Change is hard. Whether it’s getting a patient to change his lifestyle or adhere to a medication, or convincing an executive to implement a new tool or strategy, getting humans to change course is no easy thing. Hamid Ghanadan of the Linus Group spends his time thinking about how to build products and campaigns that will lower the energy barrier to change. In this episode, Ghanadan talks about the barriers to change and how change management can make a difference for the healthcare system. He also provides some specific examples of how minor changes – nudges – can create an outsized effect.

Be sure to check out Ghanadan’s books here.



Talk about the difficulty of change and how we can get around that.

So we have this bias about the future, we believe that the future is going to be better than the present. […] And we actually see this in a lot of market research with scientists, with clinicians. We asked them to project out five years, six years, seven years and say, how will your work be different? And they can’t really articulate that [but] they believe that it’s going to be an incrementally better version of what they’re doing today. Which is really interesting because if you think about it, if you ask them the progression of changes from five years ago until today, it’s a very different story. The world was very different to them five years ago and they couldn’t even fathom how much has changed.

So one of the interesting things that we do when we do market research is to [ask] them to go back five years and sort of recount how much change has happened. And that’s a sort of heuristic. It’s called availability. If there’s an example of change that’s available to us, then we tend to estimate the change moving forward in a very different way than if we haven’t queued up that availability of how much change there is.

How does this apply to healthcare?

This really plays in healthcare quite a bit because if you think about […] a healthcare provider or an organization or any kind of an enterprise, if you think about the sum total of their initiatives or goals or desires or mission, it requires some sort of change somewhere in the overall enterprise. Whether they want to make their patient population healthier or they want their physicians to act differently or whether they just want to market themselves to get more customers. All of those things require some change to happen to an audience member. The problem is we can’t just go and make people change. We can’t make people take a specific action by just telling them to do it. They won’t. That’s where the difficulty comes into play. And you have to really understand the human behavior or tendencies to influence them, to nudge them, to get them to change in incremental ways so that you give them a psychological incentive to want to change. Because absent that psychological incentive, people are pretty invested in not changing.

Talk a little bit more about kind of change management and handling these things in incremental ways to slowly turn into a new direction.

The reference to the word that I use – “nudge” – was actually a reference to the book by Richard Thaler who won the Nobel Prize in economics in 2017. His contribution to our knowledge is all around choice architecture, and essentially the premise is, he’s sort of known as the father of behavioral economics, and he essentially said that classical economics doesn’t really take human behavior into consideration. We have to take human behavior into consideration in order to develop better models. And so he developed choice architecture, which is: if you want something to happen, make it easy for it to happen.

And he has a great example about when 401ks first became popular as part of corporate benefits. […] When this product first rolled out, they were not getting a lot of adherence, people were not opting in to 401k’s and that’s just bizarre. That’s so outside of any rational thinking. Why? When they looked at the situation, they found that they were making it really, really hard to opt in. […] So essentially what they did was, they flipped it all around so that you were automatically enrolled and your funds were automatically put into some sort of a default set of funds and you could opt out or change it at any time. They just made that choice very, very easy for people to make.

Same question: how does this apply to healthcare?

The same thing really applies to healthcare. No matter how sophisticated the treatment modality and no matter how sophisticated the hospital standard of care, many hospitals right now are looking at patient experience because they believe and they know that patient experience is a really critical part of healthcare. Our interest is going in and developing these patient experiences for the healthcare providers, but also maintaining this understanding of the intended outcome, the best outcome for the patient, and giving them these cues and nudges so that they will be much more receptive to making these smaller changes to have better outcomes. […] There’s so many places in healthcare from all the way up in research all the way down to patients’ lifestyles after they’re done interacting with the healthcare system, that there are ways that we can optimize it around the human behavior in order to get the intended outcome.

Why did it take so long to get to the point where we’re taking all this into account and designing for human behavior?

There’s a lot of different, different answers to it, but ultimately it has to do with the fact that I believe that it’s just easier to focus on technology and. There’s money, there are incentives to focus on technology.

[But] People are now just starting to realize that [human interaction with technology] can make or break the adoption of the technology. It can make or break the intended outcome of that technology.

And, you know, honestly, humans are really complex technologies themselves. Our brains are a really complex technology and so we just haven’t had the ability to really study human behavior in a systematic way up until now. And I think that the recent development of that is really exciting.

I feel that I’ve been put on this earth to try to close this gap between the systematic part of science and the human beings that [science] is meant for and interacting with it. And so that’s really where I’m seeing this convergence, and I believe because technology [was] not mature enough and that’s why we’re starting to focus on it now. And that’s why it took so long. I think we just didn’t know.

Final thoughts on improving usability in healthcare?

What I always recommend to healthcare developers, no matter who they are – they could be companies doing research, making great instruments all the way down to diagnostics and hospitals. And even patients or all of this around mobile health and digital health. What I really recommend is: think about the human first and then design the usability around it and then apply the technology to that usability because you’ll have the best chance of getting the best intended outcome as a result.


Image from The Linus Group books page

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