CLEVELAND — When Walmart assessed a subset of its 1.2-1.6 million associates about wellbeing it found the two biggest obstacles are psycho-social and financial determinants.

“The problem was, how do we get people to change?” said David Hoke, Walmart’s senior director of health and wellbeing, here at the HIMSS and Cleveland Clinic Patient Experience Summit.

To that end, Walmart partnered with startups to build two apps for associates: Even and ZP Challenge.

Even is a fintech app to help associates manage finances, avoid overdraft fees, give users an okay to spend money, and if need be they can receive up to 50 percent of their forthcoming paycheck. ZP Challenge, for its part, is the health-centric app that as the name suggests challenges associates to make healthier choices one day at a time.

Hoke said that the apps have lead to an increase in associate satisfaction as well as more revenue per square foot in Walmart stores. Specifically, more than 70 percent of users have lost 20 pounds and 95 percent spend more time with their families.

“Individual results lead to company results,” Hoke said. 

Hoke also shared the tenants of Walmart’s design philosophy for engaging its associates in health and financial improvement: build a movement, understand that people follow people, make it simple and believe that trust + authentic + relevant = results.

Here’s a look at each of those.

Build a movement. To begin creating a movement, Hoke and the Walmart team talked to the U.S. military about how it creates self-sustaining cells in other countries and nurtures those to life.

“To build a movement, you have to create a compelling reason for someone to join and give them a place to join you,” Hoke added. He pointed to a test in Georgia where 11 people who had become enthusiastic about their own results were empowered to go to other stores and evangelize their experience.

The result? A 150 percent increase in engagement, Hoke said.

People follow people. While it’s tempting to think that education solves a lot of health problems, Hoke said the truth is many people don’t really care about the science — they just want to feel better. “We started with ‘most people want to feel better but life gets in the way,’’ Hoke added. “People want ideas from people like them. Those stories are the ones that resonate the most.”

One example is what Hoke calls “lick a chip.” A serial dieter came up with after taking the challenge. The first day she left one chip in the bad, the second she left two until she reached the point of running out of having one more chip to leave in the bag. So, she licked the last chip instead of eating it. While that may not be the ideal scenario for many, it helped that particular patient lose and keep off weight.

Keep it simple. “Simple is really hard,” Hoke said. “We’re really good at making things complicated but we’re not so good at making them easy.” In 2013, for instance, Walmart made a big breakthrough by ditching digital and going to print because 30 percent of associates could not download an app. Plus, books are more anonymous, don’t require anyone to give personal data away, and it does not inject shame and guilt into the intervention. “The power of those books has been immeasurable,” Hoke said.

Trust + authentic + relevant = results. When Hoke began this work, trust was the number one issue he heard in visiting associates in break rooms. “We assume trust very easily, but trust is earned, not granted, and it’s easily fractured,” Hoke said. “Everything we did for first 5 years was about maintaining trust with our associates.” The authentic and relevant aspects, Hoke continued, are within the real people of the world who only want to trust people they can relate to, not celebrities.

From there, Walmart uses a three-measurement rubric: attitudinal impact, staff turnover, and the medical impact, which is not just healthcare costs but also includes workers compensation and disability, among others.

And designers need to include empathy in the entire process.

“Empathy in design is a key that can unblock engagement,” Hoke said. “Engagement is on the road to influence. Influence is required for results.”