How to Change: makeit Easy to overcome Laziness
John Gusiff
Chief Experience Officer | CX Strategy | Brand Loyalty | Customer JTBD | Experience Design | makeit toolit | Behavioral Science | GenAI |
In her book, How to Change, Katy Milkman talks about how impulsivity, procrastination, forgetfulness, laziness, confidence, and conformity can get in the way of making lasting change. It’s a great read!
The Make it Toolkit is designed to not only identify these types of common barriers (e.g., procrastination, forgetfulness, laziness, etc.) to making progress in one’s live, but, also provide a set of Behavioral Design Strategies (15 of them) and Tactics (over 200 of them) to help overcome these barriers to progress.
In this post, we'll take ‘laziness’ as an example barrier to change and talk about how Penn Medicine, University of Pennsylvania Health System overcame this specific behavioral change barrier in relationship to physicians prescribing medications.
The Situational Context
Penn Medicine had a problem. Despite having been informed and educated it’s physicians on recently released generic drugs, they were continuing to prescribe 'brand' name drugs (when not necessary) rather than the equivalent generics (roughly 25% of the time) at a significant cost to both patients and the health system. Studies had shown that prescribing generic medications tended to lead to higher adherence (due to the lower cost of the drug) and better outcomes (more likely to sustain usage over time). Their physicians were well aware of these studies through internal communications and education.
Current State (Autopilot Mode)
However, when a new digital electronic health record (EHR) system rolled out (supporting the prescribing of medication) it had been designed to list out both 'brand' name and generic medications in one list for the physician to select from. Therefore, in order for a physician to prescribe a generic medication, they would have to ‘opt-in’ by selecting the new generic medication over the ‘brand’ name drug they were most familiar with (selected almost sub-consciously).
Physicians were simply on autopilot (their System 1 brain in control) and in the 'speed of the moment' were continuing to prescribe the 'brand' name drug they were familiar with, already had a habit of prescribing. You could say they were taking the "path of least resistance" by avoiding the more effortful decision (their System 2 brain) of reflecting and thinking about the choice alternatives.
The makeit barrier they were experiencing was Autopilot which refers to the fact that we are prone to make very quick decisions which can result in regrettable outcomes. Even though we are somewhat aware of the better or alternative choice.
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Auto-pilot is related to both Attention and Ability and is a function of both the Person and the Environment.
Future State (Default Option + Reflection Point)
So what did the Penn Medical Health System team do to address this behavioral change barrier of 'laziness'? They made a simple UX interface design modification to default all prescriptions to the equivalent generic (a Default Option), if available. In doing so, they also were also introducing a Reflection Point.
Moving forward physicians now had to stop and think about whether a 'brand' name drug was preferable in each medical situation. And in some cases it was preferable given the specific medical conditions for each patient. Since, the new UX interface design change made now required the physician to 'opt-out' of prescribing the generic drug (a more conscious choice) by selecting the 'dispense as written’ checkbox and typing in the ‘brand’ name drug (more effort).
The makeit Strategy and Tactics
In summary, they makeit Easy by leveraging two different makeit behavioral design tactics together:
(a) A Default Option tactic when taken pre-selects the most desirable option making it Easy (no friction) to choose; and
(b) A Refection Point tactic introduces friction points to trigger a pause or reflection into a decision point, making it a conscious choice.
You makeit Easy by decreasing the real or perceived cost and the cognitive or physical effort required to encourage a behavior.
The Business Impact
Before the intervention, the generic prescribing rate at Penn Medicine was steadily hovering around 75 percent. Immediately after the change was made, the generic prescribing rate increased to over 98 percent. Two and a half years later, this simple change was estimated to have saved Penn Medicine more than $32 million during that time span.
Expert on Perfecting the Patient Experience
1 年The change in the interface and opt-in protocol should get most of the credit. It replaced one auto pilot with another. Prescribing generics whenever possible should be a no-brainer. My octogenarian parent is being asked to pay $600-800 per month for Xiidra… as no generic is available to alleviate dry eye. Guess what? She’s avoiding it. Our system is just so broken.
Behavioural Design - Product | Campaign | Culture
1 年Autopilot is a great example of what happens in conditions of scarcity. Being pressed for time but having forgotten to bring your lunch that day, will the newly health oriented person walk over that healthy food place with the long line and the unfamiliar menu, or run down to the place their familiar with? Most likely, autopilot will guide them back to the old place. Introducing a reflection point before this event (before lunch time) has good potential to work.