The Science of Motivation and Behavior Change – Episode #4

In this episode we are digging into The Science of Motivation and Behavior Change, and here are our Big Three Takeaways:

1. Knowledge rarely leads to action
2. Action is a product of motivation to change, ability to change, and critical triggers that spark, facilitate, or signal a behavior
3. BJ Fogg and others have provided us with invaluable tools for understanding these elements and how we must leverage them to engineer change

Our community seems generally aware that to drive behavior change one must be appropriately motivated. This is not a simple task and here is a great overview from Daniel Pink:

We now know far more about what types of motivations work best – and intrinsic motivation is far more powerful than extrinsic motivation

Extrinsic MotivationIntrinsic Motivation


More recently intrinsic motivations have been further explored by Fox and colleagues – we must, as educators understand perceived needs!

Intrinsic Motivation - Actual Vs Perceived Needs

In 2012 while he and I were both speakers at the first Medicine X conference at Stanford, I had the pleasure of first hearing, and then spending some time chatting with BJ Fogg – Dr Fogg is a behavioral scientist at Stanford University. In 2009, Dr Fogg began sharing what he refers to as the Behavior Change model. Here is just a bit of what he describes,

This paper presents a new model for understanding human behavior. In this model (FBM), behavior is a product of three factors: motivation, ability, and triggers, each of which has subcomponents. The Behavior Change model asserts that for a person to perform a target behavior, he or she must (1) be sufficiently motivated, (2) have the ability to perform the behavior, and (3) be triggered to perform the behavior. These three factors must occur at the same moment, else the behavior will not happen. The Behavior Change model is useful in analysis and design of persuasive experiences. The Behavior Change model also helps teams work together efficiently because this model gives people a shared way of thinking about behavior change.


To simplify Fogg’s work think in terms of the relationship between motivation, ability, and triggers!

Fogg's Equation

Fogg and Triggers

Fogg and Ability

Fogg and Simplicity


Finally, before we end – a complementary field of behavioral science study referred to as Nudge science or Theory has emerged over the past decade. And it might help for our community to understand its impact on behavior change too.

In 2008 Rich Fowler and Cass Sunstein introduced Nudge science to the masses with their landmark book called Nudge. In their words,

[a nudge] is any aspect of choice architecture that alters peoples behaviors in a predictable way without forbidding options or significantly and changing their economic incentives.


Nudge Book

Nudge science focuses on creating environments that make it easier for behaviors to change. Implicit in this emerging field is the reality that we, as humans, find it nearly impossible to consistently make rational decision – we struggle to balance short-term and long-term benefits and 9 times out of 10 we will take the easy way out….and we, as designers must account for this with effective nudges! For example,

Nudge Staircase

Nudge Alarm Clock

I have put together a primer for Nudge Science and if you are interested the following may provide some invaluable references:

In brief, the basic idea of Nudge Science is that humans are unrelentingly irrational. As a result, our choices are often neither rational or constructive – worse yet, our everyday choices are usually just the opposite. We struggle to balance long-term and short-term benefits and risks, we are more in tune with negatives than positives when reflecting and more in tune with positives than negatives when forecasting…and this undermines our lives, moods, and careers more so than just about any other element of ‘being human’….The research behind these statements has been masterfully summarized and explored in the following works:

To help construct a practical value proposition – this NY Times article from 2013 is a great place to start: Britain’s Ministry of Nudges 

And, just to end with one, more analytical perspective – check out the work of Stanford professor BJ Fogg. I love Dr. Fogg’s work because of how simple he has connected decades of research into Behavioral economics (Motivation), Adult Learning (Ability), Nudge Theory (Triggers)…B = M x A x T!

Finally, to connect these dots – as educators we must understand that learning alone will rarely lead to the behavior changes that are needed in the provision of the highest quality healthcare. But even more importantly there are critical behaviors OF learning that we must drive to support our learners as they engage in continuing education. From our research over the past 4 or 5 years, triggers and nudges have emerged as a critical piece of the Learning Actions Model and educators must leverage these devices to ensure that learners effectively learn!

New Learning Actions Graphic


The Natural Learning Actions – Episode #3

In this episode we are digging into new research that has lead to the development of the Learning Actions Model and here are our Big Three Takeaways:

  1. Much of what this community has come to believe about Adult Learning Theory is based on an assumption
  2. By demonstrating that this assumption is false – we have identified a critical new opportunity to mitigate the extraneous load of learning and optimize educational outcomes
  3. The new instructional design framework known as the learning actions model provides a roadmap for how to effectively leverage this new understanding in your educational planning

We tend to see learning as an entirely cognitive process – information appears in our sensory memory, if it intrigues us or confuses us it moves into working memory – which is quite limited – and then we struggle to create our own schema connecting new information to prior experience and knowledge so that we can create the networks that form the long term memory.

There’s been decades of adult teaching theory that’s been designed to explore how to make this cognitive process more effective. But what if it’s not enough?

What if all the time and effort and research that’s gone into understanding the cognitive parts of learning is overlooking a critical assumption that we are ALL making that undermines that process of teaching and learning? The assumption is… that our learners know how to learn.

Do they? Do Learners Know How to Learn?

Stated another way, what if after decades of research and millions of hours of instructional design efforts it turns out that the cognitive parts of learning are necessary but insufficient to ensure real learning and eventually real behavior change happens?

To address this question I developed a fairly simple and unassuming research project about 3 years ago – my goal was to better understand what the true “process of learning” really entailed. What I uncovered was what I’ve come to refer to as the Natural Learning Actions.

My research was designed around three questions:

  1. What are the actions that learners physically take as information begins to bubble from sensory to working memory?
  2. How and when are these various actions employed by learners in the process of learning?
  3. As learners explore the actions they take while learning, do they believe that these actions are taken effectively and efficiently?
    In other words: What are the actions? How and when are they employed? And, do they work?

By interviewing over 300 clinician learners and guiding them through a semi-structured exploration of what actions they take while consuming new information, four actions emerged:

As learners consume your educational content they acknowledge to need for 1) taking notes, 2) setting reminders, 3) conducting searches and 4) reacting to external nudges that support and guide their attention.New Learning Actions Graphic

But importantly, how learners leverage these actions is almost completely due to convenience and habit and not trial-and-error; meaning that these actions are often unevolved and therefore the educational planner must accept that without supporting these actions the impact of their interventions is likely to fail to meet their needs.

So what should we each take away from this work? First, is the recognition that simply being smart, does not make one a skilled learner. Each of us must commit to evolving the physical actions we take as we attempt to consume new information and transfer new lessons to positive behavior changes. And second – we can’t assume that just because our learners are some of the smartest folks in the world; that they are adequately equipped to effectively or efficiently learn. It is our job, as educators to create the environment in which the learning actions can be optimized.