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Addressing Complacent Inactions in Healthcare

Action tends to occur when it’s urgent, easy, and clearly expected by others. Otherwise, inaction is the norm, even in the face of failure and long-term threats. Many types of inaction are common:

  • Failure to be proactive: People focus on immediate concerns and "putting out fires." There is less focus on prevention. We tend to get the importance/urgency balance wrong by over-emphasizing urgent issues and neglecting many important ones.[1]

  • Procrastination to initiate: People tend to delay, "kick down the road", resist change, and generally avoid new initiatives.[2]

  • Failure to stick with plans: People often fail to follow through or continue with new programs they’ve begun.[3] Medication adherence is a common example.[4]

  • Progress is slow: People can delay and move at what appears to be a snail's pace on important projects that should have more urgency.

Inaction Involves Many Forms of Complacency

We use the term complacency to characterize much inaction. Inactions are not simply oversights. Complacent inaction is common because the human mind quickly defaults to habit-driven behaviors or behaviors that immediately provide relief or avoid pain points. We’re complacent in what we’re already doing, even if it means losing out on long-term gains.[5] This is common in healthcare where so much of what we are doing is trying to improve long-term outcomes. Short-term, immediate reactions can get in the way.

  • HCPs show complacent inaction: HCPs may be slow to adopt new products despite support in clinical guidelines and standards of care.[6]

  • Patients show complacent inaction: Patients are slow to make lifestyle changes (including exercises and medication adherence) that they recognize would bring them long-term health improvements.[7]

  • Commercial teams show complacent inaction: Commercial teams can get used to doing things a certain way and can be reluctant to go beyond their comfort zones despite market changes and weak performance.[8]

Overcoming Complacent Inaction: Initiation and Persistence

Behavior change is typically gradual, and often requires separate solutions to the initiation and persistence of new behaviors.[9] Marketers and leaders need well-designed messages and programs to support behavioral momentum. These programs will often be multi-faceted and will need to address different aspects of complacency (e.g., forgetfulness, procrastination, status quo bias, etc.).

Decades of work in academia and industry have revealed some best practices in building behavioral momentum among stakeholders. In most cases, these best practices execute on Nobel laureate Richard Thaler’s advice, “If you want to change behavior, make it easy.”[10]

Help stakeholders find the right moment to initiate action

People have daily challenges with immediate consequences (e.g., daily work and family needs.) This often prevents them from acknowledging challenges with future consequences. Even if the challenges are acknowledged, procrastination can leave them unattended.

Yet, there are moments when consumers seem to be more future-focused and want to act to create a future self that matches their aspirational self rather than their past self. We call these moments “temporal landmarks,” and they underlie a strategy called the “Fresh Start Effect.” The Fresh Start Effect describes people’s tendency to engage in aspirational behavior (including self-care) after important temporal landmarks.[11] The most famous temporal landmark is New Year's Day, but the effect has also been shown on the first day of the week, the first day of the month, and the first day after holidays and birthdays.

If marketers and leaders can frame the initiation of new behavior around a fresh start date, people are more likely to break the procrastination barrier and feel ready to change (fresh starts also make new behavior seem more urgent).

The Fresh Start Effect is one of many tools to help stakeholders initiate new behaviors. Creating defaults and quick wins are others.[12][13] The challenge then is to support persistence.

Help stakeholders persist in their good starts

Even after trial or initiation, failures in persistence are the norm. People revert to old habits. Leading habit scholar Wendy Wood notes that habits underlie about half of our behaviors.[14] And she adds an important nuance — a habit is "not what the action is" but rather "how you perform an action."[15] Specifically, a habit is something that’s performed automatically and effortlessly.

As James Clear, author of Atomic Habits, says, "You do not rise to the level of your goals. You fall to the level of your systems."[16]

Goals orient our interests, but habits drive our behavior. Habits are internal systems that drive what we do in a way that goals simply do not. Habits come to be performed effortlessly because they get frequently repeated (initially with some effort) in the same context (same time, same place, and with the same products or people), eventually becoming automatic.

Marketers need ways to attach their products to existing habits to ensure persistence. Helping stakeholders create new habits is also possible, but much harder.

Beyond habits, leaders can support stakeholders' planning behaviors with prompts, reminders, and nudges. Generally, a well-thought-out set of approaches is needed to support behavioral persistence. The good news is that behavioral science now provides an evidence-based roadmap.

---------------------------------------------------------- [1] Heath, D. (2020). Upstream: The Quest to Solve Problems Before They Happen. Avid Reader Press / Simon & Schuster.

[2] Ariely, D., & Wertenbroch, K. (2002). Procrastination, Deadlines, and Performances: Self-Control by Precommitment. Psychological Science, 13(3), 219-224.

[3] Buehler, R., Griffin, D., & Ross, M. (1994). Exploring the “planning fallacy”: Why people underestimate their task completion times. Journal of Personality and Social Psychology, 67(3), 366-381.

[4] Brown, M. T., & Bussell, J. K. (2011). Medication Adherence: WHO Cares? Mayo Clinic Proceedings, 86(4), 304-314.

[5] Thaler, R. H., & Benartzi, S. (2004). Save More Tomorrow: Using Behavioral Economics to Increase Employee Saving. Journal of Political Economy, 112(S1).

[6] Cabana, M. D., Rand, C. S., Powe, N. R., Wu, A. W., Wilson, M. H., Abboud, P.-A. C., & Rubin, H. R. (1999). Why Don’t Physicians Follow Clinical Practice Guidelines? A Framework for Improvement. JAMA, 282(15), 1458-1465.

[7] Gulanick, M., Bliley, A., Perino, B., & Keough, V. (1998). Recovery patterns and lifestyle changes after coronary angioplasty: The patient’s perspective. Heart & Lung, 27(4), 253-262.

[8] Grant, A. (2017). Originals: How Non-Conformists Move the World. Penguin Books.

[9] Milkman, K. (2021). How to Change: The Science of Getting from Where You Are to Where You Want to Be. Portfolio.

[10] Thaler, R. (2016). Misbehaving: The Making of Behavioral Economics. W. W. Norton & Company.

[11] Dai, H., Milkman, K. L., & Riis, J. (2014). The Fresh Start Effect: Temporal Landmarks Motivate Aspirational Behavior. Management Science, 60(10), 2563-2582.

[12] Johnson, E. J., & Goldstein, D. (2003). Do Defaults Save Lives? Science, 302(5649), 1338-1339.

[13] Patel, M. (2021, February 9). Test behavioral nudges to boost COVID immunization: Studies to promote uptake are as essential as research to develop vaccines. Nature.

[14] Barnett, M. (2019, October 14). Good Habits, Bad Habits: A Conversation with Wendy Wood. Behavioral Scientists.

[15] Wood, W. (2019). Good Habits, Bad Habits: The Science of Making Positive Change. Farrar, Straus and Giroux.

[16] Clear, J. (2018). Atomic Habits: An Easy & Proven Way to Build Good Habits & Break Bad Ones. Avery.


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