We are constantly making choices, every day, all the time, the majority of which seem relatively simple and somewhat subconscious. However, as the array of choices available to us grows, we are collectively becoming worse at reaching decisions efficiently. Barry Schwartz called this “The Paradox of Choice” (Schwartz, 2005), and suggested that we are becoming progressively paralysed by an excess of choice. “With so many options to choose from, people find it very difficult to choose at all”, which as Schwartz explains, after making an eventual decision, we are then dissatisfied if the outcome is not what was expected, therefore “subtracting from the satisfaction you get out of the decision [originally] made” (Schwartz, 2005).

Bounded rationality, a term founded by Herbert Simon is the concept that decision making is restricted by an individual’s ability to cognitively process the presented information in a given circumstance. Therefore it is easy to become overwhelmed by data overload because we cannot process this effectively. Christopher Wickens devised a set of principles to most effectively design displays. It was suggested that to “avoid absolute judgement limits” (Wickens et al., 2004) between five and seven levels of discrimination should be used to provide enough understanding, enabling the consumer to make a decision. Daniel Kahneman and Amos Tversky developed the theory of bounded rationality, forming insights that suggest ‘people are often not the best judges of what will serve their interests’ (Schwartz, 2014) but that institutions like the Government may be able to alter the structure of these choices to enable better choice making.

Nudging, shoving and smacking are new terms that have been coined over recent years by behavioural economists to describe methodologies that alter the way consumers react to stimuli. The Nuffield Council’s Bioethics Ladder of Intervention suggests that guiding a consumer to make certain choices begins with option reduction. The first level of restriction is nudging. If you provide the calorie count on a restaurant menu, this will encourage people to become more aware of their calorie consumption and therefore promote healthier living. The second level of restriction is shoving; this uses disincentives to make a choice less attractive. For example taxation on cigarettes could, in theory reduce their desirability, lowering the amount of people smoking. The third level of restriction is smacking; choice elimination leads to a definite result. Banning alcohol consumption in public places forcibly stops an action with fear of prosecution being the driver. Nudging pioneers like Richard Thaler and Cass Sunstein have developed a concept of libertarian paternalism. The words appear conflicting; libertarian is defined as a freedom of will and paternalism as an authoritative restriction of freedom. However, as explained thoroughly in Nudge and Why Nudge? Sunstein and Thalers aim is to promote the use of cognitive psychology and behavioural science to “improve peoples’ welfare by influencing their choices” (Sunstein, 2014). But will this be used as a positive ethical tool or a means of which to control and coerce consumers ‘freedom of choice’?

In a commercial context companies can take advantage of this information overload by developing socially considered solutions. Identified as choice architects, they harness and analyse the cognitive and behavioural nuances that cause the inability to decide. In doing so they can produce; systems, environments, brands and products that are seemingly more desirable. In England, within the Cabinet Office there is a specialist group named the Behavioural Insights Team (BIT) which aim to adapt public services to encourage “people to make better choices for themselves” (Behaviouralinsights.co.uk, 2016). As a government run initiative they have taken the theory of ‘soft paternalism’ to try and improve sectors like healthcare and finances to promote better decision making.

The BIT has completed numerous trials and studies using behavioural economics to underpin the methodology used. Two examples of these look at the healthcare sector, one highlighting a patient driven project and the other showing a health provider driven project. The first project undertook two randomised controlled trials to reduce the amount of patients that miss hospital appointments.  A series of SMS reminders were developed to encourage patients to attend. Three approaches were selected; Easy Call, Social Norms and Specific Costs. Easy Call outlined the simplicity of cancelling an appointment; Social Norms used a statistic to suggest that the ‘dominant social norm was to attend’ (Hallsworth et al., 2015) and Specific Costs directly advertised the cost incurred by the NHS for not attending an appointment. Each of these methods aimed to persuade the patient to attend an appointment for both their own benefit and for the benefit of the NHS. These trials saw a statistical increase in attendees. Would you consider this a guilt initiative or supportive reminder? In contrast an unrelated randomised trial was conducted with the intention to combat unnecessary prescription of antibiotics by general practitioners. GP practices that were in the top 20% prescribing rates were randomly assigned a letter. The letter stated that the targeted practice was prescribing at a higher rate than 80% of the local practices. This letter caused a reduction in the amount of antibiotics prescribed within the target practice. This Social Norm tactic worked both in a patient driven project and in the provider driven project. So does it matter whether it is a guilt initiative as long as the intentions are ethically grounded?

Behavioural intervention is a relatively new area of study that is up and coming, which has established itself worldwide with Nudging Networks in Denmark, Sweden, Europe and Australia. Nudging theory has been criticised as a manipulation of the public. Criticised for being a way of “covert coercion” (Local Government Association, 2013), using behavioural change to convince subjects to make altered decisions. With the combination of these statements intertwined with governmental power. There is an understandable question; why should we trust a government’s decision making ability rather than our own. After all, we are continually told to learn from our mistakes, not to be afraid of making them in the first place. It feels uncomfortable to be told that there are people that are analysing behaviours which are then used to guide, push, encourage and change consumer choices. So, is it manipulation or is it preventing choice disappointment?

Written by Francesca Oldfield  (LinkedIn/Email)

[1] Hallsworth, M., Berry, D., Sanders, M., Sallis, A., King, D., Vlaev, I. and Darzi, A. (2015). Correction: Stating Appointment Costs in SMS Reminders Reduces Missed Hospital Appointments: Findings from Two Randomised Controlled Trials. PLOS ONE, 10(10), p.e0141461.

[2] Local Government Association, (2013). Changing behaviours in public health. To nudge or to shove?. London: Local Government Association, p.6.

[3] Schwartz, B. (2005). The paradox of choice. [online] Ted.com. Available at: http://www.ted.com/talks/barry_schwartz_on_the_paradox_of_choice [Accessed 7 Nov. 2016].

[4] Schwartz, B. (2014). Why Not Nudge? A Review of Cass Sunstein’s Why Nudge – The Psych Report. [online] The Psych Report. Available at: http://thepsychreport.com/essays-discussion/nudge-review-cass-sunsteins-why-nudge/ [Accessed 7 Nov. 2016].

[5] Sunstein, C. (2014). Why nudge?. New Haven and London: Yale University Press, p.58.

[6] Behaviouralinsights.co.uk. (2016). Who we are – The Behavioural Insights Team. [online] Available at: http://www.behaviouralinsights.co.uk/about-us/ [Accessed 7 Nov. 2016].

[7] Wickens, C., Lee, J., Liu, Y. and Gordon Becker, S. (2004). An Introduction to Human Factors Engineering. 2nd ed. Pearson Prentice Hall, p.187.