December 17, 2014 — Blog Post
What Behavioral Economics Can Teach Us About the Patient Experience
In his TEDtalk, “The Riddle of Experience vs. Memory”, behavioral economist Daniel Kahneman tells a short story about a man listening to a symphony. The man experiences such joy throughout the entire performance , intensely feeling and relating to the music. As the recording meandered to its finale, the music suddenly stopped, replaced by a horrible screeching sound. This ruined the entire symphony, the man solemnly remembered. But, had it? He experienced 20 minutes of glorious music, jarred by a few seconds of madness. But those 20 minutes were now irrelevant; the experience was ruined, replaced with a marred memory.
One key takeaway from this scenario is the human memory is significantly and consistently biased. We must understand that a memory is merely the end result of an experience and the processing of that experience. It’s helpful to think of each person as two selves: an experiencing self (the one that is fully present in the moment and experiences every sight, sound, smell, taste, and feeling) and a remembering self (the one which sifts through the detritus of that entire experience, retains a few key nuggets, and forms a “memory” of it).
And these aren’t just random nuggets. We form memories based on very specific aspects of an experience: the most extreme aspect (the highest high or the lowest low) and the final moments. Shakespeare must have unknowingly donned his behavioral economist cap when he wrote “All’s Well That Ends Well.”
What does this mean for the patient experience? As healthcare systems constantly monitor patient satisfaction scores in both inpatient and outpatient settings, how do we account for what patients care about? What makes them form happy memories? Kahneman actually studied these phenomena, by comparing ‘experienced’ and ‘remembered’ pain levels during colonoscopy exams. Each patient participating was asked to rate his/her pain intensity every 60 seconds on a scale from 0 to 10, (0=no pain, 10=intolerable pain).* Let’s look specifically at two patients in his study:
Photo Credit: Donald Redelmeier; Daniel Kahneman
One would assume by total shaded area that Patient B had more pain than Patient A. Poor guy. However, when the team compared patients’ overall ratings of their pain, they remarkably found the opposite to be true. Patient A and those like him described their experience, both immediately following the procedure and much later, as more painful. Herein lays the difference between the experiencing self and the remembering self.
This seems illogical, but there is a logical factor that explains this:
The Peak-End rule: People form a memory of an experience largely based on how their experience was at its peak and at its end, rather than the total or average experience. In this case, Patient A’s final moments of the exam were filled with pain, so that’s what formed the memory. This is not to say that Patient A doesn’t remember that time around the 5 minute mark where he was in very little pain, but that relative ease is simply not factored into the memory.
What does this mean for healthcare providers?
- Do one thing better than everyone else. For many healthcare systems, this factors into their communication, branding, company values and culture. If every single caregiver embodies the mission of the organization, patients walk away with that consistent, singular experience. From their clinical care to every administrative encounter along the way, a patient who experiences care beyond their expectations will certainly remember it.
- Make a lasting impression. Again, if a memory is largely dictated by the final moment, hospitals can perfect their curtain call. For patients, the experience of being discharged from a hospital is jarring. Patients are often unprepared to move from the hospital’s controlled environment to their home, where they are now in control of their own healthcare. Hospitals need to ensure consistent communication, sufficient education and quality home care when needed, so that the patient remains satisfied, and most importantly, healthy and safe.
*Redelmeier, Donald A; Kahneman, Daniel (1996). “Patients’ memories of painful medical treatments: real-time and retrospective evaluations of two minimally invasive procedures”. Pain 66(1): 3–8.