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Environmental changes are the low hanging fruit of behavior change
• It’s far easier to change people’s environment than it is to change their mind
• What looks like a “people” problem is often just an “environment” or “situation” problem
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Keez Keiser confirmed this theory through a series of real world experiments
• When graffiti was present, the proportion of litterers more than doubled from 33% to 69%
4Keizer, K.; Lindenderg, S.; Steg, L. The spreading of disorder. Science 2008, 322, 1681-1685.
Second experiment
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• When the first sign was disregarded, 82% (more than three times as many people), disregarded the second sign
Keizer, K.; Lindenderg, S.; Steg, L. The spreading of disorder. Science 2008, 322, 1681-1685.
Third experiment
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• When the the mailbox was covered with graffiti the proportion of thieves more than doubled to 27%
Keizer, K.; Lindenderg, S.; Steg, L. The spreading of disorder. Science 2008, 322, 1681-1685.
Tweaking a College Food Donation Campaign
All Students
Givers Non-Givers
Profiling Survey
Switch by Chip and Dan Heath, 2010
They Prepared 2 Different Donation Letters
Basic Letter
• Announced the launch of food drive the following week
• Asked them bring canned food to a booth in a well known place on campus
More Detailed Letter• Announced the launch of food
drive the following week• Included a map to the precise
spot on campus where booth would be
• Requested cans of beans specifically
• Suggested that they plan a time when they will be near booth so drop off will be easy
Switch by Chip and Dan Heath, 2010
Tweaking a College Food Donation Campaign
All Students
Givers Non-Givers
Profiling Survey
Detail Basic Detail Basic
42% 8% 25% 0%Donation
Rate
What looks like a people problem is often an environment or situation problem
Switch by Chip and Dan Heath, 2010
3X
2. Setting action triggers
• Create a mental plan of action that gets triggered when a cue is present
21Switch by Chip and Dan Heath, 2010
Research shows that action triggers are most useful in difficult situations
• In one study of patients recovering from hip- or knee surgery, one group was asked to set action triggers
• Individuals were asked to write down when they would take their walks and where they planned to go on those walks
• On average, the action trigger patients were bathing themselves without assistance in 3 weeks versus 7 weeks
• Action trigger patients were standing up in 3.5 weeks versus 7.7 weeks
• In just 1 month, the action trigger patients were getting into and out of cars on their own versus 2.5 months for patients in the other group
22Switch by Chip and Dan Heath, 2010
And while action triggers aren’t foolproof, it’s hard to find an easier way to drive change
• A recent meta-study that analyzed 8,155 participants across 85 studies found that the typical person who set an action trigger did better than 74% of people on the same task who didn’t set one
23Switch by Chip and Dan Heath, 2010
Checklists are slightly more detailed forms of action triggers
• The Story of Dr. Peter Pronovost
– ICU physician at Johns Hopkins
– Mission: Reduce IV line infections in ICUs
– Challenge: No direct authority over his colleagues
24Switch by Chip and Dan Heath, 2010
• The medical literature confirmed 5 major sources of line infections
• Studies in other hospitals confirmed that reductions in any of these 5 indicators resulted in reductions in IV line infections
• Peter drafted a 5 step checklist
• Published his checklist in a leading medical journal
So he began by studying the literature on IV line infections
Switch by Chip and Dan Heath, 2010
1. Wash your hands before inserting a line
2. Clean patient’s skin with antiseptic at the point of insertion
3. Put sterile drapes over the entire patient
4. Wear a sterile mask, hat, gown, and gloves
5. Put sterile dressing over the catheter site once the line is in
Peter’s Checklist
Source: New Yorker Magazine; December 10, 2007
Peter’s initial test at JHU was a major success
• Peter decides to test the checklist in more challenging environment
• He works with state of Michigan to implement the checklist at all state managed hospitals
• State managed hospitals were among the lowest performing hospitals with the worst reputation for quality and outcomes
Source: New Yorker Magazine; December 10, 2007
The Results speak for themselves
• Peter’s checklist implemented in Michigan ICUs over 18 months
• ICU line infections declined to almost zero
• The checklist saved approximately 1,500 lives
• The reduction in line infections reduced costs by $175 million
Source: New Yorker Magazine; December 10, 2007
Summary
• Environmental changes are the low hanging fruit of behavior change because it’s far easier to change people’s environment than it is to change their mind
• In fact, what looks like a “people” problem is often just an “environment” or “situation” problem
• By making small changes in our environment we can have a big impact on behavior
– Tweaking the environment you’re trying to change
– Setting action triggers to preload important decisions
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