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03-05-2019

Improving customer experience in a clinic

The concepts of “System 1” and “System 2” decision making, first described in Daniel Kahneman’s Thinking, Fast and Slow, have vastly increased our understanding of human behavior. “System 1” thinking refers to our intuitive and quick processing and decision-making, such as simply “knowing” that two plus two equals four. By contrast, “System 2” thinking is activated when we have to resolve complex problems, such as multiplying 19 by 21.

 

Most of our daily decisions are processed by our System 1, and that’s for the best. We simply don’t have time to activate our System 2 for every small task and decision we make on a daily basis. This means we often end up resolving complex situations with intuitive approximations known as “heuristics”. Looking back to our previous example of multiplying 19 by 21, a heuristic would be rounding both numbers to 20 and asserting that the result is around 400. This mechanism has consequences; most of the time, our behavior is conditioned by factors that do not make strictly rational or economic sense. So how are we supposed to understand behavior from an organizational, societal or business perspective? Well, thankfully, even our irrational decisions are often predictable; we just need to understand how the System 1 works.

 

A particular example that illustrates this phenomenon is the wayfinding of visitors in hospitals. Even though extensive information is available, most visitors still get lost. Imagine – your 78-year-old grandfather has been rushed to hospital and you’ve come to visit him. You might not be in the right state of mind to calmly and rationally focus on the hospital’s map and find his room. Now imagine that your sister has just given birth to her first child and you want to visit her. The reception desk tells you that the maternity ward is located in building “H6”. Overwhelmed with emotion, you would probably not remember this name nor its precise location on the site. In both of these cases, you have the necessary information – but you still get lost.

 

It’s precisely what happened to thousands of visitors at the Clinica Las Condes in Santiago de Chile. The orientation system was based on plans and signage which were designed to appeal to people’s rational System 2. Unfortunately, most visitors were, at the time of their visit, in various states of distress that made them unable to settle down, focus and rationalize.

 

Our CEO in Latam, Xavier Genot, focused on diagnosing the problem with the signage and proposing solutions to enhance it. They studied heat maps showing people’s routes, interviewed patients and staff members, and watched CCTV tapes to estimate the volume of people going through the hospital as well as their average walking speed.

 

They observed that the visitors’ learning curve was almost flat; even visitors that came to the hospital frequently had the same – or worse – knowledge of the hospital’s map than visitors that were there for the first time. It was clear – the researchers needed to nudge the hospital’s orientation system.

 

The purpose of the intervention was to concentrate the flow of visitors and to lower their level of stress so that they were in a better state of mind to use the orientation tools.

 

Focusing on people’s habits, they relabeled the buildings with a color and a number, allowing people to orientate themselves with either depending on what was easier for them to remember.

 

A second solution focused on the fact that we are human beings. When distressed, we seek the support of human contact to calm us down rather than just a screen or a map. Consequently, they installed information desks on the first floor where people were most likely to encounter them.

 

The “spinal carpet”

The main tool to condense the flow of people was a “spinal carpet” whose colors changed according to the building. Human beings have two kinds of attention depending on the context. The “top down” refers to moments when the subject is able to fully focus their attention on what’s required for their current task. “Bottom up” refers to moments when a subject’s attention automatically changes depending on the environment’s stimuli. As visitors have limited cognitive capacities, the “bottom up” logic dominates in this case. The carpet significantly increased the mental effort it would take for a subject to deviate from the path; in other words, people were guided by their subconscious.

 

The hospital decided to implement these solutions and, two years later, the behavioral researchers came back to check whether people’s behavior had really changed. It had – significantly. When surveyed, people no longer felt that they were “going to get lost” in the hospital. Those that still felt that orientating themselves within the hospital was difficult also indicated that “it was manageable”. Almost every visitor now recognized the buildings and their functions thanks to their colors or numbers, depending on which label was the easiest for them to remember.

 

Comparison of customers’ road heat maps beofre and after intervention.

The most positive feedback was that nobody noticed the spinal carpet as a major change in the hospital’s aesthetics, even though they followed its path. This proves that the Nudge adapts itself to the mental state of the visitors and modifies their behavior thanks to subconscious and intuition.

 

This intervention had a hugely positive impact on the orientation systems, as described by Fernando Besser, Operations manager of the CLC: “We had introduced the behavioral researchers to what was a long-standing problem for us. They started from scratch, unbiased. Thanks to a methodology created especially for the occasion, they built efficient solutions to enhance patients’ orientation on campus.”

 

The main key of this project’s success was a deep understanding of people’s state of mind in this particular context, and how System 1 thinking affects human behavior. This expertise allowed the design of a unique solution which activated automatically people’s System 1, proving that, while we may be irrational, that irrationality is predictable.

Ignacio Paiva

Project Director BVA Nudge Unit LATAM / ignacio.paiva@bvanudgeunit.com

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