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Michael J. BarrettManaging PartnerCritical Mass Consultingwww.CriticalMassConsulting.com
Six Useful Ideas (Maybe!) on Health Decision-Making
Healthcare Unbound 2011July 11, 2011
© Critical Mass Consulting 2011
Your basic shameless grab for credit
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Six ideas
© Critical Mass Consulting 201104/10/2023 3
Six useful ideas
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Six useful ideas (maybe – let’s keep watching)
• From the social, behavioral and economic (SBE) sciences …
• … useful in health technology strategy and design.
© Critical Mass Consulting 201104/10/2023 5
Six useful ideas
Behavior• Decision-making
1. Choice architectures and nudges
2. Negative incentives
3. Ubiquitous computing and passive selves
4-6. Social networks and decision-making4. How networks operate (i): loose vs. tight
5. How networks operate (ii) peer support / peer pressure
6. How networks operate (iii): norms
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Behind the matter of usefulness, a question looms in the background
As good outcomes begin to determine provider incomes,
as cost containment pressures intensify for all of us, and as technology enables us to assign accountability, what do we
ask of the patient/consumer?
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Looming in the background …
“What’s the future of patient responsibility?
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Two ideas that didn’t make the cut
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• Do Malcolm Gladwell-style connectors route our communications with one another?
Contra: See Duncan Watts, Everything is Obvious, Once You Know the Answer (2011)
• Do Facebook-style social networks affect our views of choices and preferences? Contra: See Nicholas Christakis and James Fowler, Connected: The Surprising Power
of our Social Networks and How They Shape Our Lives (2009)
Possibly useful idea #1: ID choice architecture, insert nudge
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Choice architecture
• “A choice architect has the responsibility for organizing the context in which people make decisions.”– “If you are a doctor and must describe the alternative treatments available to a
patient, you are a choice architect. “
– “If you design the form new employees fill out to enroll in the company health care plan, you are a choice architect.”
• “ … seeming small features of social situations can have massive effects on people’s behavior…”
• “It is legitimate for choice architects to try to influence people’s behavior in order to make their lives longer, healthier and better.”
• “There is no such thing as neutral design.”
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Source: Richard Thaler and Cass Sunstein, Nudge (updated paperback edition, 2009) at 3 and 5.
“There is no such thing as neutral design”
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Nudges
“… any aspect of the choice architecture that alters people’s behavior in a predictable way without forbidding any options or significant changing their economic incentives.”
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Source: Richard Thaler and Cass Sunstein, Nudge (Updated Penguin paperback edition, 2009) at 6.
Nudges in the break room
• Experiment: In the break room at Manhattan Mortgage Company, Good Morning America elevates the fruit plate closer to eye level
• Result: Fruit gets eaten in less than a third of the time it normally takes.
• Experiment: GMA moves donuts away from the center, off to the side. • Result: Donut consumption drops by 10%.
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Source: http://abcnews.go.com/GMA/story?id=7127723&page=1
Anxiety about neo-nudges in the 1950s
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Anxiety about neo-nudges in the 2000s
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Anxiety about neo-nudges intensifies
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Anxiety about real nudges fuels politics
Possibly useful idea #2: Let’s have a big hand for penalties?
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At first it’s all about rewards
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But feelings about personal responsibility are complicated …
Who gets hurt when I over-eat?
Good question. We’re not sure.
• “the causes are too complex” • vs. “no one can save you if you don’t save yourself”
• “obesity is a disease”• vs. “so get a grip on the disease”
• “I’m only hurting myself” • vs. “well, actually, you’re costing us, too”
© Critical Mass Consulting 201104/10/2023 21
… and frustrated doctors are talking about negative incentives …
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Possibly useful idea #3: Post-mobile, it’s all about ubiquitous …
As computing becomes more ubiquitous,
doesn’t the quantified self becomemore passive?
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If it can stick, it’ll sense
04/10/2023 © Critical Mass Consulting 2011 Source: Joint press release, June 7, 2011
June 7, 2011:
“Proteus’ personal monitoring technology [measures] heart rate, physical activity and sleep patterns. “
“Avery Dennison Medical Solutions is providing adhesive and material technologies and developing the manufacturing platform to mass produce the wearable sensors for the companies’ respective customers.”
As computing becomes ubiquitous, won’t the quantified self become passive?
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Possibly useful idea #4: Networks -- (i) sort out loose from tight
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Possibly useful idea #4: Networks -- (i) sort out loose from tight
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Possibly useful idea #5: Networks – (ii) in tight networks, harness peer effects
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… and master the tipping points
New research:• Initiation: At the onset of a new interest or “market,” researchers find
that variety-seeking prevails
• Contagion: When a specific approach draws the support of 30% of the group, adoption takes off
• Saturation: But when group adoption hits 80%-90%, individualism re-surfaces; the adoption curve flattens out
• Takeaway: When something new gathers steam, people join in (at least
until the new practice builds to stifling conformity)
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Source: Pascale Quester and Alexandre Steyer, “Revisiting Individual Choices in Group Settings: The Long and Winding (Less Traveled) Road?” Journal of Consumer Research, Vol. 36, No. 6 (April 2010)
Obesity’s on the rise? So I’m not an outlier if I’m over-weight!
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Harnessing peer effects: If the norm seems legit and I am an outlier …
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Possibly useful idea #6: Networks -- (iii) segue from peer effects to norms
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Mechanisms of transmission
• When peer pressure operates, people externalize others’ behavior …• But when norms take hold, people internalize others’ values and beliefs.
Behavioral economists performed the experiments:1. Priming: Exposing people to small but well-timed cues can change behavior2. Conformity effects: People look to others for such cues3. Anchoring and adjustment (inertia): Once people have a point of reference, they don’t
depart from it very much
Neuroscientists find preliminary indications of “hard wiring” for norms4. Mirror neuron system: Watching lights up the same part of the brain as doing5. Agreement alone lights up the ventral striatum, strongly associated with emotional
and motivational aspects of behavior. Source: See, e.g., Campbell-Meiklejohn et al, “How the Opinion of Others Affects Our Valuation of Objects,” Current Biology 20, 1-6, July 13, 2010.
Mechanisms of alteration?
How do you change a norm?
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And how do you change it back?
Behind the issue of usefulness, a question looms in the background
As good outcomes begin to determine provider incomes,
as cost containment pressures intensify for all of us, and as technology enables us to assign accountability, what do we
ask of the patient/consumer?
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© Critical Mass Consulting 2011
My standard disclaimer
“I have opinions of my own, strong opinions, but I don’t always agree with them.”
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© Critical Mass Consulting 2011
Michael J. Barrett
Critical Mass Consulting
781-674-0097
visit criticalmassconsulting.com
Thank you!
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… targetting “outlaws” and free riders
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