Why Employees Need a Digital Nudge: an interview with Hal Rosenbluth and Dr. Michael Musci

As a business leader, I have always known that people are a company’s most precious asset. Ensuring the happiness, health and well-being of employees is key to maintaining a great culture. Overeating, stress and sitting (aka the new smoking) are just some of the unhealthy behaviors that contribute to chronic disease and cost corporations billions of dollars in healthcare expenses and lost productivity. What’s worse is the effect these unhealthy behaviors have on employees and their families. Poor health can result in a loss of income, loss of enjoyment and premature death.

In an attempt to stop these losses, corporate health and wellness programs have grown to nearly an 8-billion-dollar industry. Unfortunately, a wellness program can mean anything from onsite biometric screenings to gym reimbursement. Corporate wellness programs often fail to address chronic conditions and they fail to serve the individuals who need them the most.

When it comes to wellness, one size does not fit all. When I launched New Ocean Health, I knew that our solution had to be personalized and make an impact on the ultimate common pathway to health and well-being, human behavior. I wanted to know how we can incentivize people to make every day healthy choices? What makes people choose the apple over the donut?

New Ocean’s Chief Medical Officer, Michael Musci says “Sometimes a nudge is all we need….” So, we created a digital nudge that would help people better manage their health. The concept of nudging is just one of the behavioral economics principles we believe can have a positive effect on health outcomes.

I recently spoke with Michael Musci about the ways New Ocean uses behavior science:

HR What do you think the first barrier to people engaging in wellness programs is?

MM: The first barrier is often the first step, the health assessment. We’ve created a completely redesigned health assessment, one that’s shorter and more engaging. Our assessment offers motivating feedback throughout and quite frankly, doesn’t judge people on the status of their health. Early results with some clients show that 84% of registrants complete our health assessment—the overwhelming majority in one sitting. This exceeds historically reported results from most traditional assessments. We learned that our ability to engage the user, that is to nudge the user to take the assessment in the first place and nudge them to keep going, has a direct effect on completion rates.

HR So many wellness programs and especially wearable devices have short term engagement. How does adding behavioral economics drive sustainable change?

MM: Change requires willingness. We used the 5 stages of the Transtheoretical Model of Change (TTM) to determine readiness to change. According to this model, the stages of change are:

1. Pre-contemplation – This is the stage before you know you have a problem. You might think about getting more exercise, but at this stage you’re thinking more about what a pain it would be to join a gym, not how good it would feel to be able to walk up the stairs easier.

2. Contemplation – This is the stage where you know you want to make a change, you plan on making a change, but you’re still not sure about it.

3. Preparation (Determination) – At this stage, you’re ready to move on something. You’re going to join a gym this month.

4. Action – At this stage you’ve taken action, you’ve joined the gym and plan to keep going to the gym twice a week.

5. Maintenance – In this stage, you’ve kept to your change for six months or more. People in this stage work to prevent relapse to earlier stages.

6. Termination – At this stage, you feel like you’ve made a permanent change. You have no desire to go back to the old ways. Since this stage is rarely reached, and people tend to stay in the maintenance stage, this stage is often not considered in health promotion programs.

Recognizing those stages allowed us to apply a few basic principles throughout our lifestyle and chronic condition programs to motivate engagement and help people reach their goals. Here are a few of the principles we’ve applied:

• Tracking: This is the idea that small, incremental, repeated behaviors create sustainable change. Programs and challenges encourage users to
repeat positive behaviors.
• Concrete Goals: Allow people to avoid cognitive dissonance and choose concrete goals such as an amount of time to exercise per day and
commit to them maximizes chance of success.
• Power of Peer Pressure: Turning the process into a game with leaderboards and social components really helps people stick with their goals.
• Reinforcement Scheduling: Early and easy wins establish trust and build confidence. These rewards can be as simple as getting a badge for
completing a week-long activity, or more complex, such as receiving money for completing an assessment.

HR How long does it take for a health program to have an impact?

MM: Every one’s journey is different. It’s the reason why wellness solutions must be personalized to fit the unique needs of each individual. Another essential component of our program is a Forgiveness principle. We allow a user a 3-day grace period to track goals. This adds flexibility and can make the difference in helping someone overcome a feeling of defeat.

HR What are some mistakes you see other programs making?

MM: Being judgmental, or shaming a user about lack of progress, will never increase success. At the end of the day, everyone wants to be healthier. No one sits around wishing they had more trouble breathing, or more aches and pains. So, encouragement, not shame, is the key to helping people reach their goals.