SERMO: 'Yelp' for Drugs

SERMO’s drug-rating system for doctors by doctors has garnered over 655,000 ratings on over 4,000 medications in the last year.  SERMO is now the number one social network for doctors in the US and globally providing a safe space to solve and discuss medical cases and issues and to rate treatments.  Additionally, it offers honoraria for doctors who share their opinions. The popularity of SERMO and the transformation it represents highlights the importance of developing a multi-faceted strategy across communication touchpoints in a rapidly changing digital landscape.  Healthcare marketers must stay up to date with this on-going digital transformation in order to maximise the effectiveness of their marketing spend and to better serve the needs of doctors across the globe.

The SERMO online platform has enhanced communication and links between individual clinics and doctors allowing them to see how they stack up to their colleagues locally and internationally and challenging existing social norms.  SERMO has also challenged traditional vehicles of communication or ‘messengers’ by shifting attention away from KOLs and pharma med reps. By doing so, it has empowered your average doctor to be an influencer in in much broader networks.  Although not intended for pharma or healthcare marketers, SERMO is a powerful tool for real-time feedback about how doctors think, feel, and act in regard to a particular drug. 

Over 70,000 doctors have used the database in the last year and that has massively dialled up ‘herd instinct’ among clinicians!  According to SERMO’s own research, “Half of doctors changed their perceptions or opinions about a drug after reading the ratings.” Additionally, “83% said they believe the ratings will help improve outcomes and 74% said they’ll use the ratings again when doing research for treatment.”

Considering its scope, SERMO has be a powerful lever for healthcare marketers to look to better understand current clinician behaviour. 

Big Data: What your habits reveal about your social class

In the age of “Big Data” there is more information available than ever before; and while there are serious concerns over how this data is managed and used, there are significant opportunities for healthcare marketers as well. 

Big data offers the benefit of knowing your customer holistically and understanding the various components that shape how they think, feel, and act.  As healthcare marketers, we can look to this broader lifestyle data as a means to better segment clinicians and patients.

To illustrate how some of this big data (information about our likes and dislikes in regard to music, books, and television) can say a lot about who we are as people, check out this quizdesigned by the Australian Cultural Fields project that unravels what our habits suggest about our social class. Don’t worry, it only takes about 5 minutes! 

Cape Town: Nudges to Save Water

Cape Town, South Africa, home to 3.4 million residents, could soon be the first major city in the world to run out of water—a day that’s been dubbed ‘Day Zero.’   Day Zero could happen as early as mid-July if there’s no significant rain, and residents will have to travel to one of the city’s 200 collections points to receive their daily ration of 25 litres per person. 

While the city has taken some steps to better manage water use, they are increasingly looking toward behavioural economics to find a solution.  The city has collaborated with the University of Cape Town to develop nudges aimed at encouraging individuals to reduce their water use.  The research has identified several types of nudges including social norms, real-time feedback, and social recognition that they believe will be most effective. 

In order to challenge the current social norms around water use, the city has developed a water map by which it identifies homes and businesses that do/do not comply with set targets.  While concerns over backlash against non-compliant households have raised issues around the appropriate channels and end-users to communicate this information, research demonstrates that combining behavioural interventions with traditional measures [restrictions or penalties] can be highly effective in the short-term. 

In addition, Cape Town is offering real-time feedback regarding the daily water level in dams.  This is particularly motivating when feedback is framed in reference to Day Zero [critical level at 13.5%] and coupled with water saving tips.  The Water Tracker designed by eighty20 is a great example of this. 

Lastly, Cape Town must expand social recognition efforts.  Being recognized for hard work or achievements makes us feel good.  This prize doesn’t necessarily even have to be monetary; written or verbal recognition can be enough.  Of the nine nudges tested in this research, social recognition proved to be the most successful; households who reduced consumption by 10% were featured on the city’s webpage. 

Cape Town now faces a challenging situation that will require multi-faceted approach to solve, but the solutions or nudges suggested can be applied to healthcare.  How can we challenge social norms around prescribing antibiotics or even challenge prescribing opioids to combat the epidemic in the United States?  What are creative approaches to giving clinicians feedback in real-time as with HCV campaigns in Australia?  What ways can we incentivise good work and good behaviour beyond financial motivators? 

Using Community to Combat Illness

Human beings are undoubtedly social creatures by nature.  Because of this, it’s no surprise that the results from a UK trial published in the Resurgence & Ecologist magazine demonstrate the importance of community support in regard to health. 

 

The data suggest that when community members support people with health problems who are living in isolation, the number of emergency admissions to hospitals declines sharply.   According to the lead author of the report Julian Abel, “No other interventions on record have reduced emergency admissions across a population.” 

In 2013, the Compassionate Frome project was initiated by GP Helen Kingston to expand the scope of patient care.  With the help of several agents, her practice established a directory of agencies and community groups to connect patients.   These included lunch groups, exercise groups, and various other social groups in an effort to combat loneliness.  

These efforts align with what is already known in neuroscience—that chemicals called cytokines function as messengers to the immune system and cause inflammation, changing behaviour; they encourage humans to withdraw from social contact. 

Scientists now believe that inflammation contributes to depression.  Paradoxically while inflammation separates us from society, it also causes humans to seek additional support from their close circles.  Unfortunately research suggests that an increasing number of Americans have no confidant to seek support, and this is the problem that the Compassionate Frome project seeks to remedy. 

There are many other studies that support the conclusions drawn in this report.  For instance, HIV patients with strong social networks report lower viral loads than those without.  The chances of women surviving colorectal cancer if they have strong social connections are also better.  What these examples demonstrate is that emotions and patients’ overall disposition—both good and bad—can have a very real impact on health outcomes. 

If the patient is truly at the heart of everything that we do, we need to treat them holistically—moving beyond just mediation to comprehensive care.  What this research suggests is that social contact should be a vital component of prescription and treatment as in this case study of the town of Frome.  To healthcare marketers, what are the opportunities to provide superior patient support and how can we move beyond the traditional approach to prescription?  How can we leverage and improve social connections as well as linking knowledge from neuroscience to social behaviour in order to provide optimal patient care? 

How Behavioural Economics can help reduce GP over-prescription of antibiotics

A campaign in Australia to reduce prescribing antibiotics in the primary care setting has been largely successful, according to The Medical Republic. In part, this has been down to using a key behavioural science principle called the Hawthorne Effect.

Over prescription of antibiotics poses a major concern to the general public as it can lead to antibiotic-resistant bacteria (‘super bugs’) and shorten the lifespan and efficacy of many of the antibiotics currently used.  According to Dr. Dartnell who was involved in this study, “In 2014, 46% of the Australian public was prescribed antibiotics [at least once] and at least half of these prescriptions may have been unnecessarily issued.”

Program managers should take note of the successful strategies implemented to change the behaviour of GPs.  In this scenario, facts alone were not enough to change behaviour.  GPs have long been aware of the risks of overprescribing antibiotics in terms of broader public health but perhaps thought their prescribing habits were similar to that of their colleagues. 

The campaign to fight unnecessary antibiotic prescribing adopted a multi-faceted approach; efforts to curb prescribing rates utilized the Hawthorne Effect by sending letters to GPs that compared their prescribing habits to that of their peers.  The Hawthorne Effect is a cognitive bias that assumes that people behave differently when they feel as if they are being observed.  So when GPs began to receive letters comparing their prescribing habits to others, they realized that maybe what they thought was “normal” wasn’t normal at all.    This comparative feedback mechanism challenged the social norms around prescribing antibiotics, making GPs think twice before writing a script.

This strategy combined with national education programs involving multiple stakeholders, consumer advertising, and clinical audits had a big impact.  Six months after the launch of the campaign in 2012, antibiotic dispensing was down 20% from the forecasted amount; or in other terms, roughly 127,000 fewer antibiotics were being dispensed on average per month. 

This campaign shows that GP behaviour is malleable.  In this example, all it took was increasing the visibility of GP prescribing habits for them to challenge their own practice of medicine.  As a program manager employing behavioural economics, you should focus your efforts on moving away from facts to emotion and be explicit about your intended goal (in this case, “I want GPs to prescribe fewer antibiotics”).  Think:  How can I make this objective more emotionally tangible?  How can I make behaviour more transparent and socially engaging?  How can I make my desired behaviour change the simplest option? 

Wellth: Using loss aversion to drive patient adherence

Wellth is a New York-based digital health company, employing behavioural economics to help healthcare and insurance organisations improve overall health outcomes for their customers and avoid preventable costs.

In the U.S., nearly one-third of prescriptions go unfilled and roughly half of all patients don’t take their medications as prescribed by their doctors.  It’s estimated that this non-adherence leads to about 125,000 deaths and costs the health system up to $300 billion annually in avoidable medical spending. 

Wellth is a mobile app that encourages patients to take their medications as prescribed by their doctors.  It works by leveraging loss aversion, the idea that individuals are more sensitive to losses compared to similar gains (Losing $20 feels twice as bad as winning $20).

How does Wellth work?  Let’s imagine a patient leaves the hospital with a script and downloads the Wellth app.  The company deposits $150 into the patient’s account, which he can keep if he takes all of his medications over a set period of time. Wellth sends daily reminders to take the medication and requires that the patient send a selfie taking the medication.  If he does this, he keeps the money for the day. 

If he forgets, he will get additional reminders throughout the day.  If he fails to take the medication during the day, he will lose $2.  The patient will lose $2 for each day missed.  The potential loss has been shown to drive patient adherence, and the company has completed a pilot in Type 2 diabetes with a large American national insurer. 

As healthcare marketers we must examine all potential leakage points within a system carefully whether it be getting patients to come forward for treatment, choosing the appropriate treatment, or actually following through on the doctor’s orders in order to ensure the best patient outcomes.  What other ways can we make patient adherence easy and emotionally engaging?

To learn more and to watch a demonstration video on how the app works, check out their website! 

#TheatreCapChallenge

An Australian anaesthetist has sparked a global movement #TheatreCapChallenge, encouraging surgical staff to don their names and positions on their scrub caps in an effort to reduce confusion in operating theatres and improve patient safety. 

 The problem is that clinicians working in these environments often work across many hospitals with hundreds of colleagues; to further complicate things, only the eyes of their colleagues are visible.  Clinicians are bound to get people mixed up and precious seconds can be lost when trying to determine who’s who. 

The solution:  Team members print their names and identities neatly on their paper caps [e.g., Rob, Anaesthetist].  Such a simple idea is aimed at overcoming the bystander effect, pyscho-social phenomenon by which individuals are less likely to take action when others are present.  The effect is enhanced when more individuals are present, resulting in greater ambiguity.  The #TheatreCapChallenge directly challenges this ambiguity by allowing staff to assign tasks by name and position (in other words, it makes it easy for everyone).

Additionally, the #TheatreCapChallenge adds an element of fun to work.  Clinicians can decorate their own caps and it further creates a sense of community among staff.  It’s also great for patients as well.  According to WHO’s surgical safety checklist, staff are required to introduce themselves before surgery.  This movement ensures that step is not overlooked and can be reassuring to patients to know who is operating on them.  It strengthens the patient-clinician relationship in a simple way. 

Changing behaviour does not have to be expensive or complicated.  Sometimes, the simplest ideas can have the biggest impact.  As healthcare marketers, how can we challenge ourselves to make life easy for clinicians and patients alike? 

'Moments of Truth' Irrational Decisions

Our Managing Director Neil Doyle was recently interviewed by the Word Vietnam for an article published August 10, 2017.  To view the text in the original format, please click the following link: 

http://www.wordvietnam.com/people-culture/the-stories/moments-of-truth

Despite being ‘rational’ beings, humans constantly make irrational decisions. This is something marketers exploit for both good, and what some might say, evil.

It was 9.30pm on a Wednesday evening and Steve McGrath was returning home on his motorcycle from his teaching job when he entered one of Saigon’s busy intersections.

“I was really tired and not concentrating as intently as I should’ve been,” recalls Steve, an Australian who has been living in Ho Chi Minh City for almost a decade. “The lights had been green for about 10 seconds and I wasn’t paying enough attention to the traffic stopped on my left.”

A young woman’s scream was the only warning he got before she ran into him on her motorcycle. She had run a red light and hit Steve while he was crossing the intersection at around 30km/h.

“She hit my front wheel which spun my motorbike around and threw me onto the road,” says Steve. “I landed on my backside first but then I hit my head twice on the road.”

Although he was wearing a helmet, Steve was dazed after which he remembers bystanders coming to his aid. “By then the young woman had left the scene and I was left thinking that I’d cracked a hip bone.”

Steve chose not to seek medical attention, instead waiting to see the extent of his injury. It turned out to be only deep bruising.

“In the end I was okay, but I only use my motorbike during the day now,” he says.

Although Steve hadn’t sought medical assistance, he was covered by health insurance provided by his new employer. Had the accident happened just six months earlier and the injuries been more serious, he wouldn’t have been covered for the cost of medical attention.

“I’d never had health insurance before I started with my current company this year, other than the basic stuff Vietnamese companies must give by law,” he explains. “I was put off by the costs and caveats associated with taking out health insurance of my own.”

Doing Dumb Stuff

Steve’s decision not to take out his own health insurance isn’t an isolated one among the more than 82,000 foreigners living in Vietnam; surprising given motorcycles are the most common form of transport and 9,000 lives are lost annually to traffic-related accidents.

It raises the question why seemingly rational, well-educated people who choose to live in Vietnam, take the risk and opt out of buying health insurance in such a high-risk environment.

“We all do dumb stuff,” says Neil Doyle, the regional director of DeltaMV Knowledge Solutions, an Australian company that helps marketers overcome challenges in consumer behaviour by developing behaviour strategies. “It’s about understanding the biases at play that drive human behaviour. I call this the science of dumb stuff.”

According to Neil, humans are “sub-standard decision makers.”

“We are predictably irrational,” explains Neil, at his District 7 office in Ho Chi Minh City. “Why else would so many doctors smoke?”

Our irrationality, he says, explains why people try to economise on health care, even when it should be a fundamental thing to have in their lives. This irrationality is also exploited by marketers, as understanding human behaviour is central to devising effective campaigns.

“If you want to influence behaviour, you need to make it emotional, you need to make it social, and you need to make it easy,” he says. “If you like, that’s the new marketing mantra.”

Most of the work in which DeltaMV engages is in the healthcare space, but Neil also has extensive experience with companies who market fast-moving consumer goods (FMCGs), a field where something called moments of truth are fundamental to the success, or failure, of a product.

“In FMCG land, it’s when you walk into a supermarket and you’ve got Kellogg’s and you’ve got Nestlé, and you have a moment of truth,” explains Neil.

Neil is referring to the moment when consumers choose one brand over another on the supermarket shelf. Although a seemingly simple decision, it has been influenced by a number of factors over time, like price, brand awareness, and brand loyalty, and is the work of marketers who try to nudge you towards their product.

“A marketer will talk about the power of brand, and how it’s important to build strong, emotionally compelling brands,” adds Neil.

In the public health sector, a moment of truth might be when someone is torn between seeking medical attention or not. This may be for a host of reasons, but one of the main ones is the potential cost involved in seeing a doctor for something that may turn out to be minor anyway.

In Vietnam, it might be deciding whether or not to eat food from a street vendor on a night out, or allowing a complete stranger to drive you home on the back of their motorbike.

Making Better Choices

To make marketing campaigns emotional, social and easy, marketers work on choice architecture. As generally poor decision makers, humans will almost always choose the easier option, especially on impulse. This explains why EOA and POP (End Of Aisle and Point Of Purchase) displays are fiercely contested spaces among brands in supermarkets. Research has found that shoppers are likely to throw that last-minute chocolate bar or tabloid magazine into their shopping basket as they check out.

In public health, it’s more serious. Choice architecture is about equipping the public with the right tools to make the right decisions when they run into a moment of truth in their day. It could be the difference between accepting the offer of a recreational drug at a dance party, or choosing to abstain from sex with a stranger without a condom. Whatever the situation is, it’s important that people are not only better educated to make the right decisions, but that the resources are in place to help them follow through on positive decision making.

“What we know is that humans always have an emotional response before a ‘thinking’ response,” explains Neil, whose doctoral thesis investigated how the construction of gender and identity in the south of Vietnam impacts sexual health communication. “The thinking bit of your brain is slower than your instinct, or what some might call your gut feeling. Then your prefrontal cortex, the area of your brain responsible for decision making, catches up but it doesn’t work nearly as well because it’s biased to whatever the visceral response was.”

While marketers have used this knowledge to great effect to boost sales — perhaps to the disdain of consumers who may sometimes feel cheated or deceived into purchasing unwanted items — it has been beneficial to public health, including safe sex campaigns.

Breaking Down Barriers

“Choice architecture is about shaping the environment in a way that allows people to make positive choices,” says Dang Nguyen, an associate lecturer in Professional Communication at RMIT Vietnam, whose study in 2011 investigated the barriers consumers in Vietnam confront, both physical and cultural, when purchasing condoms. “It’s about eliminating all the choices that aren’t desirable, and making that standard practice.”

In her study, Dang and her colleagues observed how readily available condoms were at condom boutiques, like Gunshop and Golden Boy, pharmacies, convenience stores, and street vendors, often women on the street who sell condoms along with cigarettes.

“We found that convenience stores are the best at making condoms readily available to customers,” explains Dang, who holds an MSc from Oxford University. “They don’t lock them away so people have to ask for them, rather they are conveniently placed at the counter so they can discreetly mix them in with whatever else they’re buying without even having to talk to the shop assistant.”

While stores like Gunshop have largely been successful, one of Dang’s findings highlights the complications involved in implementing strategies for safer sex in a society that feels uncomfortable discussing it openly.

“From talking to people who sell condoms at places like Gunshop, we discovered that couples would go into these shops together, but they would always keep their air-pollution masks on,” says Dang, whose study was called Understanding the Condom Landscape in Vietnam. “Then, if they went to a particular store often enough, they would give their phone numbers and addresses so that they could have the condoms delivered to their homes rather than run the risk of being identified in public as a regular customer of a condom retailer.”

Neil agrees that condom retailers like Gunshop are successful because they work at a choice architecture level; they are nearby, convenient and have made the narrative around condom use more socially accepted, and thus, more normalised.

“If discussion about condom use and safe sex is able to be raised in everyday conversation, then it will mean the topic will have become less of a taboo,” he says. “And then if you happen to be at that moment of truth in the bedroom with your partner, you’ll be able to make the right decision for you and them.”

Sending the Wrong Message

But this hasn’t always been the strategy for bringing about behavioural change at a public level, particularly in Vietnam. Neil points out that traditional strategies wrongly sent “quite rational messages” to a public that has since been proven for the most part to be irrational in its decision-making processes.

“In terms of sexual health, the message used to be ‘use a condom because otherwise you’ll get a horrible disease, you’ll get AIDS, you’ll die,’ so there was, and still is, a very kind of rational parent-to-child style of communication,” says Neil.

Neil also points to anti-smoking campaigns as a good example of this.

“We still have 20 to 30 percent of the adult population globally who smoke,” he explains. “Do they know that it will give them cancer? Of course they know, so what it means is that there are limits to how compelling a rational message is from a behavioural perspective.”

Indeed the figures stack up. According to WHO estimations, there are more than one billion smokers in the world with tobacco killing more than seven million people a year.

“If you want to communicate something, you have to be clear on its strategic intent,” adds Neil, who says that billboards at large traffic junctions are effective if it’s clear what’s trying to be achieved, “but if you’re trying to build emotionally competent associations in people’s minds or trying to trigger a behaviour like trying to prevent the spread of HIV through condom use [or the use of drugs], then I’d say it’s much more inappropriate because you want to say that in a bar or bia om.”

As for Steve, he is more circumspect about life in Vietnam.

“Not having health insurance played on my mind, but I tried my best to ignore it and hoped for the best,” he says.

Would he recommend others get insurance if they were living in Vietnam?

“No question about it. They’d be dumb not to.”

Follow the Herd: Fad Toys

Pokémon, Beanie Babies, Furbies, Tamagotchi, and now fidget spinners?  What makes these products ‘go viral’ and why do kids want them so badly?  Although there has been a great deal of research in this area, Margo Bergman an economist from the University of Washington suggests that it reflects the tendency of humans to look toward others for information, and this is not limited to just children!

At DeltaMV, we call this ‘herd instinct,’ referring to the common tendency of individuals to adopt the opinions and behaviours of the majority.   In this article, Bergman states that this mentality stems from the basic problem that we all can’t be experts at everything.  We lack the time, energy, and resources to make these decisions, so our brains use shortcuts.  That being said, we look to people we trust, or in this case, who look ‘cool.’  These key influencers play a critical role in giving these fads a boost.

Her research suggests that with the right key influencers, it only takes a minimum of 15 percent of people in a group susceptible to fads to make the trend explode. As healthcare marketers, it is important for us to consider who should be the ideal messenger and what is the best channel to deliver that message.  According to Bergman, if susceptibility levels are greater than 65 percent, the fad is likely to have lasting power.  How can you ensure the longevity of your current and new products? 

New Zealand: Racism Needs Your Help to Survive

New Zealand, a peaceful country in the South Pacific with relatively high ethnic diversity, is facing a growing number of complaints concerning racial discrimination according to the country’s human rights commission.  To curb this trend, they’ve launched a clever campaign to reframe the debate within the country.

The tone of a conversation is set very early on, which means asking the right questions at the beginning is crucial to convincing your audience.  At DeltaMV, we like to call these ‘influential questions’ because of their power to set the frame of reference.

The anti-racism campaign in New Zealand aims to shift the frame of reference. Rather than taking the traditional approach of denouncing the evils of racism, the campaign is tackling the issue head on.  The campaign doesn’t tell us how to stop racism; it shows us how to help it grow.  Instead of criticizing behaviours that we may all have been guilty of at some point, this video reframes the issue by making us reconsider our role in the growth of racism.

In other words, it doesn’t just use facts.  It forces us to challenge our own beliefs and perspectives by reframing the conversation.

In healthcare marketing, it’s clear that facts don’t always change customers’ opinions.  Often, there are very few clinical differences between pharmaceutical products.  So what is different?  It’s the story, the reference point, and the perception of value around a product or brand.  How can you reshape the conversation around your product to appeal to customers in terms of lifetime or tangible value? What questions can your med reps ask early on to encourage your product’s usage among HCPs? 

Nudging New Mexico

In the United States, over $4 billion of unemployment benefits were paid out to people who didn’t qualify for them.  What caused this?  The New Mexico Department of Workforce Solutions (DWS) identified 3 primary sources of misinformation in the application process:  1) reason for unemployment 2) reporting weekly earnings and 3) work search requirements. 

The traditional approach to tackling this type of fraud has been increasing resources to prosecute low-level offenders, which can be quite costly and deny services to those most in need.    Instead, the DWS applied the nudge theory to change people’s behaviour in a simpler and more cost-effective manner. 

Nudge theory suggests that ‘positive reinforcement and indirect suggestion can be more powerful than direct instruction, legislation, and enforcement.’ They made subtle changes to the application process like showing the claimant a pre-completed letter to the employer verifying the reason for termination, suggesting that that majority of people reported new income, or asking the claimant to commit to a specific job search plan for the next week. These nudges led to dramatic results with claimants now twice as likely to report new earnings, half as likely to commit fraud, and up to 20% more likely to find work within the next few months. 

What nudges can you employ to influence clinicians and patients for better outcomes for your business? 

Seductive Veggies: What's in a Name?

A recent study in the US found that sales for vegetables at the Stanford cafeteria jumped 25% when ‘indulgent’ labels were applied.  The experiment applied four different types of labels to vegetables:

  • Basic – description was only the name of the vegetable, ‘carrots’
  • Healthy restrictive – ‘carrots with sugar-free citrus dressing’
  • Health positive – ‘smart-choice Vitamin C citrus carrots’
  •  Indulgent – ‘twisted citrus-glazed carrots’

Researchers found that the ‘indulgent’ vegetables were chosen by 25% more people than basic-labelled vegetables, 41% more people than healthy restrictive-labelled vegetables, and 35% more people than health positive-labelled vegetables.  When most people are deciding what to eat, they are motivated by taste.  Studies show that people tend to think healthier foods aren’t as tasty as other options, but when the choice architecture changed, so did people’s behaviour.

How can we apply the same labels to healthcare marketing to make products more appealing to customers?  Let’s use a popular OTC pain reliever as an example.

  • Basic – Advil (ibuprofen)   
  • Healthy restrictive – Non-addictive pain reliever
  • Health positive – Fast-acting formula (stops pain in minutes)
  • Indulgent – ‘Nothing is proven to work faster’ or ‘#1 Doctor recommended for pain relief’

While choice is complex, you can imagine the impact each label might have.  How can you reframe your products to become more emotionally salient to customers and change the choice architecture to favour your product?

Zusha: The Stickers that Save Lives

The Hawthorne Effect is a cognitive bias that refers to the idea that people change their behaviour when they are observed.  The Zusha campaign in Kenya illustrates how this bias can be leveraged to achieve the desired behavioural change, and in this case, save lives. 

Every year on Kenya’s roads about 13,00 people die.  A large portion of that is caused by the matatus, privately owned minibuses used for transport both within and between cities.  Drivers in the past have been reckless—speeding, drunk driving, or overlapping.  A new campaign seeks to change this behaviour with a simple sticker. 

Zusha+Stickers.png

Zusha stickers.  Check out their website:  http://zusharoadsafety.org 

These stickers are placed inside matatus, where they are visible to all passengers. They provide a gentle ‘nudge’ to passengers encouraging them to speak out against reckless driving.  The messages vary from ‘You have the power to slow down a reckless driver’ to ‘Don’t let a reckless driver get away with murder.’ Essentially, the stickers are there to remind passengers that it is their responsibility to hold matatu drivers accountable and to remind drivers that they are being watched. 

The impact of the Hawthorne Effect has resulted in dramatic decrease in the number of traffic accidents in Kenya, and it has been so successful that it is being implemented in other African nations.  How can you make doctors feel as if other clinicians and patients are observing their actions?  How would this impact their prescribing behaviour?

Watch the video from the BBC to learn more. 

Source: http://www.bbc.co.uk/news/magazine-40096722

Nudging: The Global Trend

When the British government setup the Behavioural Insights Team (BIT) in 2010, many questioned the effectiveness and longevity of the approach.  Since its creation, governments and bodies (like the UN and World Bank) across the globe have adopted this approach.  Time has proven the power of nudging and its lasting impact. 

Here are just a few examples of nudges that have worked.

-In 2012, American university applications were simplified for low-income students to include pre-filled data from tax returns; this increased the likelihood of these students going to college by 25%. 

-In 2014, a Qatari healthcare provider increased screenings for diabetes simply by offering them during Ramadan when most Qataris were already fasting.

-In Nigeria, the World Bank wanted to help curb corruption.  They found that keeping better records in health clinics made it less likely for money to be stolen.  They achieved this by giving those who maintained good records certificates to display in their clinics. 

How can you nudge your customers in the right direction? To learn more about how policymakers around the globe are utilising nudges, check out this article from the Economist. 

Source: http://www.economist.com/news/international/21722163-experimental-iterative-data-driven-approach-gaining-ground-policymakers-around?zid=314&ah=607477d0cfcfc0adb6dd0ff57bb8e5c9

Recycling Nudges

Over the years, psychologists have explored how Behaviour Science can both positively and negatively influence people’s recycling habits.   This research has highlighted several key biases, and we will briefly discuss a couple.      

Ownership:  We’ve all had our name misspelled on a coffee cup at some point, but did you know that people are significantly more likely to recycle this cup if their name is spelled correctly (compare recycling at 46% with correct spelling, 26% with no name, and 24% with misspelled name).  According to researchers, this suggests a reluctance to discard something that we feel ownership over. 

Social Norms: A study from the 1990s observed littering behaviour in 2 different settings:  a clean parking lot and a lot full of litter.   Participants observed a man throw a flyer on the ground and then they found a similar flyer on the windshield of their car.  In the littered parking lot, 54% of people threw the flyer on the ground.  In the clean parking lot, only 6% littered.  The underlying assumption is that we tend to model our behaviour after what is socially accepted, and deviations from this norm are easily identified. 

Reframing:  Ever seen the signs in your hotel room encouraging you to use reuse your towels?  In 2008, researchers wanted to know what would happen if they rephrased the sign.  Moving away from the standard ecological message, researchers saw a 26% increase in reuse when they said ‘most guests in the hotel reused their towels’ and 33% increase when they referenced guests who had previously stayed in that particular room. 

How does the appearance of an object impact its likelihood of being recycled?  How important are the shapes of trashcans? Can too many recycling bins actually encourage over-consumption?  Check out this article for more examples of Behaviour Science in recycling.  

Medisafe: More Than Just a Reminder

Medisafe has partnered with pharmaceutical companies to essentially create a ‘glorified alarm clock’ to remind patients when to take their medicine.  This mobile platform focuses on adherence tech and uses machine learning to personalize the experience for each user. 

Medisafe sends messages to patients reminding them to take their medicine and even connects users to a nurse hotline if they’ve missed too many doses.  If patients are facing financial constraints, Medisafe incorporates patient assistance programs’ copay cards in the app.  It connects patients to a broader audience of users when they experience side effects, letting them know they are not alone. 

The platform can also serve as an important data collection source for drugmakers.  Not only does Medisafe track adherence, it can be used to monitor how one drug is performing compared to others, switching behaviour of patients, and when exactly patients are taking their prescriptions.  This data can be a powerful tool to understand the behaviour drivers of patients.  What could you do with this data? 

Choosing Wisely?

The ‘Choosing Wisely’ Campaign is led by the American Board of Internal Medicine (ABIM) Foundation and Consumer Reports and hopes to cultivate meaningful conversations between clinicians and patients about avoiding unnecessary medical tests, treatments, and procedures. 

The greatest challenge to its success is its failure to consider the cognitive biases shaping clinician behaviour.   According to authors of a MAJ narrative review, most day-to-day clinical decisions are made intuitively, meaning they are subject to these biases.  Professor Ian Scott and his team at Princess Alexandra Hospital have identified several of the most common examples.  Let’s take a look at 3 of them.

-Commission Bias refers to clinicians’ innate desire to avoid regret by failing to perform an intervention that could have helped a few patients.  This can cause some clinicians to spend exorbitant amounts on patients on end-of-life care who may receive little benefit in terms of longevity and quality of life.  

-Impact Bias refers to the overestimation of benefits compared to the negative consequences of intervention.  While this can lead clinicians to exhaust every treatment option, the patient may ultimately end up worse off financially, physically, and emotionally.

-Sunken-Cost Bias refers to continuing a treatment path despite potential harm or inappropriate care due to time and resources already invested.  Sometimes, we get our heads wrapped around one idea and can’t let it go.  This can be detrimental to patients when our thinking becomes rigid and can increase the emotional and financial impact on patients and their families. 

Since decision-making is not as rational as you might have imagined, there are many more points of leverage to encourage clinicians to provide optimal care to their patients.  Check out the article for a full list of the most common biases encountered in clinical decision-making.

Not Your Average Vending Machine...

Vending machines have offered convenient access to snacks and beverages, but entrepreneurs around the world are now stocking them with products ranging from cycling helmets in Melbourne to needle exchanges in Las Vegas.  This demonstrates an effort to make access to these products easier for consumers.

Consider the needle exchange machine in Las Vegas, which is located in a drug treatment centre. It provides an easy-to-access, clean needle kit in a safe environment with no fear of legal repercussions.  Likewise, the ‘Wellness To Go’ Machine’ at the University of California aims to make reproductive choices for students easier by dispensing condoms, pregnancy tests, and Plan B. 

What other unorthodox approaches can make our products easier for patients and consumers to access?  How can we reduce the stigma around certain health issues and encourage people to make desired behaviour changes?  Check out this article for more unusual vending machines across the globe. 

Time to Consider More Than Just Detailing

A new study published in the journal of American Medical Association (JAMA) suggests that when teaching hospitals place restrictions on drug reps, doctors tend to use more generics.  While conflicts of interest have long existed in healthcare, this research brings new attention to the impact of the relationships between doctors and drug reps. 

This study, which examined more than 16 million prescriptions across eight classes of drugs, found that the practice commonly know as ‘detailing’ actually had a 1.67% decrease in market share for the average promoted drug.  It is important to note that researchers found statistically significant changes in only 9 of the 16 hospitals studied.  Additionally, the study does prove that that these policies directly changed the prescribing habit, but it suggests an association between the two. 

What does this mean for healthcare marketers?  It means that we must look beyond traditional methods of marketing and consider other levers to influence clinicians.  Detailing may once have been effective; but today with the help of Behaviour Science, we have many more tools under our belts. 

What healthcare can learn from Uber

Uber’s company structure differs from others in that it treats its drivers as contracted workers rather than employees.  While this reduces its labour costs, it means that Uber cannot dictate hours to its workers.  Instead, they must employ a series of behavioural tools to get drivers to work when they want them to work. 

Techniques include encouraging drivers to set ‘earning goals’ and alerting them when they are close to reaching these goals or by showing drivers their next potential fare before even finishing their current ride.  This feature works much like Netflix in regard to how it queues up the next program automatically, making it easier to keep watching rather than turning off Netflix. 

On the Uber app, drivers would see messages that say, ‘You’re $10 away from earning $X, are you sure you want to log off?’ Drivers are then presented the choices:  ‘Go offline’ or ‘Keep driving’ (with the latter highlighted as the default option).

These same strategies can be used to increase patient compliance.  For example, patients can receive text messages reminding them to take their medication at specific times.  Likewise, they can receive reminders when they are running low on a prescription.  The message could resemble the one described previously, ‘You have 3 days left before your prescription runs out.  Would you like to refill now?’ (with the default option ‘Refill’ highlighted). 

Nudging can also be applied to other aspects of the healthcare industry such as encouraging patients to complete a course of treatment, to receive all stages of a vaccination, or to return for a follow-up visit.  Nudging seems so simple, yet it can be a powerful tool.