Behavioural insights for improving resident decision making

Dr Barbara Fasolo Associate Professor Behavioural Science | Head of Behavioural Research Lab

b.fasolo@lse.ac.uk

A talk prepared for the LGA – 12 March 2019

Nudges for social good – using behavioural insights in local government

Thanks to Grace Abel & Umar Taj

What’s she like?

Jarrett (2008). Event Report. The Psychologist,

© Dr Barbara Fasolo

We cannot change, or improve, residents’ decisions unless we know their decision mindware (how, and

why they decide, or not)

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Human “decision mind-ware” is made of 2 systems

designed to see the waitress smiling, first.

SYSTEM 1FAST!AutomaticEffortlessAvoids too much thinking Loss averseConfused by infoForgets own values, long term goalsBiased

SYSTEM 2… slow… deliberate.. Reads all information… balancing losses and gains)…remembers deep, long term goalsAware of biases

Kahneman, D. (2011). Thinking, fast and slow. New York: Farrar, Straus and Giroux.

© Dr Barbara Fasolo

What’s the difference between

nudging behaviour vs decision?

“Behaviour”

- normally a binary action (“I recycle or not”)

- well-known but not appealing (e.g. I know recycling means using a recycling sack or bank, but my habit is not to recycle).

- Nudging behaviour is about breaking habits, or creating new.

“Decision” (choice)

- many possible options (often more than 2 (“I choose a payment method to pay for rent arrears”)

- some options are new and need to be discovered by new information

- Nudging decisions is also about creating informed decision-making and educating ‘conversations’ (I chose X because...)

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The fundamental conflict for all of us

who help others decide better

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How we wish

others to decideHow others

decide

Most decision helpers are optimistic

© Dr Barbara Fasolo 7

But we offer choice

for System 2

Citizens choose by System 1

Decision helpers need to be realistic

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offer training

For System 2Fasolo & Taj 2019

offer choice architecture for

System 1Boyce, Dixon, Fasolo and Reutskaja (2010)

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What do you think residents care

most about when choosing a

hospital online?

Case: Helping to choose a high-quality hospital for elective surgery

Hospital Choice was offered for System 2

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postcode

We are not

primed by the

postcode,

discount distance

and choose by

quality

postcode

postcode

365!

We are not

overloaded by

choice, have the

time and

resources to

compare all 365

hospitals

We can understand numbers,

invert scales, combine conflicting

information, map indicators to our

preferences, scroll down…

We are not afraid

or stressed by the

statistics

Which Choice Architecture could…

(Government) (King’s Fund)

Decrease Effort for online user

(NHS choices team)

Improve transparency, informed choice

(taking into accountdifft age, numeracy etc)

Increase # residents choosing

Best Quality Hospital

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The 3 stage project (for your later reference)

Focus GroupsPhase 15 choice

architectures

Phase 22 architectures

- simpler and more consistent format of data;

- clearer and more consistent definitions of indicators;

- more balanced scorecard

Effect of designs on:

a) Choice outcomes (Prop People choosing best)

b) Awareness of informationc) Post-choice perceptionsd) Information search (heatmaps)

Any long-lasting effect of Phase 1 on subsequent choice and choice perceptions?

January 2010

1168 valid participants

March 2009

44 people

February 2010

744 valid participants

Dr Barbara Fasolo 12© Dr Barbara Fasolo

Before nudging a decision, structure it!

Create “Choice Menus”:

- 2-5 Options (e.g. hospitals)

- 2-3 Clusters of Criteria

- First the most important that is forgotten

- Last the one that people overweigh/think most about

- - Easy labels+checks + numbers13

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Consider Decision Mindware,

Design Choice (Not information) Architectures for System 1

Test them before choosing the one to implement (here, just 4)

Before implementing a choice architecture:

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1. Best first, Sort by Quality

Best Quality is FirstActive Choice Required

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2. Opt-out Default(Highlight the best overall on all the criteria and set as opt-out default)

Same Scorecard as Sort-by-Quality

Best is highlighted pre-selected

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Best is 4th (away from edge and close to

middle). Active choice required

Scorecard Pre-sorted by Distance

(Quality not Mentioned)

3. Sort by distance, best in the ‘hotspot’

© Dr Barbara Fasolo

4. Preference Articulation (list all objectives that are relevant and ask to rank them by own preferences)

ac

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Rank all indicators from 1 (most important) to 9 (least important to you)

The first indicator tells you how good the quality is… Numbers greater than 100 mean…

…No Hospital is excellent across all indicators…You will need to make trade-offs…

Then Scorecard(same as Best-in-Hotspot)

When did most residents choose the highest quality hospital?

Best First?

Opt Out Default?

Hotspot?

Preference Articulation?

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0.44 0.35 0.52 0.480

0.1

0.2

0.3

0.4

0.5

0.6

Default(214)

Best-First(254)

Best-In-Hotspot(256)

Preference(219)

Pro

po

rtio

no

f b

est

cho

ice

s

Condition (number of observations)

Prop ‘best quality hospitals’ choices

(Reutskaja & Fasolo, 2013)

With opt-out default When preferences are asked

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When were residents making most informed choices?

1. Present your residents a simple menu/scorecard laying out 2-5 options available?

2. Highlight the option recommended?

3. Include the do-nothing/no-decide option (as choosing not to choose is a choice!)?

4. Include a checklist of objectives?

5. Ask to interact and rate these objectives by importance?

Going back to your decision, can you…

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Thank you, and keep in touch:b.fasolo@lse.ac.uk