hollie delaney has worked at zappos.com, inc. for more than four years. she’s married with one child, so she knows first-hand the struggle of enjoying a full-throttle career while giving all to oneself and one’s family. as the senior HR manager at zappos.com, inc. in charge of their wellness effort, that knowledge comes in handy. i caught up with hollie by email and by phone to find out how zappos.com, inc. is approaching wellness. hint: it has something to do with delivering happiness.

fm: let’s start with the basics. how do you define wellness?

hd: right now, it’s a little different here than elsewhere. we don’t have a huge initiative. we’re focusing on how we get people excited about getting up and moving, eating right. i look at myself. i’m a person who used to be very healthy. but then i got married, had a family…something gives. from my standpoint, i think about what’s it going to take to get me to move and eat well? we’re focusing on this first, and as we get more established we can look at the tougher challenges, like focusing on the different health issues common in our population.

fm: why is it important to zappos.com, inc. to get people up and moving or eating well?

hd: well, we have a conflict with the mainstream about “why.” most are looking to help with rising health care costs. of course, that’s important to us as well, but our main focus is when you’re well, you’re happier. when you’re happier, you do your job better. we want to give people the knowledge and opportunity to see how much better they feel and how much happier they are when they’re healthy. that’s our main focus.

fm: given that, what does “wellness” look like at zappos.com, inc.?

hd: we look for things that work for everyone and that will bring a little more happiness into people’s lives. we want to show people that wellness is important but can be fun. we also want to cover everyone from the person just starting on the wellness track to the person who’s already on the track and looking to sustain their lifestyle.

we provide educational classes on nutrition, finances, parenting. we have weight watchers on-site and offer smoking cessation classes to employees, and we subsidize a portion of these classes if employees complete their commitment. our on-site exercise classes cover everything from hip hop dance classes to how to sit and be fit to laugh yoga to wii competitions. our insurance carriers come in to give employees a better idea of how their benefits work and what things are available that they may not be taking advantage of. we also provide different discounts to gyms and encourage people to walk, hike, bike, and play sports together.

our wellness council is made up of employees from all the different departments within our company who want to be part of what we’re doing. they help us find those vendors who’d work for us culturally and figure out how to take information we all know and make it memorable.

fm: make it memorable. exactly! i’m a big fan of your off-the-cuff youtube videos. how are you communicating with employees about wellness?

hd: video is a good way for us to reach people. we’ve been thinking more about how we can use it. we could do a video about something as fun and silly as parking farther away from an entrance. for our wellness fair, we created this “rock wild” wellness video.

our wellness program’s really just starting down this road. any campaign to date has been through video or email, and we do have a twitter account employees can follow to see what we’re doing. we’re not addressing family yet but are looking to in the future.

fm: your wellness fair video reminds me of healthymagination’s howcast videos. they’re campy fun, just like you’re talking about. your culture’s known as a really driving culture. fun but intense. and obviously, some units, like your call center, have unique stresses. how do you align these competing forces? and do you carve out units like your call center in any way?

hd: everything we do is dictated by our core values. then, as managers, we’re allowed to run our units like our own business. managers are given so much flexibility, it trickles down to everyone else.

one of the things we want to do is build relationships with each business so we can tailor our wellness services to their environment. this is a new road for us, and we’re just starting down it.  we’re looking to tailor programs that work best for different departments, so some may need help with work-life balance, some of the departments may want to focus more on stress management and so on. we haven’t started this process yet but are looking to start in the near future.

as far as the hours go, the way our culture’s set up, we hang out outside of work. so that piece, working tons of hours, fixes itself. i don’t mind; i’m having fun. i’m with my friends. when i first started working here four years ago, working was hanging with friends. now that i have a family and so do lots of others, we’re hanging as families. we’re building these relationships together. for me, this is the healthiest place i’ve ever worked. you can be who you are. you don’t have to fit into a certain mold.

fm: how are you measuring what you’re doing?

hd: we’re not a largely metrics-driven company. we are metrics-driven in certain areas, such as inventory, growth, etc. when it comes to the more subjective things that we do, we’re not as heavily metrics-driven. we know that wellness programs will have returns, but there are facets of the things that we want to do that are difficult to measure. we’re currently working on how to quantify the programs that we’re proposing.

fm: what will you be looking at to see if you’re moving things in the right direction?

hd: that’s a good question. we’re still working it out and trying to find what best works for us.  we’re looking at standard programs but also looking to break new ground, so…it’s a learning process!

check out other free-ranging interviews with health innovators.

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ernie medina is a preventive care specialist and CEO, co-founder, and chief exergaming specialist with medplay technologies. he’s a well-known speaker, board member on american college of lifestyle medicine, former executive director of the american preventive care association, and a certified health and fitness specialist with american college of sports medicine. picking up from my conversation with melanie lazarus at archimage about health games in general, i asked ernie a few more questions about health games and exergames, in particular.

fm: i know you’re a huge physical activity enthusiast. me too. i’m a real you-know-what without it.

em: a lot of individuals don’t understand that they’ll be more productive, more efficient, and have better sleep just by being physically active. when people get that, they’ll say: “how can i not do it?” president obama, the day after his inauguration, was photographed coming out of the gym. if we were elected president, wouldn’t we take the day off?

fm: there’s a great spread on the 20-somethings in obama’s office. In it, one of the staffers talks about the culture of health obama’s brought into the white house. but what you’re saying, don’t we know all of this?

em: people may know it, but they’re not internalizing it—or they really don’t believe it. some doctors don’t even promote physical activity, mainly because they don’t practice it themselves. they’re biased against physical activity because of their own habits and because they feel people won’t exercise, either.

fm:  you’re saying if we internalized the benefits, we’d make exercise a priority that didn’t shift because of money, time, or something else. so how then do we get people to internalize the need to exercise?

em: it needs to be customized to meet their individual needs and desires―find out what they want in life, and then show them how physical activity can help them get it. we also have to find out what their obstacles are to exercise. that’s where exergaming comes in because it can overcome most, if not all, the obstacles.

my wife is a loner; she’s not the club type. she exercises on her own on trails or on the treadmill. another person may have equipment at home, but needs accountability. then there are others who don’t like exercise at all. with them, you need to focus on the fun. exergames, sports, ballroom dancing. the exercise isn’t the main thing. it’s fun. stealth exercise!

fm: stealth exercise. i love it! it’s like when i exercise at 5:30 a.m. i’m halfway through before i’m actually awake. how does it work with exergaming?

em: the original word for exergaming was exertainment. exercise that’s entertaining. when you’re running on a treadmill and watching a dvd, that dvd is a carrot. that could be considered exertainment, but the action has no impact on the movie. exergaming dictates what you see on the screen. it’s not a distraction.

fm: i’m not seeing where accountability comes into play.

em: right now, the most common form of accountability within exergames are logs that track your workout and avatars that “admonish” you if you’ve missed too many sessions. but because exergames are digital, i predict that we’ll soon see exergames connecting into the health care digital loop. i can prescribe an exergame as a workout to a patient, who then goes home and works out on that exergame, which could be online-based. the online exergame documents their workout in their electronic health record and notifies me with a text message or e-mail warning if this patient hasn’t met preset exercise goals within the game. i can then contact that patient and intervene within the week instead of waiting a month or more before i see them for a follow-up in my office.

making lifestyle changes requires this kind of constant feedback monitoring loop between patient and health care provider, whether it be weight loss, stress management, smoking cessation, etc. the fun aspect of the exergame will keep the patient compliant while the digital aspect will keep the health care provider apprised of their progress. if the patient knows that their exergame will be communicating with their health care providers, that’s a major incentive for making playing the exergame a high priority. then whenever they lapse, we can intervene early on and help them see the importance of maintaining this new behavior.

fm: what exergames do you like?

em: the exergame i like and play the most is the wii, because we have that at home. i like the eye toy because it allows someone to play while seated. i’m eager to see the games that will come out for microsoft’s natal and sony’s new eye toy camera―both work as a 3-d camera (the original eye toy is only two-dimensional). if i want a more intense workout, i tend to like the cycling exergames, like the gamebike. i haven’t tried brainbike, but that looks very interesting to me. i also like the makoto and 3 kick because i like to kick, punch, and hit things. and finally, i like the trazer because that was the very first exergame that got me started on this whole journey, and it’s very intense and competitive to boot!

one that I’d like to play more is the lightspace play floor or wall. with lightspace play floor, you step on a floor made up of lots of LED lights. you play a game, based on the movement of the lights. there’s no screen, but you’re interacting with the game.

fm: how expensive are these games? could companies put them in the break room? make them part of their employee wellness program?

em: the exergaming network (TEN) is a great place to start. also, exergame fitness lists most of the exergames out there, and you can see they range in costs and space requirements. with our company, medplay technologies, we’ve set up exergames indoors and outside. so as long as we have electricity, we can set up an exergame.

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know someone who would make a great free-ranging conversation? let me know in the comments, by email (fran @ contextcommunication.com), or DM.

more on the topic:

• more free-ranging conversations

[image: threadless "the gaming revolution"]

andre is a known entity in public health and technology communities. he’s worked in the social marketing/health communication space in the nonprofit and agency world, as well as in digital public relations. he blogs at pulse + signal, which he recently expanded into a consulting firm to help organizations empower communities to lead better, healthier lives. and somehow he fits in guest blogging at healthgamers.

i got into the mind of andre (his twitter account name) about what it takes to make a decision to be healthy and what companies can learn from public health campaigns and their use of social media.

fm: what does it take to make a deep-rooted decision to be healthy? is there are core thing that needs to happen?

ab: social marketing has long been a method to improve positive behavior change among populations. in my opinion, a person needs to first know and understand the reasons why they should do something; simply saying it is good for them usually doesn’t do the trick, at least not in the long run. it’s also important to show people how to make those decisions, rather than giving them a big two thumbs down on drinking alcohol or having unprotected sex. this is especially important with youth populations.

tying behavior change to other parts of their lives—such as family, friends and self-confidence— puts making health decisions into perspective. the father who wants to be healthy in order to play baseball with his kids or the daughter who saw a family member pass away suddenly from lung cancer due to smoking. these are small components to helping people make long lasting healthy decisions.

fm: absolutely. i agree. when companies talk about saving money with health care as their main message, my response is: is that money for you? or for your employee? because employees don’t care too much about the former, unless you go on to say why that matters to them in terms of their job security, money for pay increases, etc. otherwise, connect with people through what’s important to them.

once they reach people, how can companies support them through the process of considering, planning for, and making a difficult change?

ab: although corporate wellness isn’t my expertise, i would think that companies can support their employees by giving them incentives not only for enrolling in a program that can benefit their health but also incentives for their forward progress. giving someone a starbucks gift card just for signing up and never following up with them is sort of like the college student who gets a free t-shirt for being swindled into buying a credit card – friendly up front but tumbleweeds and crickets chirping soon afterward…no continued support, which can lead to failure and unattainable goals (as well as unchecked spending!).

fm:  what are examples of public health campaigns that you think work?

ab:

this is public health (association of schools of public health)

truth campaign (legacy foundation)

national hiv testing day

all of these campaigns use a combination of storytelling, statistics, and facts. the first and third campaigns have an education component as well as a call to action, which is important in getting people to actually change their behavior. the first two campaigns also took non-traditional routes to get their message across, giving public health and the anti-smoking landscapes a breath of fresh air. lastly, each of these campaigns involves the people, increasing the chances of word of mouth dissemination. this is done by making sure there are social media components (e.g. facebook, youtube, twitter, etc.)

fm: the health care world has really taken to social media. we’re not seeing this in companies as much, though i think that’s going to change—rapidly. what should companies know about how social media has benefited public health campaigns?

ab: public health campaigns have traditionally been about informing the masses on behavior change and/or prevention issues surrounding a health issue. these campaigns can range from anti-smoking to washing your hands during cold/flu season. while those campaigns have been mostly effective and have been around in one form or another for the past few decades, social media brings another element – an element of engagement and feedback.

social media has given a voice to the individuals whose lives public health is trying to improve. these new media tools allow the public health world to do a few things:

1)      be there first: by establishing an easy to navigate presence on the web, state and local health departments can quickly give their constituents a place to go when there is an outbreak, question on a specific condition or general health alerts.

2)      be the credible source: apart from being their before any misinformation, valid public health information sources such as health departments, the cdc and other public health organizations, can show themselves to be the authority on questions or issues.

3)      word of mouth power: once you are there quickly as a credible source for public health concerns and information, you can look to social media engagement to help provide widespread distribution through contacting leaders in various online communities. local health departments can look to possibly reaching out to location-based blogs to add an information widget (e.g. about vaccination locations, reasons to wash your hands, a text messaging campaign, etc.) to their site where readers of that blog can learn and interact.

fm: you have lots of experience reaching hard-to-reach audiences. many companies struggle with reaching non-tech savvy workers, for example. do you have any crossover lessons we can learn from?

ab: many times hard to reach audiences make use of other communication forms – it’s important to understand the statistics surrounding which forms are useful for which populations and then connect with them there. at that point, you can coach them into making use of other forms of communication (e.g. text messages), but it’s important to find them where they are first to introduce them to your message. another example is that of african american and latino youth, who although may not have the best access to broadband internet – they are avidly using their mobiles/smartphones for communication. interacting with them here first, where they are already comfortable, will go a long way in reaching your communication goals.

have a question i didn’t cover? ask andre in the comments.

know someone who would make a great free-ranging conversation? let me know in the comments, by email (fran @ contextcommunication.com), or DM.

thomas goetz is the author of an outstanding book about participatory medicine, the decision tree: taking control of your health in the new era of personalized medicine. he’s also the executive editor of wired magazine, a blogger on huffington post and his own blog, the decision tree, a former reporter for the wall street journal, and a contributor to the new york times.

i asked thomas to be a part of this conversation series after reading the decision tree, which the former commissioner of the fda, dr. david kessler, proclaims “a game-changer, a brilliant synthesis of science, public health, and practical advice that puts each of us at the center of our own healthcare revolution.”

thomas and i happened to speak the day after the health care reform bill was passed.

fm: i want to start by asking about your reaction to the bill being passed.

tg: having coverage is essential to health care change. there’s a whole other segment left on the table—comparative effectiveness, pay for performance, using the information we have to advance treatment and empower patients. a lot of that was left out, but there’s still a lot that individuals and the medical community can do now.

fm: and that’s truly what your book is about. can you sum up the decision tree in a few sentences for those unfamiliar with it?

tg: there’s no lack of information, but we have few ways to delve into and use it. the decision tree approach is about finding ways to use information in a way that makes sense to us.

fm: how does a decision tree respond to this?

tg: there’s a disconnect between our rational and emotional self that’s especially fraught when it comes to our health care. and yet it’s important with health that we make smart decisions and can use skills that we don’t use much. we need to help people understand quantitative information, for example. and personalize information, letting an individual input a few particular points from their medical history into a tool that guides them and refines the information they receive as they provide more information.

feedback loops help us assess and fine-tune our progress. with sites like patientslikeme, you can compare your feedback loop to others. you gain support, knowledge, motivation. it’s reassuring and comforting—the emotional side—that we’re not alone.

what’s a new ideal is creating more simple tools with much less friction. they’re less difficult to use and data’s collected automatically.  that’s really where the change is. for example, the ipad’s loaded with apps that make it easier to collect data. that means the individual can focus more on the behavior. i think that’s what’s hopeful. you can engage a larger group, not just those who are prone to tracking information. if all the numbers are automatically there, more people will do it because it’s easier to do.

[note: nike+ and the fitbit are two additional examples.]

fm: what’s interesting about sites like patientslikeme and what you’re really driving at in the book is how much we need to understand, share, and use our own data. yet many people consider their health private. and there’s certainly a strict line around employee privacy.

tg: some of us have a great incentive to share. we want to reap the benefits of sharing. we used to think it [poor health] was a stigma. that’s changing now, as we share and use our information to yield greater insights that benefit us. data now has a “currency,” a value, that will reduce the stigma. there’s also a generational tide against privacy about this data. it’s the same as with online dating. online dating is the norm now. it’s seen as a more efficient way to find a match. there’s an efficiency— a value—in joining these sites that won’t be seen soon as stigmatizing.

employers can set up programs to help employees measure their progress and share data. they need to be individualized tools that are highly motivational. and in terms of privacy, they need to be extremely explicit about what happens with the information.

fm: you talk a little about disease management in your book. i’ve certainly seen the stigma of disease in the way individuals consider disease management programs, and even in employers’ reluctance to promote them.

tg: there is something about a health crisis as a spur to action. the open question is how do we engage people, not scare them.

there are two approaches to health: a pathological approach or a maintaining health approach. for example, physicians get upset when patients are not in compliance—a chronic problem. “how can we get patients involved if they won’t comply?” but some of it is in the terminology: you comply. there’s no emotional, tangible side—where’s my invested side?

if you can start giving people a sense that they’re contributors and partners to their own health, they have control. it’s a change from obeying instructions to engaging in their own health.

fm: sometimes i think there’s a disconnect between what employers are doing and what they could be doing to engage employees and their families.

tg: i am not a wellness program expert, but i’d think it can seem paternalistic from an employee’s point of view, and that’s antithetical to engagement. companies may have programs pointed more toward things that are important for the company. they need to be cognizant about how much ownership they give the individual and make everything an employee-facing tool.

fm: patient engagement is a big goal of health 2.0. shouldn’t companies be playing a bigger role and not be miffed, as one recent survey found?

tg: there’s a moment right now that something new is happening. companies should be aware of and excited about it, and it may improve their effectiveness.  every HR will have to decide when they’re ready to make the jump, but companies should stay engaged with this.

it’s similar to doctors and electronic medical records (EMR). EMRs promised so much, or overpromised, and initially delivered so little. many docs wrote them off and missed their opportunity to realize the upside. we’re converging on a similar moment with employers and wellness efforts and the health tools for them to offer.

i hope that we aggregate these new technologies and offer reassurance to people so they don’t give up on their health.

you can follow thomas on twitter. if you have a question you’d like to ask him, please leave it in the comments.

read more free-ranging conversations with health innovators.

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mayo clinic uses social media to build their brand, connect with current and future patients, and educate people about their health. but they go beyond this, helping to educate others about how to use social media for their own purposes. all of this is largely due to lee aase, the social media manager for mayo, who’s invited non-mayo employees to join mayo webinars to learn more about twitter and started smug, social media university, global.

lee works separately from the mayo team that supports companies and their workplace wellness communications. i chatted with him about what he’s learned about social media and its impact on health that companies can benefit from knowing. i’m hoping to chat with the team associated with workplace wellness, so watch this space!

you’ve obviously been using social media to build mayo’s brand and competitiveness.

our philosophy is we’re giving away information that’s helpful to others. over time, it’ll make people more likely to use mayo or refer their friends. using social media—this is the way word of mouth happens in the 21^st century.

you’ve also devoted a lot of time to sharing what you’ve learned so we all benefit. what are the critical lessons?

the biggest mistake is studying it to death and never implementing anything. another is to throw a ton of resources at it right away.

take a smart first step so it’s unlikely you’ll have to ask for that much forgiveness, and pick as low-cost an effort as you can so you can prove the value. there will be some of these tools that don’t get a huge following, but if it doesn’t cost a lot and it serves people…

what have your efforts taught you about social media’s contribution to health?

we use videos, podcasts, blogs, and facebook. they let people share experiences, support, and encouragement. they also let them become more informed and more involved in their condition management. for example, one of our patients came to mayo clinic after his mother had interacted on a yahoo health group where her discussions with others led her to seek out a second opinion. he had been diagnosed with long QT syndrome, a potentially fatal heart rhythm abnormality, and may be the youngest patient to have received a pacemaker-defibrillator. his mom not only became suspicious of the diagnosis after interacting with this long QT syndrome community, but also received advice on where she and her husband might get a second opinion for their son. a community for a relatively rare condition wouldn’t be possible without online platforms like this. companies can form support groups to provide this same type of network to their employees, using these tools to serve as continuity for what they’re already doing.

those are instances in which being involved in a group ultimately led to a change in care. do you see that a lot?

we’re seeing social media as a way to improve care. we’re in the process of building some closed patient-support groups on facebook that will have a moderator. we want to research different ways of providing support groups—moderated, unmoderated—to see what affects behavior, like medication compliance, for example. we’re in the early stages of exploring this, and look forward to sharing what we learn to help patients and health care providers everywhere.

and, of course, i must ask, do you use social media internally to support mayo employees and their families’ health and well-being?

we’ve been experimenting with social tools internally as well, but more in relation to how we work together and share information as colleagues, not so much specifically aimed at health and wellness. still, some of the applications have related to our mayo clinic dan abraham healthy living center, where social tools have provided support for exercise and nutrition programs. i really believe we’ll be implementing social media enterprise-wide in a significant way now that we have the proof of concept from what we’ve done externally.

for more on mayo’s use of social media, in general, read this interview with guy kawasaki. this blog post by erin turner, one of mayo’s patients, tells how blogs, twitter, and a story in usa today combined to help her find treatment for a painful condition that had bothered her for five years.

you can follow lee on twitter and join social media university, global (smug). if you have a question you’d like to ask lee, leave it in the comments.

the free-ranging conversation series explores workplace wellness from a number of angles. read more free-ranging interviews here.

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this interview is part of an ongoing series of conversations on workplace wellness.

intel wants to create a health and wellness culture. to foster that, they offer employees “health for life,” a three-step program consisting of on-site health checks, health risk assessments, and wellness coaching. in addition, they partner with the mayo clinic for more specific interventions, such as tobacco cessation and stress management. they offer u.s. participants an incentive of up to $75 and have recently added preferred medical plan pricing for participants (effective 2011). the program’s been in place since 2007 and is offered to employees in the u.s., costa rica, israel, and china today, with plans to expand in more countries down the road.

michelle and i focused on what she’s learned about communication messaging since they first rolled out health for life.

what’s the primary point you’d want others to walk away with?

communications play an important part in creating a culture of health. we don’t just focus our health communications during annual enrollment season; we make health a year-long campaign. we provide information on choosing your health benefits during annual enrollment, and for the remainder of the year we focus on making wise decisions on using health benefits and living a healthy lifestyle. we leverage multi-media channels to reach not only our employees, but also our employees’ families who are major choosers and users.

intel’s use of social media is well known. how are you using it to support a shift in employee health and wellness?

you may have heard about planet blue, intel’s social media network. on planet blue, we have a health for life group where employees share their perspective and experiences of wellness programs and can ask questions of one another. topics range from “my workout forum” to “healthy recipes” and “stress management tips.” we’ve also created a group for health benefits, which makes it possible for employees to discuss their health benefits and our benefits representatives to blog about them. to date, 67% of u.s. employees have viewed our health social media groups.

do you have guidelines for use?

benefits representatives monitor the group, in addition to our wellness coaches, who often refer employees to creditable resources. but we welcome constructive comments and encourage employees to keep the discussion real. when constructive comments are posted, we often see other employees respond with a positive comment or useful information.

during annual enrollment, we did see some employees posting questions or expressing a negative perception about consumer-driven plans, such as the plans don’t provide comprehensive coverage. other employees were quick to provide correct information, including personal stories.  we attribute greater take-up of our consumer health plan to these open conversations. constructive comments also help us improve our communications and allow us to address issues we may not have considered.

convincing leadership to open the communication gateways can be a challenge, to say the least! what was key to gaining your leaders’ support?

the value of word-of-mouth and showing engagement. most of us can relate to going down the hall and asking a co-worker their opinion on what benefits they’re choosing during annual enrollment or what their experience was when participating in a company program. social media provides this at your fingertips—in masses. and allowing two-way communication engages  employees in the topic.

most companies who tackle health and wellness experience employee concerns about privacy and the company’s intent. what advice do you have?

you’re right. employees have questions about privacy and “why are you doing this?” we had an idea that confidentiality was an issue, but once we held focus groups, we were able to drill down to the specifics. employees thought that insurance companies would get their HRA information and drop their coverage. we’re self-insured, so nobody’s going to be dropped. the feedback from the focus groups helped us develop key messages about these concerns.

finally, what results have you seen?

fifty percent of all eligible employees currently participate in health for life. we’ve tracked a global cohort group that’s participated in year 1 and year 2—47% of this group reduced their health risk by at least one level. (note: this is a referral to data from a health risk assessment, where reports isolate a health risk level for employees, such as low, medium, and high.)

we’re excited to see the health risk results and want to continue engaging more employees. our goal is to better understand why some employees haven’t participated and develop communication messages to engage them.

if you have a question for michelle, leave it in the comments. she’ll answer them through next week.

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more free-ranging conversations:

• greg matthews, director of humana’s consumer innovation team, on innovation
• melanie lazarus, editor at playnormous, llc and archimage, inc., on health games
• steve boese, director of products, community, and on-demand services with knowledge infusion, on benefits websites
  

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this interview is part of an ongoing series of conversations on wellness with wellness managers, providers, communication professionals, and innovators.

steve boese wears many impressive hats: blogger at steve boese’s hr technology, host of hr happy hour, professor at the rochester institute of technology, and his latest chapeau: director of products, community, and on-demand services with knowledge infusion, a leading hr technology consultancy. and did i mention, he loves bacon?

i sought out steve to talk about how companies can best employ technology to support their health and wellness efforts.

where would you advise company’s to begin, given that most companies aren’t starting from scratch?

many legacy intranets and even some portals are beyond fixing. most started the same way, with forms and pamphlets that may or may not have been edited and customized for this format slapped up on the website and behind a firewall. it’s essentially an electronic conversion of paper documents. and the truth is, they’re probably no more accessed here than they were on the paper rack.

i’d advocate considering open-source and/or commercially available solutions. realistically, the very large organization isn’t likely to embrace open-source, but licensing solutions are available that can speed the development process. the other benefit of commercial software is the ecosystem of support and development resources that can be leveraged as the company evolves and requirements change.

the employee’s experience as a consumer is driving the requirement that enterprise technology work like consumer technology. companies need to consider how they can make their intranet experience like facebook’s. i’ve heard anecdotes of companies simply abandoning “dead” intranets and moving to new, more social and collaborative platforms. many companies already have lively employee networks going on these platforms. the value from these social networks is the give and take and two-way nature of the platform. instead of emailing changes to benefits—the responses are private in nature—why not let employees communicate upward and to each other? that’s the real benefit.

exactly. i love the idea of using ning to rally employees around issues of importance to them—similar to tudiabetes—and issues important to the business, like chronic conditions. still, many companies are fearful that employees will share bad information about how benefit plans work or say something horrible about the increase in premiums, for example. (note: my next conversation with michelle james of intel talks about their experience with benefits blogs.)

that’s classic big company philosophy of “we’ll share what they need to know when they need to know it.” they’re just not thinking about more openness in general.

besides the dead intranet, technology adoption is still an issue. how can companies reduce or eliminate this barrier?

in technology adoption, ease of use trumps everything. any type of technology you want people to use—if it requires training, you’re doomed. you’ve just created a second barrier, the first being change. if benefits open enrollment has always been paper-based and handled by hr and you’re now introducing a technology-based process, you have to manage the change and make sure that employees see the benefit to themselves and the organization. if the technology itself is not simple and intuitive, you’re going to have adoption issues.

what are your ease-of-use guidelines?

simple designs are the best. don’t clutter up the tool with features just because the system has the capability. think about how your organization’s culture and employee attitudes can influence the design. some companies are very precise and detailed (like an engineering firm) and won’t mind lots of help text and context information on the system. other companies and cultures value process, and a design that prominently and forcefully guides employees through the process will have a good chance of success.

another recommendation is to create two sets of information: the information that employees need and that a job seeker wants. you don’t want to bury job seekers in details. a company should prominently feature those benefit programs that are a real differentiator. most job seekers don’t need to get into the granular details of the copay on a vision plan, for example. 

lastly, spend time in the testing stage working with as many employees as you can, from as wide a cross-section of the company as is possible. systems meant to be used by all employees are very different than what most IT and systems people are used to working with. get out from the lab and see what the employees really think before you roll out a new technology to thousands of people.

if you have a question for steve, leave it in the comments. he’ll answer them through next week. for more from steve on hr technology in the enterprise, follow him on twitter and check out his blog or this interview.

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more free-ranging conversations:

• greg matthews, director of humana’s consumer innovation team, on innovation
• melanie lazarus, editor at playnormous, llc and archimage, inc.,on health games

my free-ranging conversations series has been picked up by ragan’s healthcare marketing and communications news. if you’re unaware of this resource, definitely give it a look. the daily roundup includes information from recognized global media outlets, bloggers, and local news sources. it’s the efficient (aka lazy) person’s way to stay informed.

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Getting the most out of healthcare games

Is the healthcare game industry a serious business? In this interview, Melanie Lazarus, the director of marketing for Archimage Inc. and Playnormous LLC, says playing games can help children and adults change behavior, but it has to be fun. “Games are interactive and provide a safe zone to experiment and to practice what you want to achieve,” Lazarus says. Take Glucoboy. It’s a game for kids with Type 1 diabetes. Players hook up the Glucoboy meter (which reads blood levels) to their Nintendo Wii. “They get points for testing and maintaining good levels,” Lazarus says. “These points unlock more advanced games or can be converted into game currency. Playing the game changes kids’ attitudes about monitoring their levels and teaches them to be more independent.” Read more…

this interview is part of an ongoing series of conversations on wellness with wellness managers, providers, and innovators. free-ranging conversation’s first guest was greg matthews, director of humana’s consumer innovation group.

melanie lazarus is the director of marketing for archimage, inc. and playnormous, llc, the editor of healthgamers and author and editor of monster’s blog, playnormous’ corporate blog. healthgamers is a community forum that provides reviews, articles, and up-to-the-minute research and news. playnormous is an online health gaming community for kids ages 6 to 15, parents, and teachers and was just nominated for marketer of the year award by the american marketing association.

i invited melanie to be a guest out of purely selfish reasons: i know precious little about health games—beyond wii games—and i’m sure i’m not alone in that. yet health games are serious business and they’re getting serious attention. just this past month, the robert wood johnson foundation’s health games research national program dedicated $1.85 million in grants to study their effectiveness.

sitting in front of a computer to improve health seems counterintuitive to me. what’s the logic behind health games?

we’ve worked with the medical research community for many years to base our health games on sound scientific theory. for example, bandura’s social cognitive theory—a well-respected and highly used psychological theory—tells us that enhancing people’s skills and confidence can help them change. so, say you want a child to eat five servings of fruit and vegetables a day. using a game can teach a child not only how to identify those foods which count as a serving, but also how to incorporate them easily into the day (such as substituting a side at lunch) and even buy them on a small budget (such as frozen or canned).

for behavior change, knowledge is necessary but not enough. we really believe that to change behavior, it has to be fun. health games are fun. they’re also immersive and emotional—users become invested in a story or in trying to get a higher score and compete with their friends. this keeps their attention, a necessity for changing people’s behavior. games are interactive and provide a safe zone to experiment and to practice what you want to achieve. in some games, you can see how characters work through health problems—role-modeling, in other words. and games are tailored to the user. users can create avatars based on their ethnicity, age, [and] bmi, which gives games more meaning.

can you give me some examples?

i focus on children’s health games, so i’ll share some of these. in archimage’s games, like nanoswarm, escape from diab, and squire’s quest! 2, users first learn how to reduce obesity and avoid type 2 diabetes by watching how a character acts. they then set their real-world health goals and their real-world actions affect the goals of the game.

other good examples are glucoboy and me2universe. glucoboy is a game for kids with type 1 diabetes. kids can hook up the glucoboy meter, which reads their blood levels, to their nintendo gameboy^®. they get points, or glucoreward points, for testing and maintaining good levels. these points unlock more advanced games or can be converted into game currency. playing the game changes kids’ attitudes about monitoring their levels and teaches them to be more independent. me2universe is a physical fitness game that connects kids to a 3-d world. using a handheld device, similar to a pedometer, kids perform physical activity. every step they take powers their avatar, and they earn powerpoints by doing things like run up stairs. their game performance depends on how active the person is in the real world.

what results are these games producing?

in a pilot study of 3rd–5th graders, children who played food fury more than once increased their knowledge about what constitutes a healthy choice by 60%. the longer they were exposed to the game, the closer they came to 100% correct identification. after playing squire’s quest!, kids increased their fruit, juice, and vegetable intake by one serving a day (huge!).

do you see games moving more into the forefront of our health conversation?

many health games are still research-based. they’re put on the shelf once the research is complete, either because they’re outdated by the time the research is complete or there’s no funding to distribute them. i think that groups like the robert wood johnson foundation keep funding new projects because they don’t realize there are many good ones already out there. i hope this changes in the future.

with our employer-based insurance system, are insurance providers including health games in their services?

humana has humana games for health. and i’m starting to see more interest from other providers, such as kaiser permanente with their school-based health game, the incredible adventures of the amazing food detective.

how can companies leverage health games or the ideas behind what makes them successful?

most companies don’t know the average game player is 36 years old. companies can use games to support their interests in prevention and maintenance, exercise and nutrition, tobacco prevention, heart health, [and] stress management.

i highly recommend adding a section of interesting free health games to a corporate benefits or wellness website (check out how university of texas is doing it). if a company’s really serious about using health games to their fullest, they can invest in creating their own suite of health games or licensing existing ones that fit their corporate culture. if there’s a particular game they want and can’t find, a health game design firm like archimage can build one from scratch or re-skin an existing game with a health theme. whichever route a company chooses, it helps to associate the company brand or logo with whatever’s offered to employees (such as licensing games to put on your own site versus just sending out an email with a link). employees are more likely to actively use health games if they feel their hr department values them enough to put their name on it.

if you have a question you’d like to ask melanie, ask away—she’ll respond on the blog.

if you want to keep informed on health games, healthgamers is an excellent resource, as is health games research, which will soon have a searchable research database.

welcome to the first free-ranging conversation, an ongoing series of wellness chats with managers, innovators, and experts from related disciplines. my first guest is greg matthews, director of humana’s consumer innovation team.

the consumer innovation team was created in 2000 and charged by mike mcallister, humana’s ceo, with the task of being disruptive to “business as usual—to be the sand in the oyster.” i chose greg as my first guest because i felt this idea of being the sand in the oyster set the perfect tone for what the “free-ranging conversation” series is all about: new ways of thinking about employee wellness programs.

i learned tons in the hour we shared, as evidenced below. i was particularly impressed by humana’s broad definition for “member”—employee, public, actual customer―and the way they’re turning the notion of wellness on its head. not program-centric, but patient-centric. built into our lives—what we like to do, how we like to do it.

where does your group typically get its ideas?

our ideas can come from anywhere. we’ve set ourselves up to be very good listeners and trend watchers. in terms of a formal innovation process, we have a daylong session every quarter with a representative group of employees. with them, we develop 20 to 30 different ideas for health problems we’re trying to solve; our team picks the 10 best ideas. for these, we develop a concept prototype—a storyboard, or a picture, a video, even clay models—some way to better demonstrate the idea. we then narrow these down to two or three to further develop to see if they have practical application. we build actual physical application prototypes that come to “live” on our floor. our employees, executives, partners, and guests can come and play with them for a few months to see how they’re best used and what we might do with them. we also have relationships with universities, engineers, and health entrepreneurs where we get additional ideas.

how do you determine whether there’s a practical application?

we pilot a lot of ideas with our employees. we piloted high-deductible health plans, our more options and choices for humana’s associates (mocha). (after eight years, this is now the only medical plan option humana offers.) early on, we incorporated “mocha mentors,” power users for annual enrollment who help answer other employees’ questions. we piloted our mobile phone-based nutrition project, which now operates under sensei. our freewheelin’ program was also piloted with employees, then taken to presidential conventions. now this program is in its next stage: a joint venture with trek and crispin porter + bogusky, b-cycle.

it’s a laboratory approach. we build and incubate ideas. we test something on a small scale to learn whether the idea will work and how to leverage it. we survey and conduct data analysis before, during, and after pilots. eighty percent of our ideas don’t make it to real life.

when do you need to show the business roi of these ideas?

after the pilot, we develop a business plan. we see whether the idea will scale, whether we can be profitable. going back to the bike-sharing system, for example, we developed a business plan that led directly to this joint venture and b-cycle. another example is a health game we created with walt disney studios for their movie “g-force.” operation planet savers tied in to the movie and was part of the movie launch. the idea is to create products for commercial use.

what’s your team working on now?

we believe health rewards—financial incentives—are in their early development. they provide a “guardrail” for employees and are a great way to get someone started. we want to take rewards to the next level, to nonfinancial rewards, incorporating all of our innovations into rewards.

we’re also running two experiments with some communities right now. one is with an online health community. we’re testing the effect of dropping experts into existing social networking communities. the second experiment is in our guidance centers. we’re taking these real communities and bridging them with online social communities. the more we can incorporate social concepts, we’ll make wellness “sticky.”

unfortunately, most of us aren’t in idea incubators. what can companies take from you and apply themselves?

i think the most important takeaway for anyone who’s serious about making an impact in wellness is to stop thinking like a health professional. we default to a really paternalistic view of what people “ought to be doing” and are baffled when they don’t. then we think that maybe we haven’t communicated clearly enough about what people ought to be doing. but the truth is, in almost every case, a lack of knowledge isn’t the issue. it’s not our communication style. it’s that we haven’t fit our program into the typical health consumer’s lifestyle—we haven’t appealed to the things that they already want to do. it’s really at the core of any consumer-centered design.

question for greg?

greg’s agreed to make himself available to me for a little longer. so if you have a follow-up question or a thought, please leave a comment.

i want to say thanks to greg for his willingness to jump in and support this uninitiated endeavor. via his tweets, blog posts, and email exchanges, greg impressed me with his intelligence, creativity, energy, and generosity. after talking with him, i’m even more impressed. you can find him on twitter and contributing to his team’s crumple it up blog.

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