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Implementing the reward mechanism to encourage behaviour change

As grown-ups in the 21stcentury, we are all patently aware of what we should do to live a healthier life. So why is there still a large proportion of the population that seems unable to do the right thing and make the correct decisions for their health?

A couple of things in this statement bear further scrutiny.

First is the vaguely judgemental tone employed by those of us involved in the healthcare industry to express our frustration. We tend to do this when large swathes of the population don’t take their medication, won’t increase activity, won’t eat the right food and won’t quit smoking. However, our judgment is often based on what we would do. This assumption makes us victims of what’s known as the false consensus effect. This is an attributional cognitive bias where we believe that our own personal beliefs, opinions, behaviours, likes and dislikes are also normal for most other people. Unfortunately, that bias is often reinforced by reflection from our friends and colleagues in our industry. The reality is very different.

The truth is that only a small proportion of the population actually spends its waking and working hours thinking about its health. Now let’s look at it from another, incredibly obvious, point of view. A lot of positive health behaviours, especially those that many people REALLY need to adopt, aren’t particularly attractive. Why? Simply because they often involve doing less of stuff that people like and more of stuff that they really don’t want to do.

Which brings us to the second thing.

Rewards are only rewards if they feel good to people. Again, from a healthcare industry perspective, what could feel better than a new personal best on a Strava segment, or smashing my 25,000-step record on Fitbit? Quite a lot, as it turns out. Non-health obsessed people (i.e. most of the population) are constantly expected and encouraged to replace things that have a built-in reward with something for which the reward is completely and utterly intangible. Reducing the odds of something bad happening at some unspecified time in the future does not get those dopamine juices flowing in quite the same way as a nice carb and fat laden meal, a drink, a cigarette or a Victory Royale in Fortnite. Tragically however, none of these aforementioned delights will do much to improve anyone’s type 2 diabetes, for example…

The key to making differences here is to make rewards for healthy behaviour relevant to the audience in whom we are interested, rather than to us. Harnessing the reward mechanisms in our brains is very helpful here. The interesting thing is that the way we process reward doesn’t appear to differ for real or virtual rewards. Creating surrogate, virtual rewards that are immediate for healthy behaviours is a powerful way to reward behaviour change. The most important thing to do here is to define rewards that our audiences find attractive and to keep changing and adding to those rewards over time to maintain interest.

So you’ve set yourself a New Year’s resolution…

So, you’ve set yourself a New Year’s resolution… That’s great, but how do you turn this expressed desire into a real, lasting improvement? The evidence for successful adoption of New Year’s resolutions isn’t encouraging. According to Forbes overall success is about 8%. However, before we abandon any hope of self-improvement let’s look at ways we can change our habits. Erasmus wisely said that “A nail is driven out by another nail; habit is overcome by habit.” This view is supported by our increasing knowledge in neuroscience.

Why we form habits

We form habits, essentially, to save precious energy. The brain consumes energy at 10 times the rate of the rest of the body per gram of tissue. Even at rest it uses around 20% of the total consumed energy of the human body. So, anything that automates processes and reduces that demand is of great evolutionary benefit. Habits are about short cuts. The more often we repeat them the more likely it is that we will do it the next time without even thinking about it. They are automated processes that, with each repetition, are wired further into our neurones. So how do we form good habits?

  • Step 1:  Understand what triggers your current habits. To change a habit, you first need to recognise what triggers that response? Does receiving a deadline for a major project trigger immediate procrastination?
  • Step 2:  Decide which behaviours you would like to become your new habit. For example, would you like to replace the procrastination with an immediate period of outline planning? Be very specific.
  • Step 3:  Decide how you are going to reward yourself for each successful deployment of your new behaviour. Rewards are important. The establishment of habit is closely linked to dopamine reward, which is often how we get into bad habits. Problem gambling is strongly linked to this mechanism. Augmenting the brain’s reward system helps establish the new habit.

So, try this. Imagine you’ve received a deadline. You’ve immediately done some rough planning and role allocation. Try going out and getting a coffee or having a 5-minute walk… or something else simple that you enjoy doing. Repeated often enough, your brain will rewire your neurones to create a new habit to replace the old one, giving you the best chance to be one of the 8% who succeed over time. Good luck!

Book review by Gabriella Rose – “When breath becomes air”

Paul Kalanithi sought to understand one thing, the meaning of life. He wanted to grasp what it is that defines our existence and endeavoured to explore the boundary between life and death. This book is a beautiful memoir in which Kalanithi shares with the reader his own personal journey into discovering such meaning. You experience his shift in perspective of the world in which he lives and the decisions he faces once being diagnosed with terminal cancer at the age of 36. Kalanithi was an impressively intelligent and high striving individual who, as a chief resident of neurosurgery at Stanford, was just months away from completing 10 years of hardest and most gruelling training of any clinical fields.

His journey there was not a straight road. From an early stage Kalanithi’s fascination with the inevitable interaction of science and mortality, he strived to learn about “what makes a virtuous and meaningful life”.

He began this mental exploration with two B.A.s and an M.A. in literature combined with human biology at Stanford, but gave up the pursuit of a full-time career in writing by doing a Masters in the history and philosophy of science at Cambridge. Unsatisfied with philosophical reasoning, Kalanithi looked to the most critical place for human identity; the brain – he pursued a career in Medicine at Yale before returning to Stanford for a residency in neurological surgery and a postdoctoral fellowship in neuroscience.

Having led a fascinating life, Kalanithi did not want to leave it unrecorded, in his inspirational memoir he expresses his insights and emotions, without a hint of self-pity, of being a doctor, a patient, a husband, a father and the strains and gratifications that came with them. He invites you to become entirely emotionally invested in his journey, and the issues that he faces during his shift from the all-powerful doctor to the helpless patient, you share his pain and anguish. He soldiers on writing the book through his weakest times, a real representation to his commitment and dedication to the cause.

Kalanithi’s wife writes the afterword posthumously about his last few days and his inspirational outlook on his short but successful life. He was a man that had so much to contribute to the world.

A beautifully powerful book. Truly thought provoking and eye opening, it will most likely leave you sobbing at such a tragic loss of an unbelievably talented man whose words will change your perspective on the world we live and die in.

We just need to know one more thing…

Ever seen a boss, a colleague or (heaven forbid) yourself behave in a way that, however seemingly rational, is incredibly obstructive? Before they’ll approve or support a project, there is always one more fact they need.

Chances are that they are in the grip of a cognitive bias called the “information bias”. This is what drives us to look for information about a situation long past the point that this information has any bearing on the decision being made. Worse still, if you play along hoping that you’ll eventually get what you need, you could be stuck there until you get to a point where the question can’t be answered and they’ll never approve it.

This was illustrated best by Baron, Beattie and Hershey (organizational behaviour and human decision processes 42,88-110 (1988)) in their fictitious diseases diagnostic problem. In essence, a patient presents with symptoms suggestive of one of three conditions, one of which, globoma, at a probability of 80%. There is a test, the ET scan, which would certainly rule in or out the other two diagnoses but would give a 50/50 for globoma.

In spite of the fact that the probability of the patient having globoma (80%) was unchanged before and after the ET scan, and the patient should be treated for globoma irrespective of the result, a small but significant number of subjects insisted on the test before treatment.

For these subjects it took a significant amount of questioning about the usefulness of the test before they realised their mistake.

When faced with this situation, it’s probably best to approach the person after the meeting (it’s always in a meeting, right?) and ask specific questions about what and how the extra information will change the decision. Otherwise, when you spend precious time and resources getting the answer to this question, the chances are there will be another.

Trying to influence someone? Offer them lunch or ask for a favour?

This would seem like a stupid question with a pretty obvious answer. But, as with many things involving human beings the most likely answer is pretty surprising. There is a behavioural bias at work here which makes asking a favour more likely to be successful.

Asking someone, who you’d like to create a positive impression with, to do you a favour probably seems a bit strange, even counter-intuitive. But there is a good psychological basis for doing just that. There is a great deal of evidence that supports the idea that doing favours for people disposes us more positively to them and makes us more likely to do them another favour.

A simple example would be sending your “target” an article you wrote and ask their opinion prior to your first meeting. Or you could ask them to contribute to your thinking by sharing what they believe to be important new products, trends etc. arising in the market place. The important thing is that you are asking personally. Asking favours like these have a very low barrier to fulfilment (people love sharing what they think) and are likely to be more successful than asking if you can borrow their Aston Martin for the weekend.

The “Ben Franklin effect” posits that a person who has already done you a favour is more likely to do you another than someone for whom you have done a favour. He described it as an old maxim in his autobiography:  “He that has once done you a kindness will be more ready to do you another, than he whom you yourself have obliged.” He then also described how he had practically used this maxim on a hostile rival in the 18th century Pennsylvania Legislature.


This effect has been connected with cognitive dissonance theory. We try to avoid conflicts between what we do and what we believe. In this instance, the behaviour drives the belief: “I did that person a favour, so obviously I must like them”.

It’s useful to know in many situations. Who wouldn’t want a new customer, your boss, or a key opinion former feeling positive about you? As a strategy for dealing with more people who may be less well disposed to you, asking them to do something for you that will help you solve their issue is particularly powerful.

If you are stuck with an approach strategy to a particular person, it may be worth stopping thinking about what you can do for them, and think of what they can do for you.

Is your brand a few bars short of a symphony?





If not, why?




Beethoven’s Dopamine Symphony




Clever huh?



Bespoke means a better ROI






Four watch-outs when creating sonic branding






What would Steve Jobs have said about your eDetail campaign?

I recently saw a Steve Jobs YouTube clip from the 1997 Apple worldwide developer conference. There he was, in his trademark black polo neck, perched casually on a bar stool, taking questions from the floor. There’s a good chance you might have seen it too as it’s been watched by over 6 million people.

One man in the audience stood up and said: “Mr. Jobs; you are a bright and influential man” (so far so good) but then he added, “…it’s sad and clear that, on several counts, you don’t know what you are talking about. I would like you, to express in clear terms, how, say, Java addresses the ideas embodied in OpenDoc…”

Essentially, what this man was saying to Steve Jobs was: “you don’t understand the technology”.

This reminded me of a recent discussion we witnessed at a meeting with one of our clients.

It centered around one of their recent eDetail campaigns. Apparently, less than 10% of reps were using the tablets the company had supplied to them.

As you can imagine, such a disappointing usage figure quickly prompted a heated debate. On one side, it was argued that “the reps clearly did not understand the platform”. Similarly, a counterpoint was made that “the marketing department weren’t developing solutions that made best use of the platform”.

The truth is that the eDetail simply wasn’t addressing the fundamental needs of the reps. They weren’t using it because it added absolutely zero value to their sales calls. Much worse, what transpired was that the eDetail was actually making their calls much more difficult than they had previously been with a print detail aid.

Unfortunately, this is an issue we’ve seen played out at a number of pharma companies. And it isn’t the fault of the marketeers or reps.

Closed Loop Marketing (CLM) platforms were conceived at a time when the internet was in its infancy. They were originally set up to realise the opportunity of the laptop computer. Companies would simply take their paper detail aid and put it onto the laptop, and, later tablets.

Now, nearly every CLM platform is really just a locally-hosted web solution which captures data and uses it to deliver a semi-personalised experience.

But ultimately, it is a restrictive, and obsolete technology. Website user experience, and supporting technologies already deliver personalised experiences that far outpace any CLM. But too many organisations have invested too much in CLM to simply admit any shortcomings and “pull out”. (The observant will have recognized this as classic loss aversion in action.)

Which brings me back to Steve Jobs.  His answer to the challenge was: “You’ve got to start with customer experience and work backwards to the technology. You can’t start with the technology.” And everyone knows how well Apple grew under Steve Jobs.

Maybe it’s time more of us in healthcare marketing followed Steve Jobs’ example and paid more attention to the customer than the technology.

Why apps that fail to reward ultimately end up failing

I was in a client meeting the other day when I was asked a very blunt question. We were talking about behaviour change, gamification and apps. His question was simple. “Why do many apps, gamified or not, suck and fail?”

From a fail point of view, probably the main cause of failure is that no one ever sees them. All the money went on dev with nothing left for promotion, the cause of death for many an app.

The second reason is that the usage opportunities are so narrow there’s little point in having an app. Staying at a hotel chain the other day I was invited to download their app “to chat live with a host”. Really? I can’t just ring room service or talk to the concierge? I’m sure that it does other stuff but if this is their lead functionality, unless I am mainlining this chain’s loyalty programme, that download is never going to happen.

These two are pretty obvious, as are their solution. Don’t spend all the cash on dev, have a plan to promote your app. Don’t develop an app that only you need…

Another fail is the experience itself. This is more subtle…

The experience, particularly in health, may well not be all fun but could be challenging, interesting or even plain hard work at times. The key is that it must be rewarding. This too is a concept clearly understood by the mobile gaming industry. Many games contain an element of the “grind”. This is when, at points during the game, you have to carry out repetitive tasks in order to achieve a better level/equipment/skills which allows more interesting stuff to happen.

The way that this is handled should be of enormous interest to anyone wanting to harness gamification techniques to drive behaviour change. It is well documented that our brains release dopamine – a key reward neurotransmitter – both when we get a reward and/or achieve an objective and in anticipation of that reward or achievement.

It’s easy to see how this could work from a health behaviour change perspective. Starting with simple day-to-day objectives and tiny changes which are rewarded, then building harder to complete multiple missions around diet, smoking, activity, health education etc. with each carrying increasing perceived rewards. The piece about perceived rewards is key. The rewards experienced via dopamine can be triggered virtually as effectively as in reality.  This explains why so many millions of hours have been eaten by Candy Crush Saga™…

So the three main answers to my client’s question are as follows:

  1. they’re invisible
  2. they’re not useful
  3. they’re not rewarding

You might just survive getting one wrong (as long as it’s not the first one) but good luck surviving two!


The Fall and Rise of Useful Advertising

Remember when programmatic was going to effortlessly turn DDA (digital display advertising) into a push-button instant revenue generator for clients, agencies and media owners alike? As we all know, this prophecy hasn’t quite turned out as many would have hoped. But fear not. As Joe Hoyle explains, the digital world is well-served by opportunities to fulfil everyone’s and every brand’s qualities and ambitions.

Programmatic tools were widely deemed to be the promised land for digital display advertising (at least that’s what the media industry wanted us to believe).

However, it didn’t count on the power of consumers to deploy their own new set of powerful tools, effectively enabling them to ’cock a snook’ at the advertisers and their agencies who were producing a glut of ubiquitous, lazy creative that followed them around the web like a bad smell.

And it’s a real shame, because brands can most certainly advertise, entertain and sell products and services, whilst still delivering useful customer experience as added value that will engage the audience.

Back in 2008, online display advertising was starting to get really interesting – both technologically and creatively. There was an opportunity to start delivering real, tangible super-rich customer experiences inside new, larger-format display units that could be targeted to specific users and even personalised in terms of their content. In parallel, programmatic media buying was gathering pace.

Things were looking up for advertisers. They were about to be armed with tools that would allow them to buy media on the fly at much better value, target more accurately and progressively re-message to encourage consumers further into the purchase funnel. We were even starting to look at producing commerce-enabled campaigns.

A step back

However, things didn’t go exactly to plan. It quickly became obvious that the new media technologies couldn’t serve or interrogate the more advanced and intelligent creative that was being produced. As a result, the industry ditched creative innovation in favour of simply following the media money until advertisers became disgruntled with the return to basic creative messaging and a meaningless 0.01% CTR.

The stark legacy of this practise is an industry that has clearly become more and more inward-looking over the last few years. Also, it has completely disregarded the audience and, in turn, its clients’ needs. What it also precipitated was a general widening in the gap between the creative and planning departments.

An integrated approach

So what’s the answer to this? First and foremost, we need to adopt a completely new creative approach to digital advertising… one that intelligently combines all tools at the disposal of creatives and planners and encourages them to work more closely to realise digital’s true potential. Hopefully, campaigns will then become much more integrated, using a combination of channels and mobile devices as a enablers rather than standalone channels.

Putting users first for Vodafone McLaren Mercedes

In our experience, the best results come when campaigns put users’ needs at the forefront of the strategic planning phase.

When the Vodafone McLaren Mercedes F1 team approached us a few years ago, they initially wanted us to stream a selection of HD videos inside our proprietary display unit. They wanted to create a distributable channel inside a media unit that could be seeded in paid media and blogs then shared across fledgling social media and earned, free media.

This was all well and good (not to mention also being a media first) but something was missing. We felt that the audience we were targeting would be more engaged with another data set that was available. So, we set about taking the difficult steps to persuade the racing team to provide is with the live telemetry from the two McLaren cars of Lewis Hamilton and Jenson Button. And it worked.

Over an extended campaign of four years using essentially the same unit with updated functionality and content – much like an app these days – we delivered 10% interaction rates and astounding 32-minute interaction time during practice, qualifying and race sessions.

Lessons we’d all do well to learn

There are several key take-outs from our work for Vodafone Maclaren Mercedes, and subsequent campaigns that still ring true.

First, campaigns don’t just have to advertise, they have to engage and fulfil.

In the campaign for Vodafone Maclaren Mercedes,  the content channel was as critical as the content itself. As someone once said, “if no-one can hear you scream, you may as well whisper for help!”.

Secondly, programmatic and fast-pace retargeting deliver highly-sought efficiencies for clients and their brands – the real challenge is to reignite a passion for innovative and successful advertising that engages within this landscape.

Finally, and possibly most importantly, people – be they customers or marketers – will always find a way around limitations. The best way to make this work is to collaborate, co-create and re-imagine together.

Read the full Vodafone McLaren Mercedes case study

Are you making the classic multichannel marketing mistake?

When we consider MCM it is vital that we remember what the last ‘M’ stands for – Philip Kotler defines marketing as “the science and art of exploring, creating, and delivering value to satisfy the needs of a target market at a profit”. Fundamentally, this still defines how we approach marketing strategy and MCM as an integral part of that.

From an MCM point of view, one common definition brings together most of the required elements:


For me, the key take-out is that it’s all about customer need and choice, ie the customer chooses the channel so they are in control. Therefore, the multichannel approach is built firmly around customers to meet their needs.

None of the definitions that I could find says that MCM is a way of using different media, built around the sales force, to deliver a sales story.

“So what?”, you might ask. Well, the reason I am writing this is that I have just read a recent piece (2016) by IMS titled ’The Essential European Revolution: Why Multichannel is Vital to Europe’.

The key success factors that they identified in their lead case study make interesting reading:

  • Content is king: Doctors seek content that is interesting and useful to them – rep personalisation of content and feedback on what doctors use enables reps to further establish
  • Empowering the reps in the move to multichannel is vital: Regional multichannel rep “ambassadors” understand the need for change and can effectively communicate the benefits of a multichannel approach
  • Digital enhancement of each rep’s effectiveness and reach

As an observation, “content is king” has been true since we learned how to smudge pictures onto cave walls, but do doctors really want representatives to filter it for them? The last two points really frame why this thinking is problematic.

For me, the big questions are “where is the customer?” and “where is the mobile revolution?”. IMS are talking multichannel selling here, not multichannel marketing.

This is the crux of the problem. And it’s not simply semantics; there is a key difference here. Yes, in multichannel sales we use limited channels, controlled by us, to tell the customer what we want to say. But that’s very different to multichannel marketing. And, if companies like IMS make this basic error, it isn’t surprising that it is still a common misapprehension in the industry.

Google talk about “winning the moments that matter” when building multichannel strategies. This entails creating approaches around our customers, their needs and behaviours to ensure that we are there with the right mix of push and pull interactions whenever key information is being sought or key decisions are being reached. Or, as Byron Sharp terms it, “building memory structures that trigger recollection of our brands at those points”. So we still get to say what we need to say, but at points where it is much more relevant to the customer.

If we wish to be successful we need to build our strategy and infrastructure around those objectives. Delivering the selling story is part of that, but can’t define its totality.

Maintaining focus on our customers’ needs and how we meet them, as part of the overall marketing strategy, in an integrated way, is much more likely to lead to success than sawing off a part of that, labelling it MCM and somehow treating it as a separate activity.