Amy Bucher is Chief behavioral officer at the digital health company Lirio. She is the author of Engaged: Designing for Behavior Change, and has a Ph.D. in Psychology from University of Michigan.
Amy Bucher is Chief behavioral officer at the digital health company Lirio. She is the author of Engaged: Designing for Behavior Change, and has a Ph.D. in Psychology from University of Michigan.
Intro: [00:00:00] From Silicon Valley, the heart of startup land, it's Getting2Alpha, the show about creating innovative, compelling experiences that people love. And now, here's your host, game designer, entrepreneur, and startup coach, Amy Jo Kim.
Amy: Amy Boucher is on a mission to bring the psychology of motivational design to healthcare.
I recently talked with Amy about how she uses a mix of nudges. External rewards and motivational design to encourage healthy behavior. One of her key insights is that different types of rewards work in different situations.
Amy Bucher: I used to be a total naysayer on external rewards, but there's been some work that shows that if you structure a financial reward according to different milestones.
You can get more sustained behaviors. I might put a financial reward around something like going to your ophthalmologist once a year, but I would not want to do that [00:01:00] for something like checking your blood sugar, which needs to happen several times a day. That's where I'd really want to try to tap into that motivation or those bigger G goals.
Amy: Let's listen to Amy talk about how she's improving healthcare by tapping into people's core motivations. Be sure to stay to the end, to hear her insightful take on the role of crypto in healthcare.
Welcome, Amy to the Game Thinking Academy. Thanks for being here with us.
Amy Bucher: Oh, thank you so much for having me, Amy Jo. I've really been looking forward to this.
Amy: I have been following you for a long time. I love your book. We're gonna be talking about that. And your career is really fascinating. I think a lot of folks are waking up to digital therapeutics, behavioral health, this whole area.
But you've been really digging into this for a long time. So, now you are currently the Chief Behavioral Officer at Lirio, is that correct?
Amy Bucher: Yeah, that's [00:02:00] right. As of early last month.
Amy: Congratulations. Very exciting. We're going to be getting into your job in a moment and learning about what you mean by behavioral health, why you wrote a book, et cetera.
But first, give us the helicopter view of how you came to be doing what you're doing as chief behavioral officer, a title that probably didn't exist a few years ago. How did you get into design and tech? And then, like, what were some pivot points along the way that led you to being here?
Amy Bucher: I, I feel like a lot of my career was happy accidents in a way, because as you mentioned, you know, these job titles really didn't exist when I was starting out.
I finished my PhD in psychology in 2006 and I really, really loved what I had learned to do in grad school and wanted to apply it in a corporate setting. But I had no good sense of what types of organizations hired people like me, or what, what would a job title look like for somebody like me? And it took me a [00:03:00] few years, um, you know, I had a starter job right after grad school that wasn't the right fit.
But it was the job that got me into healthcare. It helped me to realize that there's a huge opportunity for behavioral scientists in healthcare, because so much of what people do around their health is behavioral. So, you know, if you think about somebody with diabetes, they, they have so many different behaviors they have to do in order to improve their outcomes and live a good quality of life.
And when I say happy accidents, I really stumbled into my next job a bit. I had been doing some competitive analyses, looking at what was out there in terms of patient support and patient programs, and I found this online, it was called digital health coaching program, um, that was built by a company called health media.
And it turned out health media was a spin out from the university of Michigan where I had gotten my PhD. It was two miles door to door from my house at the time, and they were hiring for a content developer and I've always been a good writer. So I thought, well, I'll give this a try and I applied for and [00:04:00] got the job, but I was very lucky because they had a behavioral science team who recognized me very quickly as one of theirs.
So I was given some of that scientific discipline back that I had thought I kind of had to leave behind if I was going into a corporate workforce. And at the same time, I was part of a product team. So that's really where I started to learn about digital about building product about working cross functionally with engineers and visual designers and other folks who, who bring a digital product to life.
And then the next happy accident that came from that job was we were acquired by Johnson & Johnson. So I was given access to this amazing global company that does business across the entire spectrum of health care. So it was like I went from this, um, you know, small job that maybe wasn't quite the job I wanted, but I thought would be interesting to try.
To this really fruitful career where I was exposed to, um, you know, I got to travel internationally. I got to work across like medical devices and diagnostics to pharmaceuticals to over the [00:05:00] counter therapeutics, and it really set me up nicely to be a product person with a behavioral science specialty or expertise.
And since then, I've had much more, I think, discipline to the jobs that I've chosen because I was able to establish myself in that space.
Amy: So now you're at Lirio, what pulled you to the company? What is it that is exciting to you about this role and what's in front of you?
Amy Bucher: Yeah, so Lirio, um, is a company, we have an artificial intelligence platform, but we use it to leverage behavioral science messaging.
So our AI agent is able to learn quickly about a person and determine what behavioral science techniques might be most effective to get them to take action on their health. And when I first heard about Lirio, what it sparked for me, first of all, I've been interested in AI for a long time, but, um, I've learned that a lot of companies will say they're doing AI, but it's, it's not really, or they're doing it in a very surficial way.
So as much as I was interested, I never [00:06:00] had a chance to really dig in deep and work with it. But then, um, you know, in my first phone calls with people at Lirio, it reminded me of those health media days. I picked up on the same kind of energy and collaboration and, swarming around a mission that made my time at health media so fulfilling, um, even through the J&J acquisition.
But, um, to me, it felt like an opportunity to kind of go back and capture some of what was wonderful about that point in my career from a more senior position. And, uh, you know, I, I also just really believe in the technology and what we're doing. So I feel good about the mission. I feel good about the technology and it, It recaptures that, that energy for me that I really thrived on.
Amy: Wow. So let's define a few terms. What do you mean by behavioral design?
Amy Bucher: Yeah. So behavioral design, I, when I've presented on behavioral design and I've done many times like kind of a one on one on one of behavioral design, I sometimes use this stock photo that's like a pair of colored sunglasses coming down over the image.[00:07:00]
Because I think behavioral designers do a lot of the same activities that other designers do, but they do them through the lens of behavior science, frameworks, theories, approaches. So, for example, um, I myself, like, if I, if I were to produce a design deliverable, it would probably be written. Um, whether that's in terms of content for a product or requirements, because that's my skill set, but I've worked with behavioral designers who are visual artists, you know, who can create the actual wireframe and then the interaction design for an app that's designed to change behavior.
What we have in common is that as we approach the research and the development of these things, we're, we're pointing back to specific theories or frameworks about how human behavior is influenced and determined. Um, I do a lot of work on the research side and I frame that research consistently around, um, one, one framework I use a lot is called combi and I do talk about it in my book quite a bit, but it's really about identifying the behaviors that we want people to do.
And then starting to identify the barriers that stop people from [00:08:00] performing those behaviors. The facilitators that help them to do it and then figure out how can we make our design either overcome those barriers or amplify the facilitators so that the end result is we're making this behavior easier for people to do.
Amy: So removing friction from behaviors is a great threat because that's fundamentally what you're talking about. Um, how do you think about the role of motivation and identity?
Amy Bucher: Yeah, I think about that a lot. And I would say if anything, it's, it's my primary lens. So I have been trained in a school of motivation that, um, called self determination theory.
If you have, um, people who want to look that up, there's actually a really great website, selfdeterminationtheory.org, where the researchers have, um, accumulated a lot of their original research papers and made everything kind of searchable and easy to understand. But...
Amy: So we, by the way, incorporate self determination theory throughout the game thinking methodology.
Yeah, yeah. Yeah. Self determination theory. Okay. So [00:09:00] autonomy, mastery, purpose. So you, yes. So there's that. And of course there's other, uh, motivational theories, but that's like the groundwork, the granddaddy. So the reason, by the way, the reason I ask it just to help you answer it is that I'm also trained in psychology in my background.
And one of the things we learn in that training is, the behavioral school of psychology, B.F. Skinner, et cetera, et cetera. And of course that led us right into all of the Skinner box mechanics and such that, you know, permeate a lot of gaming, but that is not completely separate from motivation when you're a designer and you're building products.
A lot of people think it might be like, they'll say, well, if you can just do just nudges solves the problem. Don't worry about motivation. Just worry about. You know, nudging and, you know, removing friction and no matter what, that should work. And there's definitely people in behavior science kind of arguing [00:10:00] for that.
Amy Bucher: Yeah, no, I don't come from that school of thought at all.
Amy: Tell me your, give me your perspective.
Amy Bucher: Yeah. So, and I will just note here too, that Lirio's, um, primary product is called precision nudging. And one of, that was a question I had when I was hiring in, you know, do we only do nudging because I believe that nudging has a purpose, it has a role, but it's, um, it's limited and specific and we don't just do nudging.
It's partly a, you know, it's a name that resonates with the market. Um, you know, when I think about health care, I think that there are some areas where we really do need to tap into motivation. And I think of that in terms of people's, as you said, identity, what type of person do you believe you are? What are your core values?
What are the things that you have to do behaviorally to feel consistent and good about who you are? And then what are your personal goals? Like kind of your, your life, your big G goals that these smaller behaviors moment to moment could help you live into and then there are the things where nudges are appropriate.
So if it's, [00:11:00] um, making an appointment, which is a behavior that we often targeted Lirio, but that's something where you don't really need a person to think very deeply about it, or, you know, harness all of their motivational energy to approach it. It's kind of like, okay, just a pick up the phone and make the appointment and a nudge can get somebody to do that sort of quick episodic behavior.
But that's in contrast to something like if you need to adapt, adopt a special diet for a medical condition, you are making hundreds of decisions every single day around what that means behaviorally. And there's no way as a designer that I can be there moment to moment nudging you for every single one of those decisions.
I need you to have something within yourself that will provide the guidepost in those moments. And perhaps, you know, as a designer, there are other key opportunities to check in with a nudge. Um, you know, maybe it's something where at the grocery store, we can use nudges to help put better things in your cart.
But again, you're going to go home and I'm not going to be there to nudge every bite you put in your mouth. So I see the two approaches [00:12:00] needing to work together when we're talking about these larger types of behavior changes that span long periods of time.
Amy: That was really well expressed. So valuable.
Following on, on that, what are some of the biggest misconceptions people have about behavioral design?
Amy Bucher: Oh boy. Um, a really big one I think is that it's more powerful than it is. And that feels like a funny thing to say, because I'm obviously a huge believer in behavioral design. I've chosen to have my career be here.
But, um, you know, I, I will encounter people who feel like it's an extremely manipulative, um, design approach that we're forcing people to do things. And, you know, first of all, it's just not so effective that we can get people to do whatever we want without them pushing back or consciously reflecting on it.
Um, there's certainly some places where we see remarkable changes in behavior based on a nudge or, or relatively light intervention. But for the most part, I, I am not able to [00:13:00] control a person. And part of that is there's so much variation person to person when we're designing a product and it's going out to hundreds of thousands of people to personalize at the level to be like that puppet master, right?
It's just, it, it doesn't make sense. Um, but I think it comes out of fear too. You know, people are very afraid of being manipulated. There's been some kind of high profile stories of companies that have not, um, acted in the best interest of their users.
And so it's coming from a natural place, but that that's a big one. Um, and it's a fine line to walk between, we can create an effective intervention that will change results and we can't control an individual. But it also comes back to some of those central theory. Actually, even nudge theory, the definition of nudge from the failure and Sunstein book is very explicit that people retain their free choice in the presence of a nudge.
There's no forcing. There's no coercion. And similarly, if you think about motivation and motivational theory, as, you know, it's really about connecting people with goals that matter to them. And so that pulls us [00:14:00] back from that manipulative space somewhat. So that that's a big one. And then another one, um, when I've identified myself as a psychologist because of my PhD in psychology, I have gotten more than one person who said something like, Oh no, can you read my mind?
Or that's one psychic, or are you diagnosing me? And I'm not a clinician. So, um, but I, I, my understanding is even if I were a clinician, most people aren't walking around with that lens on when they're in casual conversation.
Amy: So when you talk, that's again, really, really interesting. When you talk about, um, no coercion, no manipulation, you maintain free will.
It's about connecting people to goals that matter to them. Yes, yes, yes. So how do you think about, and how do you answer people that just want to throw a bunch of external rewards in there and say, yeah, yeah, that takes too long. We need them to do this. I've heard that the answer is just reward them. Mm hmm.
Um, maybe you've experimented with that or had [00:15:00] clients who wanted that at some point. How do you think about that? And what have you seen, um, play out with those kinds of systems and adding external rewards to the mix?
Amy Bucher: Yeah. So I, I used to be a total naysayer on external rewards and self determination theory would predict that you're going to get pretty for poor follow through at least over time with a reward based intervention.
But there has a couple different things here. There's been some work. Kevin Volpp out of the University of Pennsylvania is behind a lot of it that shows that if you structure a financial reward, according to different milestones, you can get more sustained behaviors. So he's done a lot of work with smoking cessation, where maybe there's a 100 dollar reward or incentive for somebody, but they don't receive most of that until they've gone, like, 6 months without smoking, at which point.
You know, their bodies have been able to adapt and they're more likely to keep up that that new behavior. So, things like that, thinking creatively about what specifically gets rewarded across [00:16:00] the journey or the lifespan of the behavior. There's also some evidence that being rewarded in the short term does not necessarily burn out your longterm motivation.
And that's in contrast to some, um, older research. But what I take away from that is if I'm in a situation with a client where they're really insisting, and this, this pertains more to previous roles that I've had where I have worked more, um, you know, in consulting or with these sorts of client integrations.
But, um, if they're going to move forward with an incentive now, it doesn't necessarily mean that this patient population will be hard to recover into a more motivational intervention in the future. And so one of the things that I think about is, are there behaviors where we can reward somebody and it won't matter as much?
And I tend to think that things that are episodic are good candidates for rewards. So. If we're doing a health risk assessment, one of those surveys that has a hundred questions about everything health related, I feel okay rewarding somebody financially for that because they probably have to do it at most once a year.
Um, even [00:17:00] things like having a mammogram or a colonoscopy that happen, you know, at most once a year. Okay, like, there's not a lot of in between motivation that we need to be spurring, but when I'm thinking about an overall, and again, I'm going back to diabetes because that's a really complicated area of health where there's many, many behaviors that people need to do.
I might put a financial reward around something like going to your ophthalmologist once a year, but I would not want to do that for something like checking your blood sugar, which needs to happen several times a day. That's where I'd really want to try to tap into that motivation or those bigger G goals again.
Amy: Right. We could probably talk about the nuances of this for a while. Yeah. Um, fun rabbit hole to go down. Let's put that, let's pin that for part two.
Okay. Um, so yeah, that's really interesting. So one of the things I'm getting from your stories is that you really stay up to date on the research.
Amy Bucher: I try. I try.
I feel like I don't do as good a job as I'd like to, but yeah, it's a goal.
Amy: Right, because you want to be able to [00:18:00] bring that research into your work and meld these two worlds of true scientific research and, um, results. With making a difference in patients lives. I feel like that's the story of your career And it's so cool that you're getting to do this now in this position So along the way to making it here you wrote a book.
Amy Bucher: I did.
Amy: Engaged. So I'll have some questions about how did you come to write that book? Like what pushed you to say, okay, this is going into a book. And also what were some of the surprises along the way of writing the book?
Amy Bucher: Oh boy. Yeah.
Amy: I didn't expect.
Amy Bucher: I'd say the book, I'm going to put it into my happy accident bucket again.
I, and I will say, I always had an aspiration to write a book. I remember finding this diary of mine from when I was seven or eight years old. And I wrote, I will be a writer. So it's, it's not a new thing for me to be interested in writing, but the actual book, I had a long weekend. I think it was Memorial Day weekend a few years ago, [00:19:00] and I was on the Rosenfeld media website, and I think I was actually browsing to buy books because that's one of the ways I do try to stay up to date with, with research is through reading books, which I find can be a lot more engaging than an article.
And they had a place on their website where you could submit a book proposal. And I'm like, you know, I have some free time this weekend. Why don't I put this together? And so I, I did, um, I submitted it. I didn't hear anything for a few months. And then Lou Rosenfeld, who is the head of Rosenfeld media, reached out to me and basically said, we think there's a, there, there, but it's not ready yet.
And so they worked with me for quite a while to go back and forth and reshape that proposal and really articulate where it could make a unique contribution to, to the world. So, um, you know, through that process, it helped me kind of get crisper on what I wanted to accomplish with the book. But what was in the back of my head when I first saw that submitted proposal was as somebody who kind of accidentally stumbled into this behavioral design, applied [00:20:00] behavioral science.
I spent a lot of time educating myself on the design and product part of it, so attending UXPA conferences or local meetups that were really heavy on the design side or the UX research side. And when people learned about what I did, they'd be very interested in the behavioral science side.
So I was getting a lot of outreach from people about how do I bring these skills into my work? How do I infuse my UX role with behavioral science? And I was kind of running out of capacity to do any justice to these requests. And also I was frustrated that I had no resource I could point people to. So in my head, like those were my readers, as I was putting the book together, the people who are working in UX and who want to understand enough about behavioral science to really integrate it with the job that they're doing.
Um, and I'd say one of the surprises, one of the reasons I actually wanted to write a book with a publisher, as opposed to doing it on my own. Was having access to an editor. So I had a wonderful editor at Rosenfeld, uh, Marta [00:21:00] Justak. And one of the things that surprised me were, I, I thought I was doing a really great job writing things in plain language and she would flag things as being very jargonistic or hard for her as a person without that expertise to understand.
And so I had this kind of mini education inside of the process of learning what is familiar to a new reader and what really is kind of industry or experience specific to me. And I think that that process of working with Marta really made. Me, a better communicator in general, because I have that stronger sense for that now.
Amy: Wow. From a seven year old, uh, scribbling in a diary to, uh, launching a book is very cool. We'll be sure to link the book and, uh, info about Amy's career and her LinkedIn in the description and bio. So for everybody looking for that, never fear. Talk to me about when you say I do a lot of research. There's so many different ways to do research, in particular in product and game development, which is where I live.[00:22:00]
So what research techniques do you use, both to understand the research as you expressed earlier? For us, what's more interesting is, what research techniques do you use with people in order to develop better products?
Amy Bucher: Yeah.
Amy: And develop better nudges?
Amy Bucher: Yeah, and you know, I feel this little tiny like heart sadness as you asked me this question, because in my current role, I'm not personally doing the research anymore, but I am overseeing some of the research function.
So, um, some of my answer is really going to be based on my more recent, past experiences. Um, but but first one foundational activity, it's not sexy or exciting, but it's really important is to do a literature of you to actually canvas the relevant literature around the problem space where we're working and that's a really helpful activity as well for staying up to date.
So, um, you know, I've been working on some of the same healthcare problems for all of my career, but the research has advanced quite a bit in that time. So even if it's something where I feel like I, I am [00:23:00] coming in with some expertise, it's worth the time and the discipline to do that refresh. Um, my favorite form of what I'll call user experience research and the one that I've used most often is the one-on-one interview.
So, um, what I was at mad pal for 5 years prior to joining Lirio as part of their behavior change design consultancy and we very frequently did and we did participatory design sessions with groups, which are also fantastic. But the 1 on 1 interviews, I thought were a great opportunity to really develop rapport with people and understand in their own words.
How they're experiencing a particular behavior, whether they're doing well at it or poorly at it. And I will say, I think there's value in talking to people who are in both of those buckets. So people who've already figured out how to do something well, and people who are struggling with it and understanding what some of the differences in their situations might be.
And one of, one of the things I particularly love about the one on one interview is that You get such emotionally rich data. You get to see people's facial [00:24:00] expressions, hear their tone of voice, um, the specific words that they use to talk about their experience. There's a lot to unpack in the implicit data that you're receiving there that is missing from something like a survey, which has its place in research for sure.
But, um, especially when I'm just starting out with a product design, I really want to understand that, that rich level of experience from the people who will ultimately be its users.
Amy: Awesome. So at you're now a very senior behavior designer, you've written a book, you're the chief behavior officer, you're overseeing research rather than doing it.
What are some of the really common mistakes that you see junior behavior designers make? You know, wind back 10, 15 years that you see people early in their career, excited like you were about this. What are some of those common mistakes you see and what do you wish that you could, you know, help them understand?
Amy Bucher: Yeah, I think one common mistake, and I, I'm [00:25:00] not going to blame the junior designers here, I think it's more an artifact of the way organizations are set up around this, this function. And this role is not leveraging enough of a feedback loop around what they've designed. So, um, and this is something I've fallen victim to as well, especially when I have been a consultant. Because as a consultant, one of the big drawbacks is, you may do a strategy or a set of requirements or a design for a program, but then you are not ultimately usually involved for.
The execution and evaluation of it the same way, but I see junior designers getting very excited because they believe that they have the answer to something, you know, they've hit on the clever design that will ultimately help people do the target behavior the way that they want to be doing it. And they are resistant to push back on that, whether it's coming from others on the team who perhaps have experience or more importantly, from actual data.
One of the things that we're really trying to pay attention to at [00:26:00] Lirio is using our own data as a feedback loop, because we do know on a pretty regular basis who is responding to our interventions and who isn't. And so, um, you know, I'm really working to make sure that we are crystallizing that in our design structure.
Amy: Yep. So, what is your take on the digital health care market in 2022 and a little beyond pulling back? You've had several really interesting positions. You work for Johnson & Johnson. You were for consultancy. Now you're at this cutting edge AI company. What do you see going on in digital health care?
Amy Bucher: You know, one of the things that I've, I've really started noticing in the last few months is actually non-health companies getting into the digital health space, making a play in the digital health space in a bigger way than they have in the past. So one really well known example is like salesforce, where they have their customer relationship management platform, you know, their CRM, and they are more and more often taking that to healthcare [00:27:00] organizations as a way to understand and communicate with patients.
And it's, it's just been a really interesting dynamic because a lot of these companies are bringing the technological horsepower that hasn't historically existed in the healthcare space and the digital healthcare space. Um, but they also are bringing a perspective that in some ways it's good to have the fresh perspective, but I, I do also think that sometimes you get outsiders who believe they will disrupt healthcare and they just don't understand how complicated it can be and how, how difficult it's just really, really hard.
Um, probably anywhere, but I'll say in the United States, there's so much regulation red tape around the way healthcare is done that even if we can all recognize that it's not optimal, it's just, um, beyond the scope of any one organization to disrupt it. So that that's a really big trend and I'm, I'll be at HIMSS in a few weeks.
So it's on my mind that, um, you know, a lot of the companies that we will see they're exhibiting and talking about their work are going to be outside of the traditional healthcare space.
Amy: Interesting. What is HIMSS?
Amy Bucher: It [00:28:00] is a huge conference. Um, gosh, I never remember what it stands for. It's like Health Informatics and Management of Information Society.
Something like that.
Amy: HIMIS?
Amy Bucher: HIMSS.
Amy: SS. Got it.
Amy Bucher: Um, but it's,
Amy: HIMSS. We'll link that also in the...
Amy Bucher: Yeah. If anyone will be at HIMSS in Orlando in March, um, Lirio will be there. I will be there. But, um, it's a conference. I, I joke with my family, like every year I don't wanna go to HIMSS. And every year I'm voluntold to go to HIMSS because it is a really important conference in the digital health space.
But there's something like 35,000 people who attend it. Um, and it's almost like the CES of the health world.
Amy: Wow. Sounds a bit overwhelming.
Amy Bucher: Very, very. Uh, but it's a great place to take stock of the landscape.
Amy: So, that sounds really interesting. Something I'm really curious about. Um, and this question also came in from our community.
So, um, in the Game Thinking Academy, one of our backbone tools [00:29:00] is conceiving of your customer experience as a journey with stages that require different kinds of design. And in the last six months, I've gotten more inquiries about how do you design a journey from people in healthcare than I had in the last six years.
So in my world, that concept which I think is being driven by larger scale shifts and recognition about retention is everywhere. And I'm wondering if you've seen shifts around people caring about things like retention versus just like get this short term thing going.
Amy Bucher: Yep. I, I have, I haven't thought of it exactly that way, but yes.
And also re-engagement as well. So if they've lost somebody from their, um, their system, you know, how do they recapture them? So definitely seeing that. I'm also seeing the journey language a lot, which is fulfilling for me because, um, at Mad*Pow, you know, we were an experienced strategy group and we did a lot of work with journey maps and thinking about what those needed [00:30:00] to look like.
And how do we weave in behavioral science to them? And, found that sometimes we really had to make the argument for why this sort of approach is valuable and how you use it. So to hear that this is more on people's minds and they're seeing the value is really gratifying. I will say one of the things at Mad*Pow that came out very frequently when we did journey maps, and we, we would go in, um, to a customer environment and, you know, really start fresh in terms of building a journey map.
So doing the groundwork, the research to understand what the customer experience or the patient experience was, and then sitting with that data to figure out from a visual perspective, how do we illustrate this journey? And we frequently found that linear was not an appropriate shape for a patient or healthcare related journey.
So there were often either loops like a roller coaster. Or we had a couple that were fully circular, um, but oftentimes you find with healthcare, it's very natural to have relapse states or plateaus, if you think about something like weight loss, where you may make really good progress for a while and then it slows down or even [00:31:00] reverts, um, you may have new issues come up or even just aging changes the list of health concerns that people have just thinking about things like recommended screenings.
So, yeah, just really getting flexible and thinking about a journey as a non linear entity and being comfortable with the idea that people may move back and forth along that.
Amy: Yeah, I think, um, thinking in terms of loops is certainly something we do in game design or anybody that's doing any kind of system.
But I love how you really put the loops into the journey and sometimes they double back. You know, you aren't gonna ever get re-engagement without some sort of loop. I mean that, so, I think it sounds like from what you're saying, triangulating it with what I'm hearing, the industry is waking up. People are open to thinking about customer journeys and the question becomes what's the most effective way to map that out and get our arms around it as a product team, right?
So that we can deliver a great [00:32:00] customer experience and a successful business, which is our goal at the end of the day.
Amy Bucher: Yeah. Yeah. And I think this relates to game design as well. Um, a phrase that I'm hearing a lot and we use it at Lirio is next best action. So if a person accomplishes something or reaches a milestone, what is the next best action?
And one of the things that game designers do really well that behavioral designers are just starting to get better at is making that call to action part of the feedback so that you have that continuous progression over time. I, I think back to some earlier examples and it just felt like the communication, the engagement with a patient was very episode bound.
It was like, okay, you did the appointment. We'll give you feedback now. We won't talk to you again for another year. But there's an opportunity to have more of this ongoing conversation and keep giving people these small calls to action that keep them, you know, walking along the journey to go back to that metaphor.
Amy: Exactly. Yeah. And designing that is, uh, it's no small trick, you know? And I think part of the [00:33:00] undercurrent running through this conversation, we touched on it earlier when we talked about identity and nudges and how they have to work together is blending a great experience delivered to a customer or a player or a user, whatever word, a patient, whatever word you have.
Delivering that great experience. In a way that makes sense to the patient that, you know, they don't have to ask questions. It just feels natural. It makes sense. It's clear while also including all the details, all the nudges, all the mechanics, all the calls to action because those are mechanics and you know, one of the tensions that we struggle with a lot, every game designer struggles with.
And I think in behavioral health, as you said, it's on the rise, is how you really bring those together. Um, one thing we talk about a lot, I'm really curious if you bring this to your work, is mental models. You know, that's a staple of UX, people mean different things by it, [00:34:00] but I mean something really pragmatic and commonsensical about it.
Which is, what your customer would tell someone else your thing is, if they were trying to describe it, right? It's like, what is their mental model? Is this a game? You know, are you, is this a gamified something? Is it a game? Is it, oh, there's this app that's kind of like a really nice mental health therapist, you know?
Oh, there's an app that's my friend. Those are completely different mental models with different sets of conversational expectations. In healthcare, this issue is like front and center. So how do you think about that?
Amy Bucher: Yeah, it's funny, so I, I use the phrase mental models a lot, but in a different way, because it is one of the constructs that goes into that combi model that I use.
Um, so it's part of what we call automatic motivation, and it basically is, does a person have an idea that this is a behavior that's appropriate for them, that it will help them achieve their goals? What is their mental model around the behavior? [00:35:00] But what you're talking about, we, we do also encounter and as you were talking, I mean, I can remember when I was at J and J, and we were talking about a new product idea that never came to be, but, um, the working name for it was pocket friend.
And just built into that name was this assumption that that would be people's mental model of it, but in fact what Pocket Friend was designed to do probably didn't feel very friendly because it was really about, you know, keeping people on track with all of these health behaviors and not necessarily in like a buddy, buddy sort of way.
Um, the other place where I've encountered what you talked about with mental models a lot is actually around games and gamification, and I think this is something that's gotten better, but maybe about, I don't know, 7 to 10 years ago, there was, I, I, I frequently encountered external organizations who would say, well, can you gamify this experience?
And upon talking to them, It became clear that they didn't understand that Gamify was the addition of gaming elements to an experience and instead they were really looking for something that was game like. And that is not appropriate for a lot of [00:36:00] healthcare type applications, you know, people who are coming in to manage a very serious health condition are not looking for like a Mario Brothers esque experience around that.
So that, that was something that felt really frustrating for a while. I spent a lot of time, I actually had a bunch of documents and things that I would use in these situations about like, here's gamification and here's games. And here's why we do this and not that. And we need to like, why do you want a leaderboard for your blood pressure management app?
Is that really a good idea? Um, that seems to have faded. Fortunately. Yeah. I'm not, I'm not even kidding leaderboards for awhile. Everyone was asking for leaderboards and it's like, you can't have people compete. On some of these things, like you're just going to demotivate and it is weird.
Amy: Yeah, I think, you know, what I see is that the gamification trend is very unevenly distributed all over the world.
I think some people are over it. They tried it and they found out that no, that's not the solution. Some people are still really excited about it. Uh, it means [00:37:00] different things. It means completely different things to different people. Like the word community. What does that mean? Right? It means, uh, so, um, I think that there's so much promise in behavioral health to deliver better feedback mechanisms, which is a huge part of game design, right?
Like throwing a bunch of points or leaderboards at something, most of us by now have learned that that's not a good idea. And I, I have to say, I've seen that up close and personal. And like you, I'm not against external awards or leaderboards or points, I use them all the time. Right. But when you see people use them in a way that is not connected to how the customer is thinking about the product and what they're looking for out of the product is when you get into trouble.
I have a client who did a play test. We help people do a lot of play tests for his product and it was gamified mental health, gamified mindfulness. [00:38:00] And one of the play testers said, boy, when I need mindfulness, the last thing I'm looking for is a leaderboard.
Amy Bucher: Yeah. Yeah. I, we actually did a research study when I was with J&J, it was for a client.
It was some kind of medication tracking, uh, but we had built like a little, it was not even mobile. Cause this was so long ago. It was like an online interface for them to track their medication. And one of our respondents said, if I could remember to go online and track, I'd remember to take the medication.
And for me, I'd like, I still remember I can picture the guy's face like that, that, that was a changing moment for me to hear that.
Amy: Wow, very interesting. So before we go, Amy, from where you sit, what is your thinking on crypto and Web3 and what it might offer healthcare.
Amy Bucher: Yeah, I, and I, I think we had talked before about this, that it's actually not something I encounter as much as you might think for what a, what an industry buzzword it is, but I'm actually not seeing a lot [00:39:00] of discussion of crypto with the types of organizations that I've been working with.
So, um, payer organizations, health system organizations, for the most part, it doesn't seem to be a space that they're thinking about. When I've done a little bit of my own investigation, um, you know, where I think there might be promise is in thinking about how you correlate data to an individual or to a group of individuals.
So, one of the things that has been a systemic problem in health care is how fragmented the data is. It's something I think I've run into it every job I've had, in multiple different ways. But it's really difficult to look at an individual and truly understand what their complete health picture looks like.
And so I see there, um, you know, particularly in the blockchain technology, perhaps being some potential to start to identify the data that belongs to a person across context and organizations. So that we can more effectively help them with whatever challenges they're facing, even something like COVID [00:40:00] 19 vaccination.
One of the things that we're running into, um, is that people can get that vaccine from many different types of organizations and for most states in the United States, there isn't a really good, accessible, centralized vaccination database. So if we're trying to reach out to people and encourage them to get that vaccination, or to understand if they've already had it, it's a really difficult data problem.
So that that's where I see there potentially being some promise for this other technology.
Amy: It looks like we have a question that has come in. Awesome. It says, how important is it as a UX designer to learn about behavioral science? Where to start? Yeah, what advice can you give folks? Well, first of all, read Amy's book.
We'll make sure to share that link. But, um, someone who's a UX designer, say, you know, establish UX designer. They want to get smarter about this stuff. Where can they go?
Amy Bucher: Yeah. Well, thank you for saying the book, although you stole my [00:41:00] immediate answer. I put together on my website, a reading list of other books that are not oriented towards, you know, people who have that education and background.
So they're, they're appropriate for people who are coming in, kind of fresh to the behavioral science space and I can share that link with you. Um, there are a number of boot camps and trainings out there that offer some introductions to these I don't have a particular one that I recommend. I mean, they're all a little bit different and kind of focus on a specific application of behavioral science one resource.
I do recommend to people all the time though is habit weekly which is a weekly newsletter, but there's also a community associated with it and I've paid it paid for the annual subscription. I think it's $50 a year, which is more than reasonable for the value I get.
But I found that that's a really great community of people who are behavioral in some way, there's a real wide variety of job roles that people occupy and trainings that they have. But I've found that through that community, [00:42:00] there's almost always somebody who, um, you know, is willing to answer a question or provide a perspective. I reach out there pretty frequently when I'm wondering how to tackle something.
Um, so, so I think getting involved in that community or others like it is a good way to start to bring in some of this knowledge and to do it in a way that's specific to what you're already doing instead of just reading a book where you're going to have to do a lot of that work to knit it into your um, existing identity and workflow.
Amy: So for a digital health therapeutics company or digital health company, um, how important do you feel it is to have a specific behavioral designer as part of the staff and what qualifications would that look like?
Amy Bucher: Yeah. Um. You know, that's I'm thinking of it. So, we do have specific behavioral designers and they all do have specific training in behavioral science.
So, the folks who have the behavioral design job title right now, all of them are actually doctorally level trained. That's not a requirement in our job descriptions that [00:43:00] we, um, you know, for the most part are looking for at least a master's degree level of social science training. I have also worked, though, with people who I consider world class behavioral designers who don't have formal education in social science and have picked it up through, you know, things like boot camps and reading and on the job collaboration.
I would just say that in those cases it often takes some time to build, well, both cases. I mean, you're either going to school for it or you're, you're learning it on the job, but, um, just have the expectation that it's something you have to work at for a while before you might be qualified to step into the job type.
Amy: Awesome. There's, there's so much richness here, and there's so much overlap with game design, it makes me, sort of, tingly excited.
Amy Bucher: Me too, me too. You and I mean you and I have talked a little bit where I'm wondering it Like I would love to have my team train in game design because I see how Neatly it will plug right back into our work and help make our product more compelling.
So, and yeah, the motivational dynamics underlying both have so much in [00:44:00] common.
Amy: Yeah, it's, it's a brave new era and especially in digital health. You know, it's that area is just exploding.
Amy Bucher: Yeah. And I mean, the thing we talk about a lot too is, um, you know, we're not really just competing against our competitors.
People aren't sitting down and going, am I using this weight loss app or this weight loss app or this one? They're saying, do I open up TikTok or the weight loss app? So we're, we really do need to think about being engaging in a way that, um, you know, is, is non traditional for, for healthcare.
Amy: Wow. TikTok, yeah, for healthcare. What a funny, that's an amazing note to end on. So what's coming up for you, other than going to this 35,000 person health conference in 2022 that you'd like to share with us and, uh, tell us about. What are you looking forward to?
Amy Bucher: When I, I'm really excited about my new role as chief behavioral officer.
So part of, um, my stepping into this role is I'm really building the team. So I have a new [00:45:00] director of behavioral research starting in a few weeks. Um, so that, that will really set our, our research arm on a more steep upward trajectory than it has had. We're also going to a conference in April called the Society for Behavioral Medicine, which is more on the academic side, but I'm really excited for that because it's an opportunity for my team to show off the scientist side of what they do.
I think oftentimes being in industry, it's very easy for people to recognize the design side or the commercial opportunity of what we do, but. Um, it's just cool to be able to see my team go and geek out in the way that they were trained. So I'm really excited for that. But mostly I'm just really, I feel like I'm overusing the word excited, but it's the right one.
I am very excited about what the future holds for me at Lirio and for, for my team.
Amy: That's fantastic. And congrats on building out your team and getting some new folks to come help you bring your vision to life. That's that's really wonderful.
Amy Bucher: Thank you.
Amy: So thank you so much for taking [00:46:00] time out of your schedule to join us today.
Share your wisdom. This was absolutely fantastic. Um, thank you for your questions, folks, and for being here. I'll make sure to follow up with you, Amy, and, uh, get those links so we can include them. And, uh, especially Amy's amazing book, which is a great start for anyone that wants to know what behavioral design is and how you can harness that power for your own products and games.
Thank you so much. See you soon, I hope.
Outro: Thanks for listening to Getting2Alpha with Amy Jo Kim. The shows that help you innovate faster and smarter. Be sure to check out our website, getting2alpha.com. That's gettgetting2alpha.com more great resources and podcast [00:47:00] episodes.