Driving Better Results - Implementation
Integrating behavioral design into your training process can be uncomfortable to start, as it is not the way we have historically thought about creating learning.
The first step is identifying the specific behavior you want to change. The more precise articulation of the behavior and the required change, the better chance of success. We want to be able to measure the behavior and the change as closely as possible, so accuracy is important.
In order to better understand the behaviors, it is necessary to map out all behaviors that are involved. Any decision points, actions needing to be taken, and so on should be mapped visually.
Below is an example of a very simple behavioral map for washing your hands. This example is simple but powerful because of the COVID pandemic we are experiencing. Handwashing has been something that the Centers for Disease Control and Prevention (CDC) and other health organizations have always pushed as a method of ensuring we cut back on communicable diseases; but lately, there has been a renewed sense of urgency around the uptake of proper handwashing techniques. We have seen many interventions tried and iterated.
This is for illustrative purposes. We could get far more granular with this example as there are a lot of complexities when we talk about handwashing. This is intentionally simplified for this example.
It is important to be specific and map what is happening, not what you would like to happen during the process. In this example, there is no new step to add – and some people do the whole process correctly; we are just trying to increase the frequency of people following the behavior. For that reason, you are seeing the "proper" behavior laid out.
Ensure that your map is data-driven wherever possible. Try to not rely on surveys or interviews, and collect as much real and accurate data as possible to fill in your map. In our specific example, you do not want to rely on surveys or interviews at all, as people will self-report that they wash their hands far more often than what surveillance shows is accurate.5
Next, think through what potential barriers to the behavior change may exist. These barriers are anything that hamper the behavior we are trying to create. There are hundreds of different types of barriers, and while we do recommend looking into biases in general (they are fascinating!), here are a few that are probably the most salient for our purposes:
It is the tendency to rather settle for a smaller present reward than to wait for a larger future reward in a trade-off situation.6 This is a classic experiment – when asked if people want something today or something + bonus in a week's time, they almost always take the immediate gratification option. That's because our present selves are most concerned about our present selves – and future self is not something we are as focused on.7
What that means for us is that if it's slightly inconvenient for our present selves, we often don't weigh out the positive impact a behavior might have for our future self as heavily as it may merit.
This describes our tendency to focus on items or information that are more noteworthy while ignoring those that do not grab our attention. A good example of this would be that for many people, the benefits of a warm shower are immediate and perceptible, but the water implications and energy costs are much less so. As a result, the salience bias impedes us from focusing on the actions required to protect the environment, like taking a cooler, quicker shower.8
This is the tendency to pay attention to some things while simultaneously ignoring others. This impacts not only the things that we perceive in the environment but the decisions that we make based upon our perceptions. For example, someone who is about to buy a blue car and is thinking about that decision may suddenly notice how many blue cars there are – it will be like there's a sudden explosion of blue cars – they will notice them on TV, on their way to work, everywhere. Of course, the instance of blue cars didn't change, but that person is now "tuned in" to them and so they will stand out more than they did before.9
Cognitive Overload/Choice Bias:
When given more options to choose from, people tend to have a harder time deciding, are less satisfied with their choice, and are more likely to experience regret. This can happen when we are overwhelmed with information or choices. An example of this would be if you walk into an ice cream parlor and have 27 different good options to choose from, you may take quite some time to decide, and then when you are having your ice cream, you may think back to the menu and wonder if you made the right decision. Conversely, if you have only strawberry, vanilla and chocolate as the options, you may make your decision quickly and enjoy your ice cream without a second thought.10
Status Quo Bias:
This happens when people prefer things to stay the same by doing nothing or by sticking with a decision made previously. An example of this bias is health plan enrollment – more often than not, people choose to not move away from their current plan even if they're mildly unhappy with it because it's easier/already in place/the current status quo.11
Intention-Action Gap Bias:
It is also known as the value-action gap or knowledge-attitudes-practice gap. It occurs when one's values, attitudes, or intentions don't match their actions. A good example of this is that you may have set a goal to eat healthy this week but find yourself mindlessly eating chips while watching TV at night. You intended to eat healthy, but what you are doing in reality does not align with that intention.12 Let's return to our example regarding handwashing. Here we are overlaying some barriers that may exist at every step of the handwashing process.13
How can we overcome these barriers? This is where your design thinking and willingness to iterate comes in.
Throughout this pandemic, you have no doubt seen several ways that people and organizations have tried to manage these barriers.13
After you think through the barriers and their solutions, you want to monitor and adjust often.
Iteration is important because you cannot assume that you've fixed a barrier just because it cognitively makes sense that it has been adjusted or removed. Think about the example of the apples displayed for employees – putting the apples out seemed to be the right solution, but until you monitor and adjust, you cannot be sure you are addressing the actual barrier.
Here are some examples of the questions you may ask yourself, the initial barrier identified, the more granular barrier identified, and then the potential solutions to those barriers.4 Think through how these questions are salient to you in your position as a learning professional? Do the solutions ring true to you?
|Question||Main Barrier||Get Even More Specific||Solution Options|
|Do people remember it?||Attention||Availability Bias||Use reminders|
|Do people see it?||Attention||Saliency Bias||Make it salient|
|Do people want to see it?||Attention||Information Avoidance||Use deadlines and scarcity|
|Is the best option clear?||Cognitive Overload||Choice Overload ||Use social proof, defaults,
and relativity and simplify|
|Do people lack time/energy?||Cognitive Overload||Scarcity/Depletion||Simplify the ask and increase
the benefits of doing it today|
|Do people lack the
confidence to make a
decision now?||Cognitive Overload||Procrastination/Decision
Paralysis||Make the ask feel easier,
reduce or streamline choice,
and use social norms
|Do people receive an
immediate, concrete benefit?||Present Bias||Present Bias||Add immediate/concrete
rewards, social proof, loss
aversion, and regret aversion|
|Is there a sense of urgency
to act now?||Present Bias||Present Bias||Use deadlines and scarcity|
|Are people motivated, but
not following through?||Present Bias||Intention-Action Gap and
|Do people realize the
opportunity cost of staying
in the status quo?||Status quo||Opportunity Cost Neglect||Make opportunity cost
salient and use choice
|Are there potential losses
from moving away from the
status quo?||Status quo||Loss Aversion, Regret
Aversion, and Sunk Costs||Make the alternative more
appealing and use financial
|Is it easy for people to
switch?||Status quo||Cognitive Overload||Reduce switching costs|
|Do people see what the
majority of others are doing?||Social Norms||Social Proof||Use majority, wisdom of
|Does the behavior of others
signal what is socially
acceptable?||Social Norms||Implicit Social Proof||Use messenger effect or
reciprocity and recommend
Earlier we took a very simple example of how learning is developed today. Let's look at the same example but apply our new way of thinking to it.
Let's assume someone comes to you saying there's a need for learning regarding a new indication for Drug X and your representatives and MSLs need to be trained.
Map the current behaviors. Because it is a new indication, maybe you can map what the representatives and MSLs do today to discuss the product. What behaviors do you want them to add? Will the new indication be relevant to the same or different HCPs they are calling on?
Understand how the representatives and MSLs are speaking about the product today. You know you'll need to add in plenty of new information – but is there anything that they are doing for Drug X today that they should change with the new indication? Add in data points. How often are they speaking about Drug X and to whom? How often do you want them to speak about the new indication?
What does success look like? What are the program key performance indicators (KPIs)? Try to get as specific as possible – What are the sales goals? How are they different from the existing product sales goals?
Put in place the measurement framework – How will you measure the success that you just defined? For sure, you will measure it for Level 1 and Level 2, but how will you measure it for Level 3 and Level 4? How will you report out to your leadership that this training was the root cause of the uptick in sales?
Create your training based on adult learning principles and with measurement opportunities built in.
Create opportunities for iterative approaches. Maybe think about a dedicated look-back period 6 months post training. What worked and what did not? What can you adjust to get closer to your KPI goals?
Behavioral design is a more in-depth way of approaching your training. Understanding behaviors and creating training that is geared toward closing behavior gaps and driving the business needs is always going to be worth the extra effort.