1. Small Changes in Your Environment Can Have Big Effects on Your Behavior

2. Environmental changes are the low hanging fruit of behavior change It’s far easier to change people’s environment than it is to change their mind What looks like a “people” problem is often just an “environment” or “situation” problem 2

3. Broken windows theory 3

4. Keez Keiser confirmed this theory through a series of real world experiments When graffiti was present, the proportion of litterers more than doubled from 33% to 69% 4 Keizer, K.; Lindenderg, S.; Steg, L. The spreading of disorder. Science 2008, 322, 1681-1685.

5. Second experiment 5 When the first sign was disregarded, 82% (more than three times as many people), disregarded the second sign Keizer, K.; Lindenderg, S.; Steg, L. The spreading of disorder. Science 2008, 322, 1681-1685.

6. Third experiment 6 When the the mailbox was covered with graffiti the proportion of thieves more than doubled to 27% Keizer, K.; Lindenderg, S.; Steg, L. The spreading of disorder. Science 2008, 322, 1681-1685.

7. Take away Small changes in our environment can have a big impact on our behavior 7

8. So how can leverage this finding?

9. 1. Tweaking the environment Make the desired task easier to complete 9

10. Amazon does this through its One-click ordering feature 10

11. Morning exercise people do this by laying out there workout clothes before they go to bed 11

12. Charities do this by placing donation drops in high traffic areas 12

13. Nurses do this by wearing red vests to discourage interruptions during medication deliveries 13

14. Dieters do this by shifting from family size bags to single serve packaging 14

15. Governments do this by making organ donation the default option 15

16. High school cafeterias are doing this by displaying healthy foods more prominently 16

17. So how big can these small environmental changes be?

18. Tweaking a College Food Donation Campaign All Students Givers Non-Givers Profiling Survey Switch by Chip and Dan Heath, 2010

19. They Prepared 2 Different Donation Letters Basic Letter Announced the launch of food drive the following week Asked them bring canned food to a booth in a well known place on campus More Detailed Letter Announced the launch of food drive the following week Included a map to the precise spot on campus where booth would be Requested cans of beans specifically Suggested that they plan a time when they will be near booth so drop off will be easy Switch by Chip and Dan Heath, 2010

20. Tweaking a College Food Donation Campaign All Students Givers Non-Givers Profiling Survey Detail Basic Detail Basic 42% 8% 25% 0% Donation Rate What looks like a people problem is often an environment or situation problem Switch by Chip and Dan Heath, 2010 3X

21. 2. Setting action triggers Create a mental plan of action that gets triggered when a cue is present 21 Switch by Chip and Dan Heath, 2010

22. Research shows that action triggers are most useful in difficult situations In one study of patients recovering from hip- or knee surgery, one group was asked to set action triggers Individuals were asked to write down when they would take their walks and where they planned to go on those walks On average, the action trigger patients were bathing themselves without assistance in 3 weeks versus 7 weeks Action trigger patients were standing up in 3.5 weeks versus 7.7 weeks In just 1 month, the action trigger patients were getting into and out of cars on their own versus 2.5 months for patients in the other group 22 Switch by Chip and Dan Heath, 2010

23. And while action triggers aren’t foolproof, it’s hard to find an easier way to drive change A recent meta-study that analyzed 8,155 participants across 85 studies found that the typical person who set an action trigger did better than 74% of people on the same task who didn’t set one 23 Switch by Chip and Dan Heath, 2010

24. Checklists are slightly more detailed forms of action triggers The Story of Dr. Peter Pronovost –ICU physician at Johns Hopkins –Mission: Reduce IV line infections in ICUs –Challenge: No direct authority over his colleagues 24 Switch by Chip and Dan Heath, 2010

25. The medical literature confirmed 5 major sources of line infections Studies in other hospitals confirmed that reductions in any of these 5 indicators resulted in reductions in IV line infections Peter drafted a 5 step checklist Published his checklist in a leading medical journal So he began by studying the literature on IV line infections Switch by Chip and Dan Heath, 2010

26. 1. Wash your hands before inserting a line 2. Clean patient’s skin with antiseptic at the point of insertion 3. Put sterile drapes over the entire patient 4. Wear a sterile mask, hat, gown, and gloves 5. Put sterile dressing over the catheter site once the line is in Peter’s Checklist Source: New Yorker Magazine; December 10, 2007

27. Peter’s initial test at JHU was a major success Peter decides to test the checklist in more challenging environment He works with state of Michigan to implement the checklist at all state managed hospitals State managed hospitals were among the lowest performing hospitals with the worst reputation for quality and outcomes Source: New Yorker Magazine; December 10, 2007

28. The Results speak for themselves Peter’s checklist implemented in Michigan ICUs over 18 months ICU line infections declined to almost zero The checklist saved approximately 1,500 lives The reduction in line infections reduced costs by $175 million Source: New Yorker Magazine; December 10, 2007

29. Summary Environmental changes are the low hanging fruit of behavior change because it’s far easier to change people’s environment than it is to change their mind In fact, what looks like a “people” problem is often just an “environment” or “situation” problem By making small changes in our environment we can have a big impact on behavior –Tweaking the environment you’re trying to change –Setting action triggers to preload important decisions 29