The Engagement Paradox


Despite the overwhelming evidence of the benefits of digital health over the traditional analog services, we have seen significant barriers to adoption that have resulted in what I refer to as the Ten Paradoxes of Digital Health. This article will address the Engagement Paradox.

Perhaps the most overused and meaningless phrase in healthcare after “Big Data” is “Patient Engagement.” Does any one really know what it means? We are led to believe that it is the Holy Grail to improved patient outcomes. If only we got people to be more engaged in the healthcare system then they would change their behaviours and all would be well.

Do patients really want to be more engaged in the healthcare system? I think not. They would rather be healthy so that they could be LESS engaged.

Too many of the digital health solutions we see out in the marketplace require significantly more engagement of the consumer/ patient in the healthcare system in ways that create tremendous friction by interrupting their lifestyles and workflows.

The definition of a great technology is one that is so elegant and frictionless that the technology is invisible – it just works without you having to know anything about the underlying technology. Great digital health solutions need to become so elegant that they too are invisible.

So what about “engagement?”

Consumers/patients need to become engaged in healthy behaviours in their daily lives so that they can become less engaged in the healthcare system. Ironically, the approach the healthcare institutions provide tend to be, well, “institutional,” and as such they are neither elegant nor invisible – they are not designed with the consumer/patient at the center but the digital health company, health system and clinicians at the center.

Look at the guidance (and discipline) that Apple has given to (and will impose upon) Apple Watch app developers that use their WatchKit. Apple Watch apps must have a clean look, provide easy access to information and mustn’t bother the users too much. Simple, elegant, useful and invisible.

Too often in the digital health space we see apps that demand many unnecessary steps (friction), provide obnoxious branding and product information (friction), and constantly annoy you with the same message over and over again that you have to ignore or else you lose your sanity (friction). Many of these companies see consumers/patients as monolithic, where the same approach to behaviour change and messaging should work for everyone in the same way. They further see consumers/patients as hostages they can subject to endless water torture, their form of “engagement,” where they are trying to engage you in acknowledging their brand, product, technology and “value.”

Effective engagement removes friction, in all its forms, integrates solutions into your lifestyle with invisible and elegant technology by supporting, guiding, enabling, educating and motivating (the Five Pillars of Behaviour Change) you to alter your behaviours to achieve greater health that will then decrease your engagement in the healthcare system.


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