Tuesday, February 7, 2012

The sweaty business of behavioural change

Imagine you are watching a focus group.  The topic is hygiene and in particular, how your gym can get people to wipe their sweat off the equipment. Low adherence to the policy has been causing complaints and some health issues around the club.  The discussion goes as expected with everyone agreeing they would feel revolted if they unknowingly use a machine that has not been wiped down, and all agreeing that they, of course, always wipe theirs off as long as it was easy to do so.  You watch as the group brainstorms some signs that can be placed to remind people of the policy and also where and how many hygiene-spray stations should be positioned in the gym. A few months after you've implemented the findings of the focus group and behaviour hasn't changed. Why?  

Awareness is not enough
This is the scenario my local gym is facing. Despite signs on every piece of gym equipment reminding clients to "Take your sweat home", "You have a towel - use it", and "Please wipe your sweat off",  and despite multiple convenient hygiene stations I reckon about one in seven people actually takes heed (and that one is, of course, virtuous me for a reason I'll come to).

So what's happening here?  Sure we all get grossed out by a stranger's sweaty trail, but when it comes to our own behaviour, could it be we don't think our sweat is offensive enough to mop up?

Give those doctors a hand
In a case well documented by Stephen Dubner and Steven Levitt of Freakonomics fame, Cedars-Sinai Medical Centre in the US decided to tackle a slightly more important issue of hygiene; hand-washing by doctors.  Did the medical staff know the importance of washing their hands? Of course.  But almost 4/10 failed to.   And this was contributing to bacterial infections sometimes leading to patient death.  So why were the doctors not washing their hands?  Ego was thought to play a big role.  The sense that "it's not my germs that harm people - it's those of my colleagues".  And before we shrug ego off as symptom of the profession, I think that's the same factor at play in the gym. 

Cedars-Sinai's aim was to get compliance up from 65% to 90% to meet required standards. They made some progress by running an awareness campaign by email and posters, providing bottles of disinfectant, and awarding spot coffee vouchers to those who washed their hands and this got them to 8/10.  For my gym, having staff parade the equipment and reward compliant clients might help, but seems like a lot of effort!

Why Cedars-Sinai Medical Centre has become a favourite case study is what they did next which saw compliance rocket to almost 100%.  One day after a typical lunch, a number of doctors were asked to take a culture of their palm, pressing it into a petri dish.  The results were striking, with the hidden to the eye bacteria seen vividly crawling around the flesh. Revolting. In a moment of brilliance the hospital then used one of these provocative petri images as a screen saver and watched as compliance rates soared.  Suddenly there was indisputable proof that it is you, me and everyone that carries germs, and simple actions can rid our hands of their bacterial dangers.  (And yes, this is why I am so vigilant when it comes to wiping off sweat.)

What it took for behavioural change
In the case of Cedars-Sinai Medical Centre, developing an awareness campaign was not enough.  And for my gym, whilst it is great to promote the expectation of hygiene on posters, it is not enough in itself to change people who intend-but-don't to intend-and-do.  As Dan and Chip Health cover in their book "Switch: How to Change When Change is Hard", use of negative emotion (like disgust) is great when people know intellectually they need to change. 

Cedars-Sinai made the issue personally confronting, overcoming the tendency we have through what is known as the Fundamental Attribution Error to rationalise our own behaviour due to the situation (I don't have time to wash my hands, I need to get on the bike before someone takes it) but judge the behaviour of others on the basis of character (I can't believe they are so irresponsible, how can they be so lazy?).   Cedars-Sinai levelled the playing field by demonstrating that all are equally impacted by germs. 

The lessons from Behavioural Economics
Let's look back to our focus group.  After the experience of the gym, we now know that there is a gap between what people say they'll do and what they actually will.  So what are some tips from Behavioural Economics that all businesses can use to help close this gap?

Vividness - a surprising and evocative image - like a hand in a petri dish - can shock us into new thinking.  Imagine if the gym had posters of bacteria on un-sanitised equipment?  Would it risk putting people off? Not if they are committed to exercise, and it would definitely get people to cleanse their machines before and after exercise.  

Herding - it is difficult to go against the herd because you risk being socially shunned. Even amongst a group of gym strangers, the more people you see wiping their machines, the more likely others are to.  Just like night clubs who pay cool people to show up, the gym could enrol and reward some clients for modelling correct behaviour.

Heuristics - we operate by rules of thumb, and are most likely to accept a new behaviour (wiping down) if it is connected to an existing one (exercising).  Imagine if the machine would not give you your work-out results unless you wipe it down first?  Or you needed to swipe a card to start the equipment, but the swipe card would only activate if it had been swiped first at a hygiene station?

Changing behaviour at the gym, at the hospital, in your line of work is tough, but it's also the reason why we are in business. After all, business is about moving people from an intended to actual purchase.  Here's the big tip; spend more time on what influences the actual behaviour and less on what people say they will do and you'll see your results flow. Happy changing.

PS If you like my blog, I'd love you to consider supporting my fundraising trek of the Larapinta trail. Every bit helps so to find out more, visit https://www.gofundraise.com.au/page/BriforICV  Thank you!

 Image from http://talktowarren.wordpress.com/tag/patient-safety/

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