborate study to demonstrate that executives prefer face-face meetings. I'm not sure that anyone with a solid understanding of business operations would even consider challeging this truism. I believe that Forbe's could have provided significantly more value to the tech industry by asking more informed questions, such as:1. when a face-face meeting is not possible due to time, money, etc. what do you feel would be the next best alternative?2. Of the face-face alternatives currently in your "Toolbox", which do prefer, and why> How could these tools be improved?3. We all understand that many people don't fully engage themselves on conference calls, webex's, etc. Assuming that face-face is not always viable, how could current state technologies be improved to increase participant engagement?
In my daily work, I have to handle "results" and objections that are consistent with the Forbes conclusion. I have been lecturing for the past year about a "Toolbox" approcah to business. In your Toolbox for example, would be: Telephone, Email, IM, Webex/Live Meeting, Video Conference, Virtual Reality, and Face-Face. Given all the variables in play when a task needs to be completed, the business user should select the most appropriate technology. "Appropriate" considers: time, money, priority, logistics, etc. We cannot/should not try to force a round peg into a square hole. Instead, we need users to understand the pros/cons of each tool in their Toolbox, and select the appropriate tool for the task. Its really a waste of everyone's time to talk about how "VR will replace Face-Face". The RIGHT word to use instead of replace, is "Augment". VR can Augment the business toolbox. A business user will likely select the tool that can best accomplish the task, assuming it is easy to use and stable. And just like we saw 10 years ago with the flight to the internet: the good ideas that have survived a decade are those that can accomplish a task better(faster, better, cheaper) than an exsiting tool, or can provide a service that is simply not possible in the real world. The same is tru of VR: it is a massive blunder to target uses of VR that are better accomplished using another means. The correct strategy is to focus on scenarios in which there is no "better alternative". leverage VR for its unique abilities: accomplish this task and you have become an essential tool, not just a nice to have tool

What is Virtual Reality?

•According to Winifred Gallagher, author of the recently published “Rapt”, we constantly make decisions determining what we are going to pay attention to. Any events, experiences, and activities not within the scope of our chosen interest will not exist to us as we immerse ourselves in our selected targets of concentration and focus. What we choose to concentrate on defines our state of consciousness and becomes our Reality.

• The fact that our mind and body may be “in two different places at the same time” is not a unique characteristic of Virtual Reality, and does not therefore create the need to refer to this immersive technology as “Virtual Reality”
–If we are deep within our own thoughts, and no longer mindful of our physical surroundings, are we in “virtual reality” ?
–If we are reading a news article on a website, and are so engrossed that we forget that we are late for a meeting, do we say that “virtual reality” interfered with “physical reality”?

•The power of “Virtual Reality” software is in its ability to emancipate the mind from the body, making physical “reality” a minor element of our Federated Reality.
–Federated Reality has two parts:
•Consciousness
•Physical Existence
–For our purposes, we will always need to address the requirements of Physical Existence and Consciousness. However, it is our objective to relegate Physical Existence to nothing more than a set of requirements for accessing a medium that will manipulate the Consciousness away from Physical Existence

•In other words, people have bodies: eyes, hands, etc. We must build software that provides convenient physical access. But after t hat, the vast majority of our attention will be turned to capturing the full attention of the user
–We use “federated” to mean that the two parts of Reality have a partnership, but are not so close as to be synonymous. They are individualy self-sustaining.

•At Étape Partners we believe that there is only one relevant reality, and it is defined as:
– A context of stimulation that acutely focuses awareness and defines our state of consciousness.

Data Visualization

How do we use immersive, multisensory technology to create interactive representations of information that go beyond adding another dimension to a well established format of information display?
I agree that immersive 3D helps with visualization, but I believe that we have not yet cracked the code on how best to use VR to provide the human brain with the most efficient exposure to data/problem solving.

and to continue my thought, I see VR misused in many different ways: creating a conference room in which you display a powerpoint presentation, creating a library filled with books, allowing web searches that float the pages returns in space, etc. there are many examples of how the multi-sensory dimensionality possibilities of VR are not used,in favor of simply extending a well establish model(eg, adding a 3rd dimension to a chart).much of what we have established in 2D modeling was done so because there were no other variables to leverage(not including time).What I am puzzled by is what I refer to as the “can’t find my shoes dilemma”. When I am at home, and I cannot find my shoes, I do not visualize a spreadsheet with a line item for all the possible locations of my shoes. What I do, is visualize my entire house, with subconcsious prioritization of the the most likely locations. and look at that – my shoes are sitting right by the door where I left them. in this case, adding a 3rd dimension to a spreadsheet will not help me much. BUT, providing a 3D representation of the “universe” of possible outcomes, with some baked in prioritization, this is how my brain works, and this is possible in VR.

What makes a "game" a Game?

Yesterday I read an interesting conceptual description for an educational "game", however it seemed to be missing all of the gaming elements, and the reason why a game has been selected as the structure for the solution eluded me altogether. I believe however that the author had selected the game concept because they has heard about how gaming can be an effective communication tool for children. But, just because you want to solve your problem with a game, it doesn't mean that a game is the best solution to the problem. that lead me to consider, if we look at something that we will all agree is a game, what are the critical few identifying characteristics that make us all agree that yes, we are looking at a game? lets use Monopoly as a our case study. What can we say about it:
- it is perceived as fun
- it is often considered a source of entertainment
- at "play time" it gets presented as an option
- it involves a group of people
- there is an objective(*)
- there are rules(*)
- players are subject to risk that has consequences
- players are subject to chance encounters with rewards
- uncertainty creates excitement
- there is a winner and a loser
- players accumulate posessions(*)
- playes achieve public status(*)
- players receive micro-rewards(*)

there are probably more ways to describe the attributes of this game, but if we want to select just the essential "gaming elements", that could be universaly applied to any game, maybe they would be:
- there is an objective(*)
- there are rules(*)

and what has made this game successful?
- players accumulate posessions(*)
- playes achieve public status(*)
- players receive micro-rewards(*)

I know this is not exhaustive, but, I am after a rudimentary litmus test. Is it a game, or not?

Nato - Second Life?????

http://www.terraplexic.org/current-intelligence/2009/9/2/natos-second-life.html?lastPage=true#comment5315489

Making the Front door to Healthcare Bigger....

I just read a fantastic whitepaper produced by PwC on the measures being taken to, and the impact of, making healthcare more accessible. The basic gist of it is: the current state of healthcare in the US is not great, due to many variables including technology inefficiences, misuse of medical resources, and lack of patient accountability for their own medical well being. The nice thing about this wehitepaper is the density of statistics that have been provided. This is hard data that is "hard" to come by, but is certainly what everyone wants to see. the whitepaper describes a situation that will worsen with the advent of potential policy change that would open the door for Universal health coverage, BUT, also points to some meaningful statistics concerning patient willingness to try electronic forms of consultation, monitoring, and treatment. its an important whitepaper, I suggest you take a look.http://www.fiercehealthit.com/story/survey-consumers-psyched-about-telemedical-remote-monitoring/2009-07-27