Six Useful Ideas (Maybe!) On Health Decision Making. Mikes Plenary Presentation At Healthcare Unbound 2011

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


Six useful ideas (maybe – let’s keep watching)

• From the social, behavioral and economic (SBE) sciences …

• … useful in health technology strategy and design.


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


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?


Looming in the background …

“What’s the future of patient responsibility?


Two ideas that didn’t make the cut


• 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


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”


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.”


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

http://abcnews.go.com/GMA/story?id=7127723&page=1

Anxiety about neo-nudges in the 1950s



Anxiety about neo-nudges in the 2000s

© Critical Mass Consulting 2011 17

Anxiety about neo-nudges intensifies


Anxiety about real nudges fuels politics

Possibly useful idea #2: Let’s have a big hand for penalties?


At first it’s all about rewards


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”


… and frustrated doctors are talking about negative incentives …


Possibly useful idea #3: Post-mobile, it’s all about ubiquitous …

As computing becomes more ubiquitous,

doesn’t the quantified self becomemore passive?


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?


Possibly useful idea #4: Networks -- (i) sort out loose from tight


Possibly useful idea #4: Networks -- (i) sort out loose from tight


Possibly useful idea #5: Networks – (ii) in tight networks, harness peer effects


… 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!


Harnessing peer effects: If the norm seems legit and I am an outlier …


Possibly useful idea #6: Networks -- (iii) segue from peer effects to norms


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?


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?



My standard disclaimer

“I have opinions of my own, strong opinions, but I don’t always agree with them.”

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Michael J. Barrett

Critical Mass Consulting

781-674-0097

[email protected]

visit criticalmassconsulting.com

Thank you!

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… targetting “outlaws” and free riders


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Six Useful Ideas (Maybe!) On Health Decision Making. Mikes Plenary Presentation At Healthcare Unbound 2011