We need to be far, far more engaging.
We are boring.
Now Thrive has come along and I have to say
that has been really exciting.
It's like the organization went from black and white to color
within a couple of years. Like the TV got turned on.
But by and large, when you look at what we have done in terms of
behavioral interventions and health education,
we're pretty boring.
Why should I be tested for colorectal cancer screening?
Now I just-- I mean I just want to tell you
because that came out of my department and so on,
what are we up against?
What are we competing with? We're competing with this, okay.
Now, if I were doing one of those psychological studies
where I could measure your eye tracking movements,
my guess is you're probably more engaged by what's going on,
on the right-hand side of the screen
than the left-hand side of the screen.
Now I don't think we can go as far right as that, okay,
but couldn't we be a little more engaging
and a little less boring?
Well, let me give you an example
of something that we really want to try.
It may be a little more lighthearted.
I was asked to consult on the redesign of letters going out
to patients from their physician to remind them
to get their lab test results, you know,
if they had high cholesterol and diabetes and so on.
And we revised the letters.
We used principles of social influence and made each letter
stronger and more directive and whatever and I said you know,
it strikes me if people have gotten a second letter,
sending them another letter of the same ilk
is not likely to engage them.
So couldn't we try something different?
So, we're drafting this and they try to test it.
Hi David, this is your heart checking in.
It'd be great if we can get an update on our
cholesterol levels and blood sugars.
To be honest, I'm not really sure how well we're doing
and by the way I also heard from your kidneys
and they are asking for a lab update too.
Dr. XYZ has already ordered some routine tests and
they're waiting for us at any Kaiser lab.
When do you think you might meet me there?
Today? This week?
And I think I know the results could help keep my arteries open
and keep you feeling well and keep us on the right path.
Now I don't know if this is going to work.
It's testable though.
I'm fairly certain that the third form letter
from your doctor is not going to work.
And what if this turns off some patients?
Well, those are the ones who probably came in on the
first or second one anyway and if you can adjust that.
We need to make this a little bit more fun.
But the other thing is this is actually a
behaviorally designed intervention.
What do I mean?
Well, there are principles of influence like the ones
Cialdini has done and this uses
the authority principle because it is signed by their doctor.
It uses social proof, and I'll show you that in a moment,
and it also uses consistency and that is people tend
to be consistent with their image of
themselves or their previous behavior.
So how does this work? Here's another example.
Set completion. Okay. We like things to be complete.
So for example there's a wonderful example of
you go to a car wash and they give you a ticket
that says if you get 10 car washes you get a free one.
And then they tested that against giving people the ticket
with 12 slots on it and they put two punches in the first two
and said you're already on your way.
You've got two. We've got you started.
Well people like to finish the set and they also really like
the idea they've already accomplished it --
I hardly want to throw away my credit for two car washes.
I'm the kind of person who's going to finish this.
Now how does this work?
So for example what if we're sending out a reminder
to patients who are unmotivated, right,
to get preventive screening?
Congratulations on getting your mammogram and your PAP smear.
You have only two gaps remaining
to complete your preventive care.
Check, check.
Oh colorectal, flu.
The majority of my patients are up-to-date.
Please join them.
When do you think you might complete your preventive care?
Now this is carefully designed to
take advantage of principles of consistency.
You're the kind of person who gets mammograms and PAP smears.
Why not be consistent and get the
rest of your preventive services?
Set completion, to complete the set.
Social proof, that is, we look
to other people and norms around us.
The wonderful ad for Kaiser Permanente which said
Kaiser Permanente women get mammograms.
How powerful that is to normalize that
that's what's expected, that's the norm.
And finally, the authority principle,
having it come from your doctor.
So I guess what I'm saying is when we go to design our
interventions, and we're going to do more about this later,
when we go to the cost of poorly designed messaging is at least
the same in terms of paper, opportunity costs,
time, printing and so on as a carefully constructed message.
And, in fact, a poorly constructed message will often
discourage behavior and not get people to do
some of the things that we want.
And if you change the response rate just by a few
percentage points, remember that's shifting that curve,
you can get a huge return on investment.
And so we need to try these small tests of change,
iterate on them, change them, learn from them as we go ahead.