An HRW Shift Summer Book Club Review

What do Andre Agassi, Mary Poppins, Victor Hugo, and Ben Franklin have in common? A top tennis player, a fictional nanny, a prolific playwright, and a founding father of America… on the surface, not much. Yet this eclectic cast of characters populates the pages of Katy Milkman’s page-turner—How to Change. Each character plays an integral role in bringing Katy’s wealth of insights to life. And, yes, I know what you’re thinking—can a compendium of behavioral science research really be described as a page-turner? Well, all I can say is—give it a read and you’ll find out for yourself!

Katy Milkman has developed the rare knack for making behavioral science fun, accessible, and applicable. You won’t find much ivory tower theorizing here. Instead, you’ll be taken on a tour through the human struggles that plague us all (think impulsivity, procrastination, and forgetfulness). In fact, these ever-looming enemies of productivity are so heavily featured in How to Change that each chapter is titled after one. And while the real-world examples and lack of academic jargon may lend the book a playful, pop-psychological veneer, don’t be fooled—a treasure trove of wisdom is waiting to be unearthed beneath its shiny cover.



The tools that help us help ourselves


To help us understand how we can tap our hidden potential, Katy first shares her own efforts at doing so. For example, in grad school, Katy had a difficult time motivating herself to go to the gym regularly. But being an engineering student, she engineered a solution to her problem—she would reserve the enjoyment of listening to her favorite audiobook for when she was on the treadmill. This way, her workouts would be transformed from a daunting feat of self-control to an exciting opportunity for indulgence. Katy termed this method of pairing an intimidating activity with a tempting activity “temptation bundling”.

Reading How to Change, I realized that I had employed the same strategy long before the idea of temptation bundling had entered my radar. The seven Harry Potter audiobooks kept me going through the excruciating first months of my tedious stretching routine. Amazingly, soon after adding the audiobooks to my regimen, I began to look forward to stretching as an excuse to “apparate” back to Hogwarts. And, surprisingly, the habit didn’t break after the series ended. To this day—over a year later—what began as an act of willpower has become an everyday necessity.


The nudges that ease our behavioral change burden


Of course, change doesn’t always begin from the inside-out (by a change at the individual level). Often it is triggered from the outside-in (by a change at the organizational level). Putting systems in place to “nudge” behavior makes it easier to for us to get the new behavior off the ground. For example, when organizations set defaults to automatically allot a portion of our salary into a 401k account, it becomes more likely that we’ll save for retirement.

One of the particularly “nudgable” concepts in How to Change is that of the “fresh start” effect—our tendency to enact behavior change during life transitions (think New Year’s resolutions).  If you’ve ever started a new job or moved to a new house and decided it was time to begin an exercise routine or quit smoking, then you’ve experienced the power of fresh starts firsthand. By highlighting, or even manufacturing, such fresh start opportunities, corporations can encourage behavior change. For instance, a gym could send an email on New Year’s Eve, reminding their members to begin the year on the right foot.

As behavioral scientists working in the healthcare space, we in HRW Shift are well-aware of the impact that subtle changes in messaging, defaults, and social norms can have on individuals’ behaviors.  We’ve seen the ways in which—especially under time constraints—physicians tend to treat default protocols like guidelines. Like the rest of us, they are less likely to engage in active thinking when there is an easier, mindless path to follow.

Social norms can also influence physician behavior. Consider multidisciplinary teams (MDTs), in which treatment decisions are discussed between a diverse group of healthcare workers. In group settings such as these, the “group consensus” often inadvertently silences physicians with different opinions.

On the patient side, we’ve recommended apps that help users track symptoms. The app notifies users to the severity of their symptoms once their symptoms cross a certain threshold. We know that it is human nature to take the path of least resistance, so, just like Katy, we’ve engineered solutions to “help people help themselves.”


A note to Katy Milkman


As avid fans of Katy’s podcast, Choiceology, and her work on the Behavior Change for Good Initiative, the HRW Shift team thought we’d close with a little thank you note to Katy. We appreciate all the work she’s done and look forward to seeing what she has in store.

So, thanks Katy, for providing us with a wonderful, thought-provoking collection of behavior change research and entertaining us along the way!


We welcome you to read along and share your thoughts with us on twitter @HRWshift or via email shift@hrwhealthcare.com



By Jeremy Koloski

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