Sales & Marketing: Making sense of the irrational

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By Deborah Lotterman, chief creative officer, precisioneffect.

“This drug will sell itself, based on the data…”

I have heard this more than one time from more than one client.

Sadly, for patients, this is rarely true. Much as we all want our physicians to make impartial decisions based on a thoughtful review of all published information, the rate of clinical advances and the demands of daily practice conspire to make fully informed decision-making more of an aspiration than a reality.

What’s more, so much of what we value in our physicians – the flesh and blood, heart and soul, know-me-and-my-history humanness – may actually get in the way of the best decisions being made. Humans, according to Richard Thaler, the recent Nobel Prize winner in economics, often act irrationally.

His work documents that we make decisions in conflict with our best interests. We do this particularly when the feedback or rewards for good behavior are invisible or pitched so far into the future that we can’t see or feel the impact of our actions. Witness so many of the behaviors that would improve general health: eating a balanced diet, exercising regularly, drinking moderately, taking medication routinely. The data consistently show humans are fairly lousy at making significant change and sticking to it. I refuse to reference this. It’s true.

 

It’s not easy to make change

As marketers, we’re generally not asking physicians to eat more fiber or run five miles three times a week (though many of them probably should). We want them to appreciate the value of a new compound. We want them to change their prescribing habits. We want them to counsel patients through complex treatment algorithms.

Often what we, as marketers, want physicians to do does not reward them in the short term. We ask them to experience difficulty and discomfort in their own daily experience so that outcomes for patients, for the hospital, for the healthcare system will improve – generally at some distant point in the future.

We should not be surprised when the data does not sell itself.

Nor should we despair. For while Thaler gives us numerous examples of humans – even highly educated humans – behaving irrationally, he also posits that, armed with an understanding of human behavior, those who design products, programs or policy can influence better decision-making by being thoughtful about how those choices are presented. Anyone in this role, according to Thaler, is a “choice architect.”

We have not put “choice architect” on our business cards, but at precisioneffect, we’ve actually been disciples of Thaler’s principles for some time. We’ve spent 40 years devoted to working with innovator companies who are changing the standards of care. From introducing the HPV assay that evolved the screening of cervical cancer to the launch of the first drug-eluting stent to our current work to challenge traditional approaches to colorectal cancer screening, we know that compelling data, while essential, is just a piece of the intricate machinery required to change minds and actions.

When we disassemble the web of connections, we can identify distinct moments where we can apply pressure towards a desired behavior. What Thaler calls a “nudge.”

 

A tool for navigating behavior change

If you’re setting out to change the standard of care, a single nudge isn’t sufficient. The progression of disease, the complexity of therapy, the confounding dynamics of hospital roles and responsibilities, the social/psychological/economic issues for patients and their families, all mean that choices – from prescribing an oral chemotherapy to trialing inhalable insulin – are the result of a series of microchoices made by the whole cast of characters, from patients and providers to pharmacists and payers.

We’ve developed a model, the Behavior Change Strat Map, which charts all the behaviors that need to shift for a new standard to be adopted. As we run the model for a brand, four key phases – Map, Measure, Monitor and Motivate – illuminate the path from status quo to the embrace of innovation.

MAP. We start by charting the terrain. We identify the key roles who can most directly or indirectly influence behavior. Physicians and patients are often central, but sales reps, pharmacists, payers, and office managers put in frequent appearances on the map. We then plot the desired behaviors across the entire disease experience towards the desired outcome. The more finite and concrete we can be about these actions, the better. Many behaviors can, and should, be broken down into smaller steps.

MEASURE. If we accept that behavior change doesn’t happen overnight, how fast does it happen? By tracking progress at every critical juncture on the map, we can start to understand the rate of headway towards the end goal. More significantly, by measuring movement (or lack of it) at each point, we can begin to see gaps and surface opportunities where a thoughtful interaction, pointed message or refined user experience can influence a choice for the better. Certainly digital tactics offer a lot of fodder here. But we’ve found there’s usually much more data available, sometimes outside of marketing’s sphere – net promoter scores, order rates, fulfillment trends, help line requests, satisfaction surveys – a mix of hard and soft metrics that pulled together can provide a strong rationale for funneling resources towards a particular flash point on the map.

MONITOR. This critical step is designed to ensure we’re being efficient in our approach. Few brands approach behavior change empty-handed. We overlay the brand’s current assets, tactics and programs on the map to understand where resources have been dedicated in the past. Do we have tactical holes? Have we stockpiled efforts against a behavior change further down the path that is dependent on an earlier shift?

MOTIVATE. We now have the dimensional coordinates in place. We’ve identified the key behaviors that need to occur, the players who may be dug in at various points, the tactical holes and opportunities. It’s time to return to Thaler’s ideas and ask, against a series of discrete, concrete points on the map, “How can we incentivize change of this particular behavior?” Now we can be wildly inventive in how we attempt to answer the question – with our nudges – because we have very clear criteria against which to vet them.

The Behavior Change Strat Map is not a tool for those looking for a silver bullet or nurturing an unshakeable belief that clinical data will drive decision-making. But for those who love data (show me a marketer who does not?) and are willing to employ it not just to measure success but as a vehicle to nudge it forward, The Behavior Change Strat Map becomes a powerful, living GPS to greater brand health and better care for patients.