Change in healthcare on a macro-scale is difficult to say the least. The government, big hospitals, and powerful pharma companies have deep stakes and strong arguments. The healthcare industry is slow-adopting, but top priority is patient’s health. Zooming in, choice is in the patient’s hands, but how come even the best intentioned lifestyle changes are thwarted by the 11am staff kitchen donuts? It is small day-to-day decisions that are foundational to wellbeing, yet change is multi-faceted. When you open your fridge, what’s at eye-level? If the first thing you saw was fruit, would you be more likely to eat it? Little changes, especially within your line of sight, ‘nudge’ you towards better decisions. For micro-change, we have to set ourselves up for success and learn to systematically mange change in line with human intrinsic behavior. Then we can take the tiny victories as a microcosm for the future of health.
Community Editor of Health:Further, David Shifrin, interviewed Hamid Ghanadan to discuss the barriers to change and how change management can make a difference for the healthcare system. The implications are endless from medication, diet, and exercise adherence to being ‘okay’ when your computer auto-updates to iOS 300.1.
Listen to the full podcast here.
Q: How does the difficulty of change apply to healthcare?
A: Whether [healthcare providers] want to make their patient population healthier or they want their physicians to act differently…all of those things require some change to happen to an audience member. The problem is we can’t just go and make people change. We can’t make people take a specific action by just telling them to do it. They won’t. That’s where the difficulty comes into play. And you have to really understand the human behavior or tendencies to influence them, to nudge them, to get them to change in incremental ways so that you give them a psychological incentive to want to change. Because absent that psychological incentive, people are pretty invested in not changing.
Talk a little bit more about kind of change management and handling these things in incremental ways to slowly turn into a new direction.
The reference to the word that I use – “nudge” – was actually a reference to the book by Richard Thaler who won the Nobel Prize in economics in 2017. His contribution to our knowledge is all around choice architecture, and essentially the premise is, he’s sort of known as the father of behavioral economics, and he essentially said that classical economics doesn’t really take human behavior into consideration. We have to take human behavior into consideration in order to develop better models. And so he developed choice architecture, which is: if you want something to happen, make it easy for it to happen.
And he has a great example about when 401ks first became popular as part of corporate benefits. […] When this product first rolled out, they were not getting a lot of adherence, people were not opting in to 401k’s and that’s just bizarre. That’s so outside of any rational thinking. Why? When they looked at the situation, they found that they were making it really, really hard to opt in. […] So essentially what they did was, they flipped it all around so that you were automatically enrolled and your funds were automatically put into some sort of a default set of funds and you could opt out or change it at any time. They just made that choice very, very easy for people to make.
Same question: how does this apply to healthcare?
No matter how sophisticated the treatment modality and no matter how sophisticated the hospital standard of care, many hospitals right now are looking at patient experience because they believe and they know that patient experience is a really critical part of healthcare. Our interest is going in and developing these patient experiences for the healthcare providers, but also maintaining this understanding of the intended outcome, the best outcome for the patient, and giving them these cues and nudges so that they will be much more receptive to making these smaller changes to have better outcomes. […] There’s so many places in healthcare from all the way up in research all the way down to patients’ lifestyles after they’re done interacting with the healthcare system, that there are ways that we can optimize it around the human behavior in order to get the intended outcome.
Final thoughts on improving usability in healthcare?
Think about the human first, design the usability around it and apply the technology because you’ll have the best chance of getting the best intended outcome as a result.