Monday, October 19, 2015

The Football Diet


BOOM! I feel better than I have since John Madden was watching Joe Montana run 2 minute drills to win Super Bowls. After gaining and losing weight for years, tearing up the middle of the field without making any real progress, I invented the Football Diet.

I used it to lose 20 pounds and maintain a healthy weight for several years. You won't mistake me for a professional athlete, and an actual football player probably wouldn't use it, but the Football Diet helps me look and feel better.

To design the Football Diet, I used a combination of behavioral science, personal experience, and tailgating creativity. It's been helpful to me, and if it's helpful to you I'd love to hear about it.
The Football Diet has three main parts:
  • Offense and Defense
  • Special Teams
  • Blocking and Tackling

Highlight Reel

Before I lay out all the details, here’s your quickstart guide to the Football Diet:

Offense & Defense. Every week you’re either on offense or on defense. During an offense week, you’re trying to lose one pound. During a defense week, you’re trying to not gain weight.

Special Teams. Every now and then, you need to punt. On Thanksgiving Day, I punt. I spend the whole day sitting down, eating and drinking whatever I want. Unlike offense and defense, which each last a week, a punt only happens for one day. Then it’s back to offense and defense.

Blocking & Tackling. Playing offense and defense is mostly about the mentality and motivation you bring to the game. And blocking and tackling is all about the fundamental skills you apply while playing offense and defense. This is where we talk about setting ourselves up for success by doing the basics right.

That’s the 2-minute highlight reel on the Football Diet. Now let's dig into the details, starting with the keys to your game plan, offense and defense.

Offense and Defense

In the Football Diet, you spend every week preparing for Sunday. And every Sunday you decide whether the coming week you will play offense or defense. You and your fans always know whether this is an offense week or a defense week.


I think of every offense week as a set of downs. If you’re on offense, your immediate goal is not a touch down—you just need to make 10 yards—enough to get a first down. For me, 1 pound is a first down. So when I’m on offense, my goal is to lose 1 pound by Sunday. If I weigh 168 on the Sunday that begins an offense week, I try to weigh 167 the following Sunday.

I weight myself every morning when I get out of bed. I’ve heard that this is a bad idea, because it can make you obsessive, and because your weight can fluctuate so much from day to day. But for me it helps, because it reminds me each day that I’m reaching for a very specific goal. If my goal for an offense week is 167, and on Thursday I’m at 169, I’m going to press extra hard to bring it down by Sunday. If I’m already at 167, then I have extra incentive to not pig out Thursday night—I’m almost there!

How do I lose that 1 pound? That’s where the blocking & tackling comes in, as described below. The important thing is that during an offense week, I’m actively trying to lose weight, but I’m not trying to make a touchdown—I’m not trying to lose 5 pounds in a week. If I can lose 1 pound each offense week, and if I play good defense, I’ll eventually make it to the end zone, my target weight. And I won’t have to starve myself to get there.

This is based on good behavioral science—you’re much more likely to be successful if you take small, achievable steps. People don’t typically give up on a goal when they’re making progress toward it—we give up when we “fail.” So with the Football Diet, you give yourself a goal that requires some effort and discipline, but is doable—it’s within reach. When you’re on offense, do whatever it takes to lose 1 pound by Sunday. That will move the chains, and you’ll be 10 yards (1 pound) closer to your goal.

Remember, every offensive play doesn’t gain yardage. Sometimes your quarterback gets sacked or your running back gets caught behind the line of scrimmage. So if you have a rough day during an offense week, just figure out how to make up the yardage—an extra trip to the gym? Salad for supper? It’s an offense week, so you have 7 days to move the chains.


Think of the best football team of all time, playing their best game of the season. Were they on offense the entire game? No. They won because they played great offense and they played great defense. If we try to play offense all the time, we’re setting ourselves up for failure. And failure leads to dropping the whole game. So the Football Diet mixes offense and defense. I don’t necessarily alternate back and forth from one week to another, but I make a conscious choice each week—will this be an offense week or a defense week?

If it’s a defense week, you’re not trying to lose weight. Instead, you’re trying trying to not gain weight--you’re playing defense, trying to keep the other side from making a first down. On a defense week, your goal is to end the week at the same weight you started. If you weigh 167 on the Sunday of a defense week, your goal is to weigh 167 on the following Sunday. Yes! This is a diet where you aren’t always trying to lose weight.

I weigh myself every day on defense weeks too. This gives me a gauge for how hard I need to push or how easy I can take things and still end up the same weight the following Sunday.

Motivational Locker Room Speech

Motivation doesn’t win games without blocking and tackling. But without motivation, none of us will get far. What the offense/defense approach does is help you regulate just how much motivation you need over the long haul.

Nobody can sustain willpower and discipline 24 hours a day for weeks or months or years. By switching between offense and defense, you can give yourself a break, not having to push yourself to constantly lose weight for months on end. It lets you build a rhythm of intensity. The really cool part is that even when you’re on defense, you haven’t “gone off” your diet. You’re still paying attention, still in the game.

Before I invented the Football Diet, I was either on offense, or I was letting the other team score touchdowns. Once I screwed up on my plan, I would just keep eating and drinking too much, and I’d stop exercising too. It took a major effort to get back on the plan. But with the Football Diet, I can take a break from the constant pressure to lose weight, without abandoning my overall game plan.

I think defense is the key to the Football Diet. Not only does it let you give yourself a break without losing ground, playing defense gives you the practice you’ll need once you’ve reached your target weight, so that you can attain your real ultimate goal, which is to maintain your target weight.

This is really important. Virtually any diet can help you lose weight. The trick is to stay at a healthy weight over the long haul. If your diet plan only teaches you to aggressively lose weight, it won’t work for you once you reach your target weight. With the Football Diet, you’re actually practicing sustainable behaviors every time you’re on defense.

I’ll leave it to you to decide which weeks are offense and which are defense. The important thing is to decide by Sunday, and then stick with either offense or defense for the whole week. You can’t win the game, or the week, without a game plan.

Special Teams

Offense and defense are the keys to the Football Diet, but there’s more!


No football team can succeed if it refuses to ever give the ball away. Sometimes we have to punt. And I refuse to accept any game plan that won’t let me eat cake and ice cream on my birthday. On Thanksgiving Day, on my birthday, sometimes while on vacation, I punt. In the Football Diet, punting means I eat and drink whatever I want, as much as I want, and I don’t exercise unless I feel like it.

Here are the keys to punting in the Football Diet:
  1. You have to plan it in advance (otherwise it’s a fumble—see below)
  2. It lasts only one day. Football teams don’t punt 2 plays in a row, and I don’t pig out 2 days in a row.
  3. After punting, go right back to offense or defense the next day.


Nobody’s perfect. We all drop the ball sometimes. Maybe it’s an offense week and I skip exercising 2 days in a row, or it’s a defense week and I accidentally eat an entire pint of Ben & Jerry’s New York Super Fudge Chunk. Just like in football, here’s the key to dealing with fumbles:
  • It happens. Get over it. Don’t beat yourself up.
  • Get right back into whatever your game plan was for the week—offense or defense.

Ball Control: If you notice you’re about to fumble,
  • The most important thing is to notice you’re at risk, so you can protect the ball.
  • Ask yourself if you’re really, really going to enjoy this fumble. Why turn over the ball for a third helping of a casserole you don’t even like?
  • If you notice early enough, ask your fans for help. The sooner you can do this, the better (see “hot & cold” below). I’ll sometimes say to my family, “OMG, they have a chocolate fountain over there. Please help me eat only one banana’s worth from the fountain.”

End zone Dance

The main thing about the Football Diet is to focus on one day, or at the most one week, at a time. Lose a pound this week. Don’t gain a pound this week. It’s all about making first downs, moving the chains, rather than scoring a touchdown. But that doesn’t mean you can’t have a bigger goal. Just don’t get too wrapped up in it, and don’t measure yourself against it all the time.

With the Football Diet, you aren’t going to score by throwing an 80 yard touchdown pass. You’re going to work you way down the field one play at a time and then score with a run straight up the middle.

But when you do finally score a touchdown, when you reach a big milestone, do a fabulous dance in the end zone. Celebrate! Here are the keys to a great end zone dance in the Football Diet:
  1. Celebrate with your fans!
  2. Plan it in advance, because you want a great dance, but…
  3. Don’t draw a penalty for overdoing it.

The best end zone dance will be a great celebration with your friends that doesn’t set you back and take points off the board. As you approach your goal, think about something you love to do, with others, that’s healthy. A great concert, 50 yard-line seats at the next game, a weekend trip, an entire weekend without doing anything useful! Plan it in advance so you have extra motivation to meet your goal, and so you don’t pick an end zone dance that will draw a penalty because you ate too much and went right back over your target weight.

The Extra Point

When I reached my target weight, I was so pleased with myself, and so confident, that I did 3 more weeks of offense. This lowered my weight just a little bit more, to the point where now I can fumble, gain a pound or two, and still stay in my weight range. Yes! Of course, that brings us to…

Blocking & Tackling

Let’s face it—football is mostly a matter of running around knocking each other over. Whoever does that better is likely to win. We call it “blocking and tackling,” and it’s the unglamorous part of the game of football and the Football Diet. So what does good blocking and tackling look like when you’re doing the Football Diet? Here are the techniques that have been most helpful to me:

Build on your strengths

Don’t make this all about depriving yourself of things you like. Make a list of healthy things you enjoy doing and eating, and do them more often—especially on offense weeks. For me, the list includes things like these:
  • Dancing
  • Walking and hiking
  • Fresh fruit
  • Ice tea
  • Kombucha (check it out!)

It’s easier to increase healthy things you enjoy than to decrease unhealthy things you enjoy. So be sure to:
  1.  Know the healthy things you love
  2. Do them more
  3. When you’re doing them, notice how much you enjoy them!

Know your weaknesses

Even great football teams have weaknesses. But they know their own weaknesses and take great care to not let those weaknesses bring them down. Think about your weaknesses and be ready to bring in a free safety or an extra blocker.

Food & Drink

When it comes to weight management weaknesses, I know where to look. For me, it’s all about ice cream, beer, and third helpings. If I can stop eating pints of Ben & Jerry’s, limit the number of days when I drink beer, and stop eating when I’m full, I have a fighting chance of at least playing solid defense.

Pay attention to your own habits, and notice which items you tend to overdo. Just noticing this will go a long way when you find yourself at Thursday of an offense week and you’re a little heavier than you were at the start of the week.

Emotional Triggers

Sometimes I eat because I’m hungry. Sometimes I eat because I had a hard day. Sometimes I tell myself I deserve a 3rd beer, a 3rd helping, and an extra scoop of ice cream, even though it’s going to make me feel like crap afterwards. I’m trying to get better at noticing when I tell myself I deserve it and will feel better, because the truth is I also deserve to be healthy, and unhealthy eating doesn’t actually make me feel better.


Again, notice the situations where you’re more likely to fumble the ball. Come up with strategies to protect the ball in these situations.

There are two situations I’ve learned to watch out for. The first is when I come home from work. I love to walk through the door, open the refridgeerator door, and pop open a beer. What I’ve found is that if I can make it past the first few minutes after coming home, the frantic desire for a beer declines dramatically. If I have a pitcher of ice tea ready in the fridge, and I pour myself a glass of ice tea when I get home, I’m not nearly so tempted by the beer.

The second situation, before which I am almost helpless, is free food. I don’t know why, but it’s very very hard for me to pass up free food. This includes anything where I don’t have to pay extra for more helpings, like at a buffet. To tell the truth, I haven’t figured out how to deal with this one yet. I rely on will power, and my will power is usually no match for free food, even on an offense week. Sigh…


Get the Ball Moving

This may have no base in science, and maybe it’s just me, but it seems that when I first start trying to lose weight, it takes several weeks before anything happens, even if I’m being really good about sticking to my plan. But once I get the weight moving, it’s easier to keep it moving. I think my body gets set at a particular weight, high or low, and holds it there. I’ve noticed the same thing when I’ve maintained a healthy weight for several months—I can pig out for several days in a row with little or no effect on my weight.

So the key is to keep working at it the first few weeks when nothing seems to be happening. And then, when the weight starts to move, keep going with some more offense weeks to keep the momentum rolling.

I’ve read that some people lose the first few pounds of “water weight” pretty easily and then have trouble moving past that. And there’s also something about the weight not moving when I start exercising, because I’m converting body fat to muscle. These reinforce my point—if your weight isn’t moving, keep believing that if you stick with the plan, if you keep blocking and tackling well, good things will happen. And when they do, take advantage of the swing in momentum by stringing together several offense weeks in a row.

Hot & Cold Times

There are some times when I am very committed to more healthy behaviors. These are called “cold” times, because my passion to stuff myself is low:
  • While brushing my teeth after breakfast
  • After eating and drinking way too much and feeling sick to my stomach

And here are the “hot” times when my passion to consume calories is high and I am least committed to healthy behaviors:
  • When I first get home from work
  • When free lunch is served at a meeting, especially if there are chocolate chip cookies
  • At about 9:00 p.m. when I get a craving for ice cream, or 10:00 when I get a craving for a glass of scotch or Bailey’s Irish Cream

So how do we make use of this? I try to take advantage of the cold times to manipulate my behavior in the hot times. Ask yourself, “if I were a controlling, manipulative taskmaster, how would I make sure someone in my house didn’t have a beer when they got home? How would I make sure they didn’t eat ice cream in the evening?” The easy answer—keep the treats out of the house.

So if I have an attack of conscience while brushing my teeth in the morning, because I had 2 beers when I got home from work yesterday and my weight went in the wrong direction, I can walk into the kitchen and take the rest of the beer out of the fridge. I hate warm beer, so I’m unlikely to have beer when I get home later that day. Even moving the beer to a fridge in the garage can help—anything to make it less desirable and less convenient during the “hot” times.

Fans can help too. My wife always knows if I’m on offense or defense. When I’m on offense, during a cold time, I ask her not to buy any ice cream that week. I’ve even been known to ask my wife and kid to eat my favorite ice cream before I get to it. When do I have the fortitude to make this request? During my cold times. I ask them while brushing my teeth in the morning. Or if I’ve just pigged out and eaten half of the ice cream and I’m feeling guilty and stuffed, I ask them to finish it off as soon as they can so there will be none left for me.

Working out

It turns out football players work out, and that is somehow related to how big and strong they are. Somewhere, sometime, we each have to figure out a way to get some exercise. This is likely even more important than all the stuff we do around eating. An offense week isn’t all about healthy eating—it’s also about getting as much exercise as possible. And a defense week is very much about keeping up the exercise routine, even if you’re not hitting the exercise quite as hard as you would on an offense week.

The three keys to regular exercise:
  1. Pick something you enjoy
  2. Do it at the same time every day
  3. Make it as easy as possible to do it

I have an old stationary bike that I found out by the street one day. It’s so old it doesn’t even plug into anything. But I’ve set up a music stand in front of it to hold my iPad, and I watch TV shows while I ride—ideally TV shows with chase scenes to help me pedal faster.

I ride the stationary bike every morning after breakfast. It’s in my bedroom. My bike shoes are right next to it. I don’t need to go anywhere, pay anything, or think. It’s easy, and it gives me an excuse to watch stupid TV shows without actually wasting time. I pick shows that run about 45 minutes.

On defense weeks, I ride 5 days a week. On offense weeks, I ride every day, and if I’m really pushing it, I’ll ride once in the morning and once in the evening, and I might watch longer TV shows to extend the ride. This is a lot, and I’m not saying you need to do what I do. But I am saying you’ll greatly increase your change of success if you make it easy for yourself to do somethine you enjoy at the same time every day. First establish the basic routine, then boost it when you’re on offense.

Away Games

All athletes have a harder time playing away games than playing at home, so they need to make a special effort to compensate. It’s the same with the Football Diet. Here’s the key: even when I’m away from home, I stick with offense or defense.

I will often choose to go on defense if I know I’ll be travelling that week. Knowing I’m on defense, I don’t have to fret if my healthy eating choices are limited for a given meal or my schedule keeps me from exercising for a day or two. But I’m still on defense. So I still look for healthy choices at the restaurant. I don’t stuff myself with airplane snacks. I still pick a place to stay that has a fitness center where I can work out. And if that doesn’t work, I make sure to take a good walk each day.

Some of my most satisfying Football Diet experiences have come when I was on offense while travelling. It’s amazing what you can do if you set your mind to it for a limited, focused period of time. I remember one week when I was traveling for work while on offense. I got up early and went to the hotel’s fitness center. For breakfast in the hotel restaurant, I actually had granola and low-fat yoghurt, which I never do at a restaurant, because I’d rather have eggs benedict. But since I was on offense, I had granola and yoghurt and felt great (and incredibly smug). All day long, I walked up stairs instead of taking escalators, and drank water instead of soda. And then in the evening I went back to the fitness center and watched an entire James Bond movie while biking.

Could I do that all the time? No. I don’t have the will power to sustain that kind of thing. But for 3 days in the middle of an offense week? Yes!

Get the fans into the game

Why are football teams more successful at home than when out of town? It’s partly because they’re sleeping at home, etc. But it’s largely about the fans. The fans keep them motivated, cheer them on when they’re doing well, remind them (sometimes not so subtly) when they’re not performing well, and generally help them feel supported.

Fans are a big part of the Football Diet.

Recruit at least 2 fans.

This could be a family member, friend, co-worker, or all of your 537 FaceBook friends—anyone you see fairly regularly. The key to a successful fan is what you do with them right from the start: you tell them that you’re going on the Football Diet, and you are going to try to lose one pound this week. Believe it or not, telling them your intention is huge. This is like Babe Ruth pointing at center field before hitting a home run (sorry for the intrusion of baseball).

By declaring your intention, you do 2 critical things:
  1. You publicly commit yourself to your goal. The behavioral scientists have shown that this is a huge deal that makes it much more likely you’ll do what you want to do.
  2. You recruit supporters. Your fans can help, and not just by nagging you. If they know what you’re doing, they can…

  •  Eat healthy things around you
  • Stop offering you cookies
  • Ask you how it’s going
  • Eat the ice cream in the freezer so it’s gone when your 9:00 p.m. craving hits
  • Join your team! How cool would it be to have 2, or even 11, people all on offense or defense at the same time?!

Take this seriously. What football team would want to perform with no fans? Why should you try to do this alone?

Weight Watcher Book

As I said at the beginning, I’m making a lot of this stuff up—I haven’t actually researched any of it thoroughly. I’ve read a good bit about behavior change theory and practice, but I haven’t read any diet books. Except one that I got free (I’m such a sucker for free stuff). But I really liked that one weight loss book I read, and I recommend it as a great resource with very practical advice about blocking and tackling. It’s by David Kirchhoff, the President and CEO of WeightWatchers: Weight Loss Boss. Check it out.

Post-game Wrap-up

And there you have it! The Football Diet. Here’s what you need to remember about what’s worked for me:
  1. Every week you choose to either be on offense or defense.
  2. In an offense week, try to lose 1 pound.
  3. In a defense week, try not to gain any weight.
  4. For special occasions, punt. Eat and drink what you want, but only for one day.
  5. Get good at blocking and tackling. Gimmicks and metaphors aside, if you eat healthy foods in moderation and get good exercise, you’re going to be healthier and feel better.

Have fun! And let me know how it goes.

Tim Kieschnick 10/18/2015

Friday, April 26, 2013

Exercises in PowerPoint Style

PowerPoint gets trashed in conversations all over the globe, and with good reason. As Edward Tufte has explained in The Cognitive Style of PowerPoint and Peter Norvig masterfully illustrated in The Gettysburg PowerPoint Presentation, PowerPoint has led to innumerable disastrous presentations.

But not all PowerPoint presentations are disastrous. The best PowerPoint decks incorporate fundamental principles of communication and visual design. The best PowerPoint decks actually enhance communication, and they do so through a wide variety of communication styles.

It's this wide variety of communication styles that led me to make a connection between PowerPoint and Raymond Queneaus' classic work, Exercises in Style, first published in  French in 1947. In Exercises in Style, Queneau tells a very simple, almost inane story. And then he retells the same story 99 times in 99 different styles with labels like metaphorically, hesitation, precision, animism, official letter, blurb, noble, speaking personally, and of course polyptotes.

I've embarked on a parallel project, using PowerPoint. This morning I uploaded 4 PowerPoint decks to SlideShare. Each uses a different style to communicate about the same fictitious project. I plan to add new styles on more or less a weekly basis, starting with styles that can be effective when matched with the right circumstances. The four I created and uploaded this morning are:

  • Bare Outline. This is the simple, boring shell that the rest of the styles are based on.
  • SBAR. This one uses a format created in the patient safety world to succinctly communicate about patients. In this case, I use the SBAR format to describe a software development project.
  • Butterfield Powerbite. This is based on the scheme I use most frequently to organize everything from presentations to short emails to announcements at staff meetings. Dick Butterfield taught me the scheme.
  • Inspirational. This one addresses the same fictional project from the point of view of a senior leader inspiring her workforce to rise to a challenge.
I'm having fun with this so far. Check it out and let me know what you think.

Friday, April 19, 2013

Managing Through Influence

I can accomplish very little on my own. So I put a lot of time into influencing other people. This can be especially difficult in a large company, where I need to influence people above me in the hierarchy, people in other departments, and often people I've never even met. Here are some ways I manage through influence, with special thanks to Creative Good Council 1 for their help expanding and fleshing out the list. 

Think of this as 20 tips for developing the art of influence.

As I walk through the list, I'm assuming you have a "target"--a specific individual whose behavior you want to change. I'll group the tips into 3 principles:
  1. Work the relationships
  2. Motivate and inspire
  3. Be practical

Work the Relationships

I can sometimes influence someone with whom I do not have a strong relationship, but it's a steep hill to climb. I always start by understanding, building, and leveraging relationships.

  • Align around something shared. Find something in common with your target. It could be anything from shared values (e.g., we both care deeply about the future of our organization), shared goals (e.g., we both want to meet the June 1stdeadline), or even something completely unrelated to work (e.g., we both love Louis Armstrong's early recordings). The more specific you can get, the better.
  • Understand the web of relationships. Everyone is influenced by someone else. Find out who your target trusts, obeys, follows, or listens to. If you can't directly influence your partner, find the path between you and your target. If your target is Alice, and Alice reports to Bernice, you need to influence Bernice. Maybe you have no influence over Bernice, but Bernice trusts Carlos, and Carlos has great respect for you. Once you've figured out this path of influence, you can get Carlos to talk to Bernice to give Alice an assignment.
  • Identify the saboteurs; defuse the bombs. Take some time to think through who may oppose your work and how they might wreak havoc. Is there someone who will tell your target not to listen to you? Is there someone in a position to make your target's efforts ineffectual? If you don't know, ask someone who does know. Then make an explicit plan for how to neutralize the negative impact. By far the most powerful way to do this is to convert your detractor into your champion. Another tried and true method is to keep the detractor busy with something else--find a way to get them focused on some work that keeps them out of your way. This doesn't have to be cynical or Machiavellian--many people can serve their customers and company better by staying focused on things they can actually accomplish rather than sabotaging the work you're trying to accomplish.

Wednesday, October 20, 2010


I'm at the Mobile Health Expo in the Ceasars Palace Convention Center in Las Vegas. Having succussfully maneuvered past Barry Manillow, Cher, Donny & Marie Osmond, and 20,000 slot machines, I encountered NoMoreClipboard and their interesting use of PHRs with low income diabetes patients.

Looks pretty straightforward—view portions of the medical record, enter blood glucose, send prompts to patients and to physicians.
Uses desktop web, mobile web, and SMS

They’re conducting a pilot w/ Howard University Hospital Diabetes Treatment Center in Washington, DC, in neighborhoods that have a high incidence of diabetes. Patients are typically low income and either Medicaid or uninsured. The program begins with community-based screening and initial treatment in a tricked-out RV (aka mobile health clinic). In the RV, their information gets entered in Howard’s EMR.

When they get off the RV, the patient is greeted by a “PHR Educator” (first time I’ve heard that term). The PHR Educator gets them set up with an account, which includes downloading their data from the Howard EMR system into the PHR, as well as filling in gaps in the data. Patients are encouraged to enter their glucose readings several times/day. About every three months, they collect HEDIS data from patients via online surveys.

They have 232 patients using the system so far. They've only recently launched the mobile component, and it's growing fast.

For the patients: The program provides “medical minutes,” essentially subsidizing part of the patient’s data plan. But they’re very clear that they don’t want to pay for everything. The patient needs to pay for at least part of the phone and part of the data plan, to ensure they have skin in the game. The program will provide new phones, or patients can use their existing phones.

For the physicians: Cupcakes. They’ve succeeded in getting clinical buy-in by providing cupcakes. Every time a physician gets another 20 patients signed up, they get a hand-delivered box of Georgetown Cupcakes, which are evidently delicious.

Preliminary findings & observations
  • Not all the patients use the system, but those who use it tend to use it a lot. This is consistent with findings from the California Health Care Foundation study that showed low PHR adoption by people with low socioeconomic status, but high usage by those who do adopt.
  • Age 60 appears to be dividing line—over 60 they tend not to use it. This is different from other data I’ve seen, which shows 70 or 75 as a clearer dividing line
  • 1/3 use once/week or more; 1/3 use PHR at least once a month; 1/3 rarely use it
  • MDs report enhanced dialog between patients and providers. Communication is more frequent, complete, and accurate
  • They’re claiming reduced HA1C, BP, cholesterol, ER visits, and hospital readmissions, but didn’t provide any specifics (to be published, but not yet)

Friday, September 17, 2010

Data Visualization, Information Overload, and Compression

In his TED Presentation on data visualization, David McCandless touches on information overload (starting ~16:38), suggesting that data visualization is one tool in our battle with information overload--that good data visualizations enable us to take in data through our eyes and process it in our brains much faster than similar amounts of data communicated through text and numbers.

This reminded me of Mark Hurst's Bit Literacy work:
Bits are heavy. Though they have no physical weight, bits--the electronic data that flows in and out of our e-mail inboxes, cell phones, Web browsers, and so on--place a weight on anyone who uses them. A laptop computer weighs the same few pounds whether it holds one e-mail or a thousand, but to the person who has to deal with all those e-mails, there is a big difference. Appearing in large numbers as they often do, bits weight people down, mentally and emotionally, with incessant calls for attention and engagement....

The problem can be solved by learning bit literacy, a new set of skills for managing bits. Those who attain these skills will surmount the obstacles of overload and rise to the top of their professions, even as they enjoy a life with less stress, greater health, and more time for family and friends. Bit literacy makes people more effective today, even as it equips them for the future.
Mark points out that you can read every day about the information overload problem, but it's very difficult to find practical help dealing with information overload. So his book, Bit Literacy, provides elegant, practical techniques for just that, most of which involve filtering, prioritizing, and organizing incoming data.

I see an intriguing connection between data visualization and bit literacy--an underlying suggestion of a powerful technique that I'll call "compression." Think of it this way:
When a program like WinZip or iTunes compresses a file, it creates a new file that contains most or all of the source information, but using fewer bits to represent that information.

And data visualization does the same thing. A good data visualization takes a large amount of data, either qualitative or quantitative, and displays it in form that conveys most or all of the source information, but using fewer bits to represent that information. This suggests the notion of "compression" as one technique for dealing with information overload.
A few compression examples come to mind.

In the last few years, management "dashboards" have started proliferating. These dashboards essentially take a large amount of information about how a product or company is performing, and compress it into one or two pages of charts, key performance indicators, and short explanatory text. This compressed version of the information enables a manager to quickly take in a tremendous number of bits very rapidly.

Design personas fulfill a similar function. We start with mountains of data from many sources to understand our customers and their needs, and we compress that data into a small number of composite characters called personas. Then we use those personas to communicate with the project team and stakeholders. Essentially, we create compressed versions of the data.

Both of these are examples of "lossy" compression. In the world of compression, "lossless" compression means the compressed file contains all of the information from the original--it's just stored more efficiently. When you download a software application, that software is typically stored in a lossless format, so that when you decompress it, you get all the information of the original. Contrast this with "lossy" compression, in which the compressed file is both smaller, and takes up less space, than the original. This is what you get with an mp3 audio file--you can still enjoy the song, but some of the audio fidelity has been removed so you can fit more songs on your iPod. The trick with lossy compression is to systematically determine a) how much fidelity is required, and b) which data can be removed while still retaining the key information.

Back in our information overload space, this becomes the key question--how can we systematically reduce the bits coming at us so that we can send and receive the essence of a large data set while retaining the key information we need to make informed decisions.

One more example highlights the potential power, and the risk, of using data visualization to combat information overload:

A stock ticker widget essentially compresses all of the data about stock trading into a handful of numbers. After millions of trades today, the Dow Jones was up 1.2%, ending at 10,603.54. This is an attempt to compress not only the stock market, but the economy as a whole. If the Dow is at 10,603.54, the economy is probably better than it was last year, but still struggling.

So the stock ticker saves me the trouble of having to look at all of the data about today's trading. This is good. On the other hand, when there's a TV screen in my elevator barraging me with data about how the Dow, NASDAQ, and S&P 500 are changing from one minute to the next, that's way more information than I need or want. Some further compression would help. As in software compression, it's not only a question of which data to keep and which to remove--it's primarily a question of how small I need the compressed version to be. In the case of a typical consumer, we could add information and compress it even more by presenting a weekly updated graph of performance over the past 10 years.

So I'm having fun playing around with this metaphor, and I have three main questions:

1) Who else has written about compression and/or data visualization as a means to combat information overload?
2) What are some more examples of compression being used effectively to combat information overload?
3) How might we apply this concept in fresh ways to make ourselves more productive and happier each day?

Wednesday, August 11, 2010

eHealth Disparities - strategies continued

A few more thoughts on potential strategies based on meaningful access...

For those who do not currently have meaningful access, but who could get meaningful access as a result of our efforts, we might think of two complimentary paths:

  1. Bring the people to the technology
  2. Bring the technology to the people
In the first case, we're changing the people. In the second case, we're changing the technology.

By "changing the people," I simply mean finding ways to help these folks take advantage of tools others already have. For example:
  • Public access computers in libraries, medical centers, etc.
  • Subsidized access (e.g., some health plans give away cell phones with unlimited minutes for interactions with the health plan)
  • Training on how to purchase, use, maintain, and troubleshoot
In the second case, "bring the technology to the people," we're changing the technology, content, and functionality to make it more accessible, appropriate, and useful to people. For example,
  • Change our push messages from phone and email to SMS
  • Optimize existing web sites for access on pocketable devices
  • Convert key Web interactions to work on IVR (touch-tone telephone trees)
For folks who don't have meaningful access and who won't have meaningful access regardless of what we do, when I blogged a couple of days ago I left off what could be a key strategy:
  • Use higher end technologies with other people so as to free up more traditional resources to attend to the needs of those who don't use those technologies. Here's a way to think about it: If we can use the web to save phone calls to a call center, that should free up call center resources. We would then need to deploy those call center resources to better serve the needs of the people who don't use the web.
I'm liking this basic approach of organizing our strategies based on meaningful access. But I also have a suspicion that we might do better to simply look at age and socioeconomic status (income & education). There's a ton of data out there, and the trip remains finding ways to simplify our approach while respecting the integrity of all that data.

Monday, August 9, 2010

eHealth Disparities Segmentation by Meaningful Access

Many of the same populations that suffer from health disparities also have lower Internet usage. How can we use the Web and mobile technologies to close the gap between the haves and have-nots, rather than increasing the gap?

As always, we need to start by understanding the people involved.

There are many ways to describe the people likely to get the short end of the stick in terms of health, healthcare, and technology. The most obvious are:

  • Demographics (e.g., ethnicity, age, language, socioeconomic status)
  • Psychographics (e.g., those deeply engaged in their health vs. those who don’t pay much attention to their health, or those who love the latest gadget vs. those who fear computers)
  • Access to Technology (e.g., those with desktop broadband vs. those with dial-up, vs. those with smart phones, vs. those with cell phones & SMS, vs. those with none of these)

The problem I keep bumping into is that these factors overlap in very complex ways, and all simple approaches to segmentation seem to oversimplify way too much. For example, Hispanics are more likely to have adverse health outcomes than whites, and they’re also less likely to have broadband, but they’re more likely to access the Internet on their phones. Does this mean we can use smartphones to decrease health disparities for Hispanics? Not necessarily—I'd guess that the Hispanics suffering most from health disparities are those least likely to have smartphones.

Four years ago, in the report Expanding the Reach and Impact of Consumer eHealth Tools, Cynthia Bauer and colleagues at the Dept. of Health and Human Services did an impress job of researching, analyzing, and organizing the field of eHealth Disparities. One of their main conclusions was that we needed more data at the subpopulation level. That gap in our understanding has closed a little in the last four years, but we're still struggling to understand the individuals most at risk of being caught between health disparities and digital disparities.

That said, I think we're close to having a practical starting point.

As we think about strategies to address eHealth Disparities, we might find it helpful to start segmenting in terms of meaningful access to technology. “Meaningful Access” refers to the need to have more than just a computer. Meaningful access requires:

  • hardware
  • Internet connection
  • skills to use them
  • ongoing technical support
  • relevant useful content and functionality

If we take the people most vulnerable to health disparities and subsegment them by meaningful access, then some high-level strategies start to emerge:

The “haves”

Those who already have meaningful access, or those who will gain meaningful access in the next few years with or without our efforts.


Promote existing content and functionality to them

Enhance current content and functionality to be more useful to them

Create new content and functionality for them

The “could haves”

Those who don’t have meaningful access, but who could gain meaningful access as a result of our efforts.


Use the same strategies as for the “haves” above, and also…

Support public access points (libraries, medical centers, shopping malls, etc.)

Support simple and inexpensive access on devices they already own, e.g., SMS texting, including paying the per-message fee

Support public policies and funding that increase access for the underserved (e.g., community-wide wi-fi, extend universal access programs to cover not just phone but also Internet)

The “won’t haves”

Those who don’t have meaningful access, and who still won’t have meaningful access 3 years from now regardless of our efforts.


Support “infomediaries” such as family members who use the Web and mobile devices on behalf of those who don’t

Maintain and enhance non-technology-based services

This might be a starting point. The next step would be to gather more information about each of these groups to understand whether these groups are homogeneous enough to have similar needs that can be addressed with similar efforts.