Facilitated by Alexandra Health System team, Singapore led by Tan Liren Industrial Designer and Ministry of Manpower, Singapore led by Teo Ya Chih Senior Manager

1. DESIGNING BEHAVIOUR CHANGE
IN HEALTHCARE
Tan Liren | Industrial Designer | Alexandra Health System
Teo Ya Chih | Senior Manager | Ministry for Manpower

2. HELLO!
And Welcome J

3. Joint workshop by KTPH & MOM
Innovation Behavioural Insights Behavioural Inasnigdh Dtse &si gDne Usingint

4. About us
Dr Wong Sweet Fun!
Senior !
Consultant!
Tan Liren!
AHS!
Lee Wei Chung!
Designer!
Teo Ya Chih!
MOM!
Sabrina Ng!
AHS!
Ee Tien!
MOM!
Wong Hefen!
MOM!
Joycelyn Chua!
MOM!

5. Objective of today’s session
Introduction to Behavioural
Economics
MINDSPACE EAST
EASY
ATTRACTIVE
SOCIAL
TTIMIMEELYLY
Developed by UK, Behavioural Insights Team
Learn 2 Frameworks for Application

6. Program for the day
Workshop
14:00
15:15
APPLICATION
APPLICATION
15:40
18:00
INTRODUCTION
TEA BREAK
• Activity: Redesigning
S-Clinic (Develop
Interventions-EAST)
• Sharing of concepts
• Closing
15:5016:30
• Introduction
to Behaviour
Insights
concepts –
MINDSPACE
• Activity:
Redesigning
S-Clinic
(Understand-
MindSpace)
NUDGE IN
HEALTHCARE
• Designing
Nudge in
Healthcare
– EAST
framework

7. Open to learn
Ground rules
Exchange ideas Be excited

8. Ice breaker
• <<Name>>
• <<Occupation>>
• I will like to be known for __________
• I hope to learn from this workshop __________

9. Quiz
1. Was Mahatma Gandhi older
or younger than 100 years
old when he died?
2. How old was Mahatma
Gandhi when he died?

10. 3. Was Benjamin Sheares older
or younger than 50 years old
when he died?
4. How old was Benjami n
Sheares when he died?

11. 5. Which tower is leaning more to the right?

12. Mei Ling is 31 years old, single, outspoken
and very bright. She majored in philosophy. As
a student she was deeply concerned with
issues of discrimination and social justice. She
drives a hybrid car and lives in Punggol
waterway area.
6. Which of these two statements is more likely?
A) Mei Ling is a librarian
B) Mei Ling is a librarian and is active in the environmental
movement

13. 7. Would you travel 20 minutes to get the discounted
toaster?
$100
$50

14. 8. Would you travel 20 minutes to get the discounted
television?
$3,000
$2,950

15. 9. How many times do you floss your teeth in a day/ month*?
0 1 2 3 4 5 6 7 8
10. How likely are you going to see the dentist if you have not
done so?
0 1 2 3 4 5 6 7 8

16. What is the relationship between design thinking
and behaviour science?

17. BEHAVIOUR SCIENCE
Explains the science of how our
behaviour is affected by what our
brains perceive
DESIGN THINKING
Understand what our users need
and desire through deep empathy

18. Design thinking and behavior science!
Understand, Explore and Affect! Examine, Explain and Test!

19. Behavioural insights
It turns out that the environmental
effects on behaviour are a lot
stronger than most people
expect
Humans make predictable
mistakes because of their use of
heuristics, fallacies, and because
of the way they are influenced by
their social interactions

20. Use of behavioural insights in public policy

21. MINDSPACE – developed by UK BIT
A framework for understanding behavioural
biases and effects
Messenger
Incentives
Norms
Defaults
Salience
Priming
Affect
Commitment
Ego

22. Messenger
- We are heavily influenced by who communicates information
Expertise and trust
Perceived authority
(formal or informal)
Peer effects

23. Incentives
- Our responses to incentives are shaped by mental shortcuts
Future discounting
Loss aversion
Overweigh small
probabilities

24. 24 Sep
27 Sep 29 Sep
TIME
Banana/ Choc
Hyperbolic discounting

25. Norms
- We are strongly influenced by what others do
Personalise the norm
Spread the word Beware of
boomerangs

26. Defaults
- We “go with the flow” of pre-set options
Defaults work because people dislike making
important decisions and like to
procrastinate

27. h#p://www.youtube.com/watch?v=2lXh2n0aPyw
Avoid choice
overload
Highlight to people
what they want/ need
to know
Salience
- Our attention is drawn to what is novel and seems relevant to us
Personalisation

28. Priming
- Our acts are often influenced by sub-conscious cues
Size of plates and portion size effects
how much we eat
Words, sights and smells
influence behaviour

29. h#p://www.youtube.com/watch?v=2lXh2n0aPyw
Moods can be more
important than
deliberation
Emotional responses
are fast & automatic
Cannot always
explain own
behaviour
Affect
- Our emotional associations can powerfully shape our actions

30. Commitment
- We seek to be consistent with our public promises, and reciprocate acts
People can actively
choose to constrain
their future self
Make commitments
public
Reciprocity

31. Ego
- We act in ways that make us feel better about ourselves
We seek to behave in a way that
supports a positive and consistent
self image

32. Understand your persona
Messenger We are heavily influenced by who communicates information
Incentives Our responses to incentives are shaped by mental shortcuts
Norms We are strongly influenced by what others do
Defaults We “go with the flow” of pre-set options
Salience Our attention is drawn to what is novel and seems relevant to us
Priming Our acts are often influenced by sub-conscious cues
Affect Our emotional associations can powerfully shape our actions
Commitment
We seek to be consistent with our public promises, and
reciprocate acts
Ego We act in ways that make us feel better about ourselves

33. Programme for the day
Workshop
• Introduction
to Behaviour
Insights
concepts &
Framework
14:00
15:00
18:00
INTRODUCTION
NUDGE IN
HEALTHCARE
• Designing
APPLICATION
APPLICATION
TEA BREAK
16:30
15:30
15:50
Nudge in
Healthcare
– EAST
framework
• Activity: Redesigning
S-Clinic (Develop
Interventions-EAST)
• Sharing of concepts
• Closing
• Activity:
Redesigning
S-Clinic
(Understand-
MindSpace)

34. WELCOME BACK! J
Tan Liren | Industrial Designer | Alexandra Health System
Teo Ya Chih | Senior Manager | Ministry for Manpower

35. Overview from the 1st session
A framework for understanding
behavioural biases and effects
Messenger
Incentives
Norms
Defaults
Salience
Priming
Affect
Commitment
Ego
We can’t help being irrational.
Our brains are wired that way.
Behavioural
Economics
helps
us
understand
many
of
the
seemingly
irraConal
behaviours

36. Program for the Day
Nudge Workshop
• Introduction
to Behaviour
Insights
concepts &
Framework
14:00
15:00
15:30
18:00
INTRODUCTION
TEA BREAK
APPLICATION
NUDGE IN
HEALTHCARE
APPLICATION
• Designing
Nudge in
Healthcare
– EAST
framework
• Activity: Redesigning
S-Clinic (Develop
Interventions-EAST)
• Sharing of concepts
• Closing
• Activity:
Redesigning
S-Clinic
(Understand-
MindSpace)
15:5016:30

37. Why do you think Behavioural Economics
is important in Healthcare?

38. As we strive to progress as a society
We are now living a more sedentary lifestyle, compared to our
ancestors as we transit to a knowledge-based economy.!
http://stcommunities.straitstimes.com/sites/default/files/imagecache/bxslider_photo/capitolsg10e.jp
http://3.bp.blogspot.com/-C7CWWkHcBXc/Uld1Zco2nII/AAAAAAAAEd4/3nzjlglCymo/s1600/ncs-office.jpg

39. As we strive to progress as a society
From living in a time of scarcity to one of abundance, our priorities
changed. We now have easy access to convenient but unhealthy food.!
http://www.thedogood.net/wp-content/uploads/2012/05/13-donate-food-lg.jpg
h#p://i287.photobucket.com/albums/ll143/hongpeng1990/Blog%20Images/JollibeeSG02_zpse388e1d3.jpg

40. As we strive to progress as a society
As a result, we now face an entirely different set of challenges, in which
unhealthy lifestyles are the key to many of our chronic diseases. !
http://news.xin.msn.com/en/singapore/moh-extends-use-of-medisave-to-cover-more-chronic-diseases

41. Problems in Healthcare
“We don’t have a healthcare problem.
We have a behaviour problem.”
-Mr Gautam Jaggi, Lead Analyst Ernst & Young

42. Healthcare Perspective

43. Patients’ Perspective

44. Patients’ Perspective
h#p://cdn.asiancorrespondent.com/wp-­‐content/uploads/2013/02/AsiaObesity-­‐621x297.jpg

45. Patients’ Perspective
h#p://4.bp.blogspot.com/-­‐UcB68Lo5CrQ/U28nJo4LjSI/AAAAAAAAnp8/RTxBTznppMU/s1600/DSC_0047jk.jpg

46. Behavioural Economics in Healthcare
Changing Behavior is one of the biggest
and most important challenge in healthcare.
"If you look at people after coronary-artery
bypass grafting two years later, 90% of them
have not changed their lifestyle, even though
they know they have a very bad disease and
know they should change.” -Dr Edward Miller

47. How can Behavioural Economics help us?

48. EAST Framework
EASY
ATTRACTIVE
SOCIAL
TIMELY
Adapted from The Behavioural Insights Team, UK
The Behavioural Insights
Team developed the EAST
framework for practitioners
to easily apply it in the
design of the solution to
nudge the desired
behavior.

49. 2. Simplify
3. Using Defaults
EAST Framework
EASY
ATTRACTIVE
SOCIAL
TIMELY
Make the solution easy by:
1. Reducing Hassle Factor
2. Simplifying
3. Using Defaults

50. Strategies for Easy
REDUCE HASSLE
Make healthy options easily
accessible
SIMPLIFY
Make it simpler for people to
understand healthier options
DEFAULT
Make healthy food the only
choice available
HOW MIGHT WE…
Make it easier for people to eat well?

51. EAST Framework
EASY
ATTRACTIVE
SOCIAL
TIMELY
Make the solution attractive by:
1. Attracting Attention (Appeal)
2. Rewarding and Sanctioning
3. Gamifying & Fun

52. Strategies for Attractive
HOW MIGHT WE…
Make it attractive for people to not litter?
REWARDS & SANCTIONS
Make people own it by putting
their reputation at stake
ATTRACT ATTENTION
Make recycling options
obvious
GAMIFY/ FUN
Make the act of throwing
trash fun
h#p://i.dailymail.co.uk/i/pix/2009/03/19/arCcle-­‐1163132-­‐03F79CFC000005DC-­‐193_468x377.jpg
h#p://chemistryteam.com/cms/wp-­‐content/uploads/bins21.jpg

53. EAST Framework
EASY
ATTRACTIVE
SOCIAL
TIMELY
Make the solution social by:
1. Social Norms
2. Commitment Device
3. Networking

54. Strategies for Social
SOCIAL NORMS
Customise the desired norm
to encourage usage
COMMITMENT DEVICE
Make users commit to a future
decisions to ensure compliance
NETWORK
Create a network to
encourage peer support
HOW MIGHT WE…
Make it social for people to lead an active lifestyle?

55. EAST Framework
EASY
ATTRACTIVE
SOCIAL
TIMELY
Make the solution timely by:
1. Prompting
2. Planning
3. Cost of Delay

56. Strategies for Timely
HOW MIGHT WE…
Make it timely for people to adopt the usage of sun screen to protect their skin?
PLAN
Bundle a service together
with the product
COST OF DELAY
Bring forward consequences
of not using sunscreen
PROMPTS
Place prompts at the
desired context
http://goodoldlululemon.files.wordpress.com/2014/05/imgp8838.jpg
h#p://www.ozarkoutdoors.net/wp-­‐content/uploads/2013/03/Store-­‐Layout-­‐From-­‐Dispatch.jpg
h#p://www.reddit.com/r/SkincareAddicCon/comments/26y97f/uv_photo_with_without_sunscreen/

57. Nudge in the Design Process
Understand! Explore! Prototype!
Frame!
Problem!
Implement!
Solution!
Observe/
Interview
Explain
Strategise
Select
Ideas
Prototype

58. Nudge in the Design Process
User needs
Design Research
Design
Solution
Social Norms Social Influence Choices
Attributing factors that explains one’s behavior
Behavioural Science

59. Nudge in the Design Process
“Nudges are like GPS units: they
tell you the most efficient, or
‘best’, route, but you don’t have
to take it; you can go your own
way and choose the scenic
route, if you like.”
Professor Cass Sunstein

60. Behavioural Design Toolkit
To stimulate ideas in the design process

61. The value in both science and design lies in
what they can teach us about people.
Wai%ng
in
an
hospital
in
2013

62. Thank You
tan.liren@alexandrahealth.com.sg

63. Program for the Day
Nudge Workshop
• Introduction
to Behaviour
Insights
concepts &
Framework
14:00
15:00
15:30
18:00
INTRODUCTION
TEA BREAK
APPLICATION
NUDGE IN
HEALTHCARE
APPLICATION
16:30
• Designing
Nudge in
Healthcare
– EAST
framework
15:50
• Activity: Redesigning
S-Clinic (Develop
Interventions-EAST)
• Sharing of concepts
• Closing
• Activity:
Redesigning
S-Clinic
(Understand-
MindSpace)

64. Closing
DEFINE THE
OUTCOME
UNDERSTAND THE
CONTEXT
BUILD YOUR
INTERVENTIONS
What you’ve just been through
TEST, LEARN, ADAPT
h#p://www.clubsnap.com/forums/street-­‐candids/463876-­‐singaporean-­‐uncle.html
http://singaporeseen.stomp.com.sg/singaporeseen/sites/default/files/public/article/images/featured/2012/12/1514844.jpg

65. Nudge in the Design Process
Understand! Explore! Prototype!
Frame!
Problem!
Implement!
Solution!
Observe/
Interview
Explain
Strategise
Select
Ideas
Randomised
Controlled
Trials
MINDSPACE! EAST!

66. Further Reading If You are Interested

67. More Sources of Inspiration
A
Beginners
Guide
to
IrraConality
by
Dan
Ariely
on
Coursera
Brains,
Behaviour
and
Design
Group,
InsCtude
of
Design
Behaviour
Economics
and
Neuroscience
101
by
Tapestry
Works

68. Thank You.