The Science Of Healthcare Engagement: Sarah O'Farrell

• Fundamental needs that drive everyday behaviors
• Sarah’s work on healthcare engagement and health behavior change
• Creating mental health products that promote resilience against mental health challenges and facilitate patient engagement and adherence.
• Turning challenges of applying behavioral science into opportunities.
• What does nudging mean in 2019?
• Where academic versus leaner approaches are necessary
• P values, effect sizes and sample sizes
• How we can ensure that we are delivering the greatest good to the greatest number
• Regulation and legislation in behavioral science
• Moving from isolation to integration: the evolution of behavioral science units

Nudging in government: Too paternalistic?

“And within the context of government, those choices are obviously aligned with government policy, so people choosing maybe to continue their education or choosing to opt into pension plans. But I think nudging has meant [that], historically, we take a paternalistic approach to choice. We present people with options, but we’ve designed some options to make it more likely that people choose path A over path B.”

When to choose results over theoretical elegance

“Where the motivation is to generate insight and find out what is driving a specific behavior, then that can be more of an academically rigorous exercise. However, where the motivation is “We need a quick change in behavior as soon as possible,” “We need to uplift sales in the next quarter,” “We need to reduce retention in the next month”—take your pick, whatever it is, where behavior change needs to happen really quickly, then that is often naturally at the expense of just a very rigorous scientific approach.

In that latter case of needing to elicit behavior change quickly, you are less concerned with the purity of the insight and the theoretical elegance of what you’re doing and you’re more concerned with just getting a result, which means that you sort of throw the kitchen sink at things sometimes. For example, [if you] have an employee engagement program and you want everyone to develop an exercise habit, you might say, “We’ll do these 12 things. We’ll put them all into a program and we know that all together they’ll work.” We won’t be sure which element of the intervention accounts for the greatest portion in variance on the outcome, but we know if we do them all, we’re really likely to get a result.”

Delivering the greatest good to the greatest number: An ethical framework for nudging

“But where we come into more public and social sector realms the question of ethics, I think for me personally, really revolves around utility and how are we ensuring that we are delivering the greatest good to the greatest number, which I think is a moral philosophy that’s followed by a lot of people.

Are we trying to, with what we’re doing, improve people’s lives more than they are experiencing any negative spillovers from what we’re doing? The question of what improves people’s lives, that’s a really interesting question and that’s actually where, again, we come back into evolutionary psychology and touch on mental health. I think any behavior change intervention that is trying to help people live more in line with their fundamental human needs: to have a sense of stability and security in life, to have strong social connections, to develop a sense of purpose, to live free from fear and threat—those are all our fundamental core human needs and any intervention that’s designed to increase those, in my mind, I think is a good intervention.”

Power asymmetry in applied behavioral science

“In the future, we will see a lot more legislation and regulation in terms of trying to redress the power asymmetry between organizations applying behavioral science and neuroscience and the stakeholders who they’re trying to affect, like employees, or the public, or consumers.

You could have a multinational company that is spending millions on neuroscientific research to design behavior change campaigns to try and sell a certain type of financial product with really high-interest rates in low-income countries. The power asymmetry there is just phenomenal. It is huge. It is unprecedented to use the most cutting edge research tools to really unpack the most subconscious drivers of change and then sell a product in a country where people might not be very educated. So I think that eventually, the legislation will come in to try and restore that balance— but I don’t know what that will look like and when it will happen.”

From isolation to integration

“In response to the question about how behavioral science may develop in organizations, to move on from just being an isolated unit, I think what we’ll see happening is the same that we’ve seen happening with digital and design thinking, which is that eventually there won’t be behavioral science units anymore. Behavioral science, insight, and capability will simply be a prerequisite for your regular operating teams. So marketing and communications will need to have an understanding of behavioral science. HR and employee experience will need to have an understanding of behavioral science. Product strategy, product design, will need to have an understanding of behavioral science. And I think that it will just become completely embedded into a core business capability.”

Behavioral science: Not an irrational science

“People talk a lot about behavioral science being an irrational science and actually, that’s a term that I don’t really like and I hope that it becomes used less and less. When we look at a lot of the key teachings from behavioral science, the fact that we have a social norm bias, or a present bias, or that we are generally loss averse when we’re in a neutral or in a positive state, these actually all make perfect sense as behavioral insights when you think about our evolutionary history. They might seem irrational in a modern world, in a metropolis where we have all of these stimuli and complex lives, but actually, when we were spending millions of years evolving in adaptive environments on the savanna, in forests, in small communities, these biases helped us to survive.”

• Moodpath: Your mental health companion 
• Headspace (meditation app)

Jakob: Thank you so much for joining us Sarah. It’s great to have you. Today, we would like to speak with you about your, take in the field of behavioral science, and what trends you foresee in the coming future. Before getting into that, I think many of our listeners would be curious to first learn how you got into behavioral science and what are some of, the more exciting projects you currently work on. Can you walk our listeners through some of them?

Sarah: Hi Jakob. Yes, of course, it’s great to be here. Thanks so much for inviting me to speak on the podcast. I got into behavioral science I believe before behavioral science was really a term, at least a term that was wide, sorry, widely used I mean. I had a real aha moment around behavioral science when I was doing my undergraduate degree, studying consumer psychology as part of a marketing module.

Sarah: I remember getting my first exposure into the power of the subconscious mind, as part of that marketing module. We were studying Jungian archetypes for example, and Maslow’s hierarchy of needs, and Murray’s psychogenic needs. We were looking at how these subconscious drivers of behavior influence people’s purchasing positions. Whether it’s buying cake mix, or mouthwash, or taking out financial products, like life insurance. I’d never thought about it before in my young life at that time. It was really fascinating to me, how people’s desire to meet some fundamental human needs, such as, a need for respect or appreciation, or belonging, or esteem, and how these drive every day behaviors in ways that are completely unbeknownst to most people.

Sarah: Around the same time that I was studying consumer psychology, I was also working as the horse riding teacher as part of my university career. I was working in a really disadvantaged area of Ireland with some children from vulnerable backgrounds. The place where I was working was a government initiative. The aim of the horse riding school in Dublin was to try, and catch children from vulnerable background when they were young and try, and redirect their trajectory, because there was a pattern of young children joining gangs and getting involved in illegal activities, and really coming out with really poor, sort of life outcomes.

Sarah: I remember reflecting when I was working there as a teacher, trying to bring some of these frameworks that I was learning about from consumer psychology and to understanding my experience there as a horse riding teacher. I started to realize that the reasons that these children from disadvantaged backgrounds were joining gangs, actually made complete sense when you understood our subconscious human drivers. A lot of these children had no families really to speak of, or were from very chaotic, the family backgrounds. They were looking for something that gave them a sense of purpose, a sense of meaning, a sense of affiliation, belonging, respect, acceptance, a chance to develop themselves.

Sarah: When you looked at it through the lens of these fundamental human drives, again, as I said to most people, were not consciously aware of them. It made complete sense to me, why these children would join gangs. They were getting all of these fundamental needs met, that they weren’t getting from a traditional social or family structures. That was really the beginning of my interest in the subconscious and how it directs our behavior.

Sarah: After that, I began talking to people about it. I began saying I was interested in solving problems, specifically social problems by better understanding the non-conscious drivers of human behavior. Someone recommended that I should watch a Ted Talk by Rory Sutherland, who I hadn’t heard of at the time, who’s the vice chairman of Ogilvy UK. I watched his Ted Talk. He was talking about behavioral economics. I just said, “This is it. I need to go and work for Ogilvy. They are talking about all the things that I’m interested in. I want to work on some of, the problems that they’re working on.”

Sarah: That was how I began my career in behavioral science. Ogilvy was really my first entry into that world. From there, yeah it’s been an exciting journey.

Jakob: Okay, Sarah. So thank you very much for explaining to us a bit about your motivation on how you went about going to the field.

Jakob: Would you be able to tell us a little bit more about that overlap between mental health and cognitive psychology and applied behavioral science? That is something that you and I had the pleasure to chat about a bit before this podcast recording and it’s something which triggered my curiosity because it seems to be a bit more unique than what most of our interviewees have been sharing so far, which is mainly the domain of doing behavioral science and kind of your classic public policy programs or in the private sector. So I’m curious, how does the overlap between mental health and applied behavioral science look like in your case?

Sarah: Well, and it’s a really fascinating question, and I first of all have to caveat by saying that I would consider myself to work in the area of behavioral and psychological science, so everything that I do isn’t focused on eliciting a tangible behavior as an outcome, sometimes it’s focused on eliciting a feeling state as an outcome and that is obviously where the mental health aspect really comes into play.

Sarah: So, for example, from behavioral science we can learn a lot about what optimal conditions are for human beings. People talk a lot about behavioral science being an irrational science and actually that’s a term that I don’t really like and I hope that it becomes used less and less because when we look at a lot of the key teachings from behavioral science, the fact that we have a social norm bias, or a present bias, or that we are generally loss averse when we’re in a neutral or in a positive state, these actually all make perfect sense as behavioral insights when you think about our evolutionary history. They might seem irrational in a modern world, in a metropolis where we have all of these stimuli and complex lives, but actually when we were spending millions of years evolving in adaptive environments on the savanna, in forests, in small communities, these biases helped us to survive.

Sarah: So we have evolved tendencies to want to observe what the group is doing and then copy the group, because thinking everything through from first principles is incredibly energy intensive, right? And for most of our history as a species, we’ve lived in a very calorie scarce environment, and thinking uses a lot of glucose, so adopting these heuristics and mental shortcuts enabled us to survive in the types of environments in which we evolved as a species. So we can extrapolate from that and say, okay, we can learn about the environments that were beneficial to us almost by reverse engineering what our behavioral biases are, and from that we can also learn about the types of environments that will make us feel good and be healthy.

Sarah: So in the effective part of behavioral science, so for people who study the relationship between emotion and cognition and behavior, we know that, or you know as much as science knows anything, we have very, very good evidence to suggest that emotions are actually an evolutionary mechanism to give us information about our environment. So if we’re feeling any sort of negative emotion, it’s telling us that something in our environment is not adaptive, it’s not suited to the human condition, and then that emotion will prompt us to engage in cognitions and behavior that will help to rectify the situation and create a more adaptive environment.

Sarah: I think that the quote that I will never forget because I’ve had a drilled into my head for so long by so many different researchers is that “emotions drive cognition in the service of adaptive action.” So when we know that emotions tell us whether or not we’re living in an adaptive environment, we can then develop strategies that enable people to feel more positive emotions, which is essentially the fundamental pillar of many health disorders. Affective disorders are really where the highest burden of disease lies in mental health. That’s anxiety and depression, OCD. So we can develop strategies that make people feel emotionally better by changing the environment in line with these insights from our evolutionary psychology.

Sarah: So that’s the first thing that I’m really, really fascinated about and that’s essentially where policy comes in at a national level, but also at a more micro level when we talk about workplace policy, for example. How do we design physical contexts, cultures in which people are more likely to experience positive emotions than negative and then prevent the development of affective disorders such as stress, anxiety, depression.

Sarah: But the second piece, which is maybe more behavioral, more pure play behavioral, actually comes into helping to nudge behaviors that support positive mental health. So I heard a great line from a researcher that I worked with briefly while I was at the London School of Economics, a woman called Laura Kudrna, who’s a really brilliant researcher, and she said, “You know, behavioral science can put the B into CBT or DBT,” or whatever therapy you’re using that requires people to take actions.

Sarah: So within a lot of these cognitive behavioral therapy based approaches, people are required to do certain behaviors in order to improve their mental health. They may be required to go out and connect with others to override an anxiety to prove that they can make a new connection and that connection won’t be threatening to them. And cognitive behavioral therapy tells people what to do, but it doesn’t actually give them or apply behavioral science in telling them how to do it, how to actually make it easy for themselves, make it attractive for themselves, remove barriers to change. So I think that that’s a big role for behavioral science in helping people to take actions that support mental health as well.

Jakob: Fascinating stuff. I recently came across an application, and as we were speaking I had to think of it, I wonder if you know of it, it’s called Moodpath and it’s in essence a tool that gives somebody who is suffering from any kind of mood disorders an ability to kind of track their mood and how they feel, I think it’s two or three times a day, and kind of just log it like a journal literally. However, there are, I guess, some algorithms behind this log and I think there’s also actually real trained therapists on the other line, so to say, who based on that log will then send individualized kind of insights and tips and suggestions on what this person could be doing in order to kind of improve certain thoughts or states or something along these lines.

Sarah: So to me that is a bit of, if I heard you correctly, what you were describing because it’s a combination of the knowledge that we have from psychology, but also leveraging behavioral science in terms of kind of nudging people to actually apply it, doing that in timely fashion, doing it in a salient way, and doing it in an individualized way. So does that resonate with you? Is that kind of the direction that you might be talking about?

Sarah: Yes, that absolutely resonates. And while I haven’t heard of that specific platform per se that’s absolutely the type of thing that we’re talking about where there may be a standard therapy and it’s how do we bring behavioral science as an extra layer into that to make it more likely that people will engage in the behaviors that we need to. And we know that there’s very simple activities day to day that if people do them that they will be less likely to develop a sort of a mental health challenge or they may be more likely to recover from affective disorders more quickly.

Sarah: So that is engaging in purposeful activities. That is going out and forming social connections. That is practicing mindfulness. These things sound very basic, but it’s easy to tell someone to do them, it’s actually much harder, as we all know, to develop the habit and to overcome the fear of doing these things. So, yes, that’s exactly the type of thing I’m talking about and it really resonates.

Jakob: Great. And I’m sure also many of our listeners and maybe you as well, Sarah, know the widely popular, I think, now application called Headspace that kind of helps you to get into meditation in a very fun and engaging way. And I think that’s also, maybe not directly, well in a way it’s also therapeutic, but it’s also, I think, it’s a pretty good overlap of potentially mindfulness and behavioral science.

Sarah: I completely agree. Yes.

Jakob: Fantastic. Well great, Sarah. So moving on and actually coming back a little bit to your personal journey and your motivation to get into the field of behavioral science, which I find very fascinating, I wanted to ask you if there were any challenges that you encountered throughout the journey and, if so, how did you go about solving them? And then also, in retrospect, do you think it was worth all the efforts and would you do it all over again?

Sarah: So again, a great question, Jakob. Thank you. There have been quite a lot of challenges because this is not an established career path and it’s a new field. So pretty much every job that I’ve had I have had to go out and try and create it. There hasn’t been a job opening that someone is able to respond to. And when you go in and you have to create a job for yourself within an organization by showing them the types of problems you can solve for them within that, quite often organizations don’t really know what to do with somebody who has a behavioral science specialization that they’re applying across different domains or different verticals.

Sarah: So really you need, yeah, you need to be very comfortable figuring out the path as you go along and not having a set path to follow. So I would say that that is the biggest challenge. And I haven’t always gotten it right. Sometimes I’ve made decisions and gone into projects or engagements where the context hasn’t been right, but you learn as you go along and I think that’s the same for anyone doing something quite new.

Sarah: One of the recommendations that I give to anyone who’s entering the field for the first time and going into an organization where behavioral science as a unit or as a division isn’t established yet, which is most organizations, the most important thing as someone who is executing behavioral science projects in that type of a context is that they are able to follow a really, really clear strategic direction.

Sarah: So it’s very easy to go out and design a behavior change intervention. That’s great, but it’s really important to make sure that what you’re doing is aligned with the strategic direction of the company. So it’s important to be very closely aligned with the senior leadership in the business that you’re going into and making sure that all of these great nudges and programs and policies that you’re developing is really what is going to add value to the organization.

Sarah: And I think, very related to that, when you are going in somewhere new with a new skillset, you also need to be able to listen to your stakeholders and the people you’re working with, whether it’s your colleagues or your clients, and really try to understand what is the core problems that are keeping them awake at night. Because they will not have a behavioral change budget or they will not have a behavioral change RFP. What they will have is problems that they don’t know how to solve. And if you can, as a behavioral scientist, have the skills to really unpick what those are, really clarify and crystallize them for your collaborators, then you’ll be able to come back with a proposal for how you can solve them.

Sarah: And you’ll have to target different parts of budgets that don’t exist for behavioral sciences. For example, it might be that you’re developing a marketing communication solution, might be that you’re developing an employee engagement program, whatever it is, but you need to figure out how you align with the, and fit into, the existing traditional structures within a business and how you solve people’s problems. So they are the two challenges, but also the two greatest opportunities for people coming in with a new skillset.

Sarah: And to answer your question, sorry, about would I do it all again, yes, I definitely would do it all again and I don’t feel like it’s over in any way whatsoever. I still feel very much at the start of this journey, which for, as with all of us, is probably going to be a lifelong journey. And, yeah, I’ve learned a lot, often through making mistakes, but gained a lot of wisdom in the process and it’s been incredibly rewarding and exciting.

Jakob: Fantastic. Thank you for that, Sarah. Which actually is a good segue into my next question. As you know, interest in the field of behavioral science, as you just said, is continuously growing and it’s growing across countries and sectors. So, but with that also views about what nudging, irrationality, behavioral economics or behavioral science are have also shifted. So if I was to ask you, Sarah, what do you think to the average person nudging means in this year, in 2019, and how do you think this is likely to change in the coming years?

Sarah: I think right now nudging still means to most people what it has meant for the last five or 10 years, which is trying to give people choices, but designing some options within that choice set so that people are more likely to choose the one that you want them to. And within the context of government, those choices are obviously aligned with government policy, so people choosing maybe to continue their education or choosing to opt into pension plans. But I think nudging has meant historically we take a paternalistic approach to choice. We present people with options, but we’ve designed some options to make it more likely that people choose path A over path B.

Sarah: I think we’re in a period right now where perceptions and interpretations of nudging are changing. I think that that has been fueled by some scandals, to be honest, recently such as the way that data was used in the Cambridge Analytica and [inaudible 00:16:02] how Facebook and Uber and other tech companies are using behavioral science to nudge people into continual use, which drives essentially sort of addictive behavior. I think that people now are beginning to be a bit more skeptical and critical about the application of behavioral science.

Sarah: And I think that that’s a shame, but it’s also natural as a tool of change becomes more widespread and moves out of the realms of health and government policy and into private sector it will be used for all sorts of different things and some of those things will be to the benefit of the consumer and the general public, but also some of those things will be to the benefit of maybe the corporation, for example. So I think that people are becoming more wary of the term nudging and probably will begin educating themselves a little bit more on how to defend against some persuasion tactics.

Jakob: Thank you, Sarah. So I definitely want to circle back to the issue and topic of ethics around behavioral science. I think this is a critical one. But before I do though, before I do that, I’d like to shift gears to talk about the application of behavioral science. So the field has a strong reputation often because it applies a rigorous, often heavy and academic approach to projects. So this is obviously something that can be very beneficial for organizations that aim to work on behavior change, but it also comes with a lot of challenges.

Sarah: At times we hear that behavioral science is embraced by project leaders because it provides fresh, new, and sometimes quicker perspective than classic economic models have done in the past, but we also hear that units do not have the needed luxury of time and budgets to conduct complex randomized control trials yet they’re still interested to apply behavioral science to their projects. So, Sarah, what do you think are the biggest challenges for an organization looking to apply behavioral science in an empirical manner and how can these be tackled?

Sarah: So I think that to answer that question we need to first start with thinking about what is the motivation of an organization or a unit on any particular behavioral science engagement. Because where the motivation is to generate insight and really find out what is driving a specific behavior, then that can be almost like more of an academically rigorous exercise. However, where the motivation is “We need a quick change in behavior as soon as possible,” “We need to uplift sales in the next quarter,” “We need to reduce retention in the next month, “We need to,” take your pick, whatever it is, where behavior change needs to happen really quickly, then that is often naturally at the expense of just a very rigorous scientific approach.

Sarah: So in that latter case of needing to elicit behavior change quickly, you are less concerned with the purity of the insight and almost the theoretical elegance of what you’re doing and you’re more concerned with just getting a result, which means that you sort of throw the kitchen sink at things sometimes. So if you, for example, have an employee engagement program and you want everyone to develop an exercise habit, for example, you might say, “We’ll do these 12 things. We’ll put them all into a program and we know that all together they’ll work. We won’t be sure which element of the intervention accounts for the greatest portion in variance on the outcome, but we know if we do them all, we’re really likely to get a result.”

Sarah: And I think that that is more often than not the way that things are done in organizations. And I think that that’s fine because a commercial organization is a commercial organization and that’s why we have academic and other types of research institutes to do the type of behavioral science work needed for theoretical brilliance and elegance. So I think once you know that and once you know that you are looking for result are not a perfect predictive model, then that’s the first hurdle overcome, because everyone’s aligned, everyone knows what the source of value is.

Sarah: Coming down to something more tactical in terms of an operational challenge within organizations, some very, very basic stuff sometimes can hold back behavioral science research being done well or even just being able to evaluate an intervention well. So you may not believe this, but quite often in organizations or in government the point of collecting data where you are intervening to change someone’s behavior and the point of collecting data at which that behavior is actually seen, for example, aren’t matched up in the background.

Sarah: So you might not have a clear way to show that the data set that shows that your intervention took place is not linked to the data set that shows where the behavior is actioned and very simple things like that happen all the time. So I think that in organizations the real challenges are actually infrastructural and political, aligning the people that you need to get the job done because organizations are complex political places. So, yeah, much more practical challenges I think than in the academic space.

Jakob: Fantastic. Thank you for that overview, Sarah. So you belong to the group of groundbreaking researchers in the topic of behavioral science, can you share with our listeners how you typically choose themes you are interested in researching about, how you link these to behavioral science, and what tools you use for your research? Also, what do you distinguish as good research from bad research in behavioral science? And finally, what tricks do you use to translate complex academic knowledge to applied work without losing any of its depth and rigor?

Sarah: So regarding the themes that I choose to research, these are generally driven just by two things. One is personal interest. So if I have a question rattling around in my head that I’m really curious about, I’ll dive into the first port of call, the academic literature. I always go straight to Google Scholar. It’s one of my most frequently visited websites. But more often than not because I work in a commercial setting, the things that we research are driven by client needs. So it is “What are the types of problems that a client or an employer is trying to solve?” And that will direct my research.

Sarah: And in terms of tools, I always start off with a literature review for many reasons. I mean, it’s personally very interesting. So I read a post recently on LinkedIn where a leading behavioral scientists said he always tried to employ people who have a high need for cognition, which is a psychological construct. And it’s people who like to understand things systematically and figure out what the causal relationships are between them and things like that. So I imagine most behavioral scientists are probably pretty high on that need for cognition. I know I am. So I like to try and understand something intellectually first, which is why I will always go to the literature first and to see how people have attempted to deconstruct the problem and solve it.

Sarah: Once I’ve been able to understand the scenario better through a literature dive, then the tools of research are the traditional experimental tools, running A/B tests, and if you’ve more time and resource running a randomized control trial. So, yeah, that would be it. I think the tools are very similar to academic tools.

Jakob: Quite. Mm-hmm.

Sarah: And just to your question about what constitutes good research, I can say that there’s a few things on my mind lately about what constitutes good research and I think they’re also things that are very much on the mind of the behavioral science and the psychological science community at the moment. We have had a problem of research being conducted with very small sample sizes historically in our field, in the academic field not necessarily in the applied policy side. I realize there the sample sizes are very, very significant.

Sarah: But when it comes to the experimental lab work, our field has always conducted with small sample sizes. And I read a paper recently which said that in order to measure an effect size of .04 you would ideally need across two groups, an intervention group and a control group, and a total sample of 328, I think, which would give you a 95% power. And we don’t really see that in many of the most seminal behavioral science experiments that we all know and talk about.

Sarah: So going forward, I think that the field is pretty self aware that that’s something that needs to be changed. And I mentioned effect size a moment ago. Another thing that we need to be much better doing is actually documenting effect sizes. So everyone will always tell what their P value is and if there’s been a result, but very, very rarely do people in research document actually what the size of the effect is. And I think that that is more important than actually just did an effect occur. Actually how big was the effect?

Jakob: Thanks, Sarah. So I’d like to now circle back to the question of ethics that we briefly touched upon earlier because I do think that that’s something that a lot of our listeners are very interested in. So as a nonprofit, we are particularly interested in the ethical dimension of nudging. One compelling argument we’ve heard for why nudging is ethical is that choice architecture happens all the time whether we think about it or not. Therefore, there is an ethical imperative to think more deeply and deliberately about how we’re doing it.

Sarah: This is a very interesting view, but it brings up further ethical questions. If nudging gives you a tool to be more deliberate and empirical in the way you affect people’s decision, how can we make sure that we do this in a way that is aligned with people’s interests as possible? Is the answer to create discourse so that people decide where to be nudged? Or should we decide for them based on societal ideals such as being healthy and prepared for retirement?

Sarah: Again, such a great question and I don’t think any clear answer there. I’m sure that everyone will have a different way of approaching this answer. To come back to the previous discussion we had about behavioral science being adopted more by commercial organizations, so often it will be applied in the service of profitability, how do we reduce our costs or how do we increase our revenues? And in those instances, I think that the application of behavioral science has to be viewed in the same way an organization would apply any tool of persuasion.

Sarah: So before we had a language around behavioral science people would use just more broad generic terms like “marketing communications” or “stakeholder relation management” or whatever it is. So I think that the ethical question there has to lie with the individual organization. But where we come into more public and social sector realms the question of ethics I think for me personally really revolves around utility and how are we ensuring that we are delivering the greatest good to the greatest number, which I think is a moral philosophy that’s followed by a lot of people.

Sarah: And that’s a good benchmark. Are we trying to, with what we’re doing, improve people’s lives more than they are experiencing any negative spillovers from what we’re doing? The question of what improves people’s lives, that’s a really interesting question and that’s actually where, again, we come back into evolutionary psychology and touch on mental health. And I think any behavior change intervention that is trying to help people live more in line with their fundamental human needs to have a sense of stability and security in life, to have strong social connections, to develop a sense of purpose, to live free from fear and threat, those are all our fundamental core human needs and any intervention that’s designed to increase those, in my mind, I think is a good intervention.

Jakob: Sounds great. Thank you. Thank you for that, Sarah. So I’d like to now switch gears and talk a bit about what it takes to have a career in behavioral science. So applied behavioral science is becoming an increasingly appealing career choice for many, especially those ones who want to sit at the intersection between various fields as well as between theory and application. However, for that very reason it is a tough field to prepare well for. So many of our listeners have asked us how they can best prepare for the field. With this in mind, what skills do you think an applied behavioral scientists will most likely need in the next 10 years? How can they best prepare? And how would you distinguish between a behavioral scientist who wants to be a researcher versus someone who wants to do more of the applied work?

Sarah: Well, I’ll take your last question first. I think someone who wants to be a pure researcher is someone who really cares about the theoretical elegance of what they’re doing and conducting research studies that are incredibly robustly designed so that we can understand all of the various causal mechanisms between an intervention and an outcome. So for someone interested intellectually in the purity and the precision of behavior and what drives it and what the behavior change mechanisms are, then I would just say stay in academia and that will be so fulfilling for someone with that mindset.

Sarah: For someone going into the commercial world, it is a lot less, yeah, a lot less precise often and you can move a lot quicker and that can be frustrating as well when you’re forced to make trade-offs that maybe you wouldn’t have to make in academia because you’re focused on the theoretical elegance of what you’re doing. But I would say for anyone that is trying to make it in the commercial world of behavioral science and applied behavioral science, yes, have the hard skills, but actually what will be even more important to you being able to work on big interventions that have impact, that involve multiple stakeholders, that span sectors will be the softer skills of engaging people, selling a compelling story, working with clients, trying to understand what their real needs are and problems are that they’re trying to solve. I think those softer skills of, yeah, of relationship building, and persuasion, and creating stakeholder alignment, and bringing everyone together on a journey that’s maybe a little bit uncertain and tough at times are really, really important for someone wanting to create impact in the applied field of behavioral science.

Jakob: Thank you, Sarah. And if I can just follow up a little bit on that question, we sometimes receive questions from people who are literally deciding on their first kind of field of study and they already know that they like the field of behavioral science, but they also know that there are very few degrees in behavioral science per se. And so a lot of people then come to us and ask us, “Well, if I want to have a career in behavioral science, should I get a degree in, let’s say, economics or should I get a degree in social psychology or anthropology or sociology?” I mean the span is quite wide and it’s always a bit of a tough issue to kind of suggest one field over another because obviously we all come in with our own biases. But if I could turn over this question to you, Sarah, what would you tell maybe the younger folks that today know that they want to get into behavioral science but are having a bit of a hard time to decide which of the underlying fields they should be studying to get in there?

Sarah: Well, the first thing I’d say is don’t worry because once they get into an organization they will be working, whether it’s an academic organization or a commercial one, they will be working with people from so many different fields as well that it will all come together in this amazing intellectual cognitive melting pot of problem solving skills.

Sarah: So ultimately you will be working in interdisciplinary teams with people from different backgrounds. So when choosing which maybe underlying field to focus on for your undergraduate degree or postgraduate degree, I would just simply say whatever they feel that they have the natural strengths in and the natural passion for. Because if you are choosing a research field that’s aligned with your personal cognitive processing style or your personal sense of purpose in the world or just your interests, you will just love every minute of it. You will perform really, really highly and you won’t feel like you’re working because you will just be so engaged in the flow.

Sarah: So I don’t think there’s one better subfield to study because ultimately throughout the course of career you’ll come together with people from so many different backgrounds and you’ll have that great mix. So for starting off your academic journey, I would, yeah, just pick what you love and what you’re passionate about and what you’re good at.

Jakob: What a wonderful answer. That really resonates with me because that’s also something I always try to tell the younger folks out there to just really follow your passion and it will all come together at the end if one does that. So that resonates a lot.

Sarah: I couldn’t agree more.

Jakob: Great. Well, so shifting gears, Sarah, now I’d like to just probe a little bit on your views of behavioral science in the private sector. So the recent trend of applying nudges to improve policies and decision making processes, as we know, started mainly in the public sector. So the UK Behavioral Insights Team was one of the first movers in the public policy world, but quickly nudge units at public multilateral structures such as the World Bank, OECD, or the United Nations, and other governments, notably the United States, Germany, Singapore, Peru, and others followed. Today many, if not even most, governments employ at least one or two behavioral scientists in their administrations. So nudging, or applied behavioral economics, seem to be best suited for effecting public policy. However, after observing the success of nudge units across governments an increasing number of private sector companies have also followed suit with their own nudge units. What is your take on the private sector’s increased appetite in applying behavioral science in their businesses? Also, given the ethical conversation we had earlier, and where do you see behavioral science evolve, especially in the private sector, in the coming years?

Sarah: So I think it’s fantastic that private sector companies are embracing behavioral science and setting up units because it’s a real rubber hits the road endorsement of the value that our field brings. So when you see industry starting to invest heavily in this type of expertise, you know that you’re having an impact. And I think the last major sort of trend in capability and thinking where we saw a similar investment was probably design thinking, and before that it was probably digital capability. And both of those two… You know, digital is now life. There’s no life that’s not digital. And design thinking is just such a fundamental capability within the world’s leading organizations. So I see behavioral science going in that way. And I think that that is phenomenal.

Sarah: To the ethics question, again, I think that the moral and ethical responsibility for how to apply behavioral science must lie with each individual or organization, not because I necessarily think that’s the best answer to the question, but I think that that is for the moment the only workable answer. I do feel, though, that in the future we will see a lot more legislation and regulation in terms of trying to redress the power asymmetry between organizations applying behavioral science and neuroscience and the stakeholders who they’re trying to affect, like employees, or the public, or consumers.

Sarah: So I’ll give an example. You could have a multinational company that is spending millions on neuroscientific research to design behavior change campaigns to try and sell a certain type of financial product with really high interest rates in low income countries. The power asymmetry there is just phenomenal. It is huge. It is unprecedented to use the most cutting edge research tools to really unpack the most subconscious drivers of change and then sell a product in a country where people might not be very educated. So I think that eventually legislation will come in to try and restore that balance, but I don’t know what that will look like and when it will happen, but it will be interesting to see. But until then, I think we’re all using our own moral compass.

Sarah: In response to the question about how behavioral science may develop in organizations, to move on from just being an isolated unit, I think what we’ll see happening is the same that we’ve seen happening with digital and design thinking, which is that eventually there won’t be behavioral science units anymore. Behavioral science, insight, and capability will simply be a prerequisite for your regular operating teams. So marketing and communications will need to have an understanding of behavioral science. HR and employee experience will need to have an understanding of behavioral science. Product strategy, product design, will need to have an understanding behavioral science. And I think that it will just become completely embedded into a core business capability.

Jakob: Right. And I guess the beauty of the field is that it can span across so many sectors. So I guess people who are worried maybe not just about the field of studies but also the sector they want to get into after their studies also don’t need to be too worried because there’s plenty of need probably across all kinds of entities and sectors out there.

Sarah: Exactly. Anywhere where there’s a human being, your skills are needed. So that’s a lot of different sectors and industries.

Jakob: Right. Great. So, Sarah, as we’re coming towards the end of this chat, we would like to ask what short to longterm future you envision for yourself with regards to behavioral science? And what types of projects you are most excited about in the coming years?

Sarah: So for me it’s continuing on this journey of health, well-being, mental health and physical health. I am increasingly involved in healthcare innovation, whether that is trying to understand the healthcare challenges that will emerge in the future based on people’s current behaviors and contexts in society today, in different types of societies today. So there’s an element of using behavioral science to develop better predictive models in the healthcare sector. So I’m incredibly excited about that. And then as I said at the start of the podcast, I’m also incredibly excited about continuing to work with innovators in the healthcare space to develop better products to solve healthcare challenges and to improve people’s health, and to working with policymakers to create better national policy in order for people to not get ill in the first place.

Jakob: Wow. Sounds like you have a very interesting and full plate ahead of you. So wishing you best of luck with all of that interesting work and keep us posted. And I also want to thank you for all your insights today, Sarah. Is there anything else you would like to let our listeners know before we wrap up for today?

Sarah: Yeah, thank you for having me, Jakob. Really, really appreciate the chance to talk. It’s been really interesting. I would just say for anyone listening today that’s thinking of getting into this field, as we’ve discussed, there are lots of options. There are an infinite number of ways in which you can apply your skills and the best entry point for anyone considering a career is to follow their passion. So I think just to end on that note will be a really good reminder for your younger listeners.

Jakob: So good to hear that. Sarah, we would like to thank you for your time and wish you all the best for this year, 2019, and beyond. Thank you again.

Sarah: You too. Thank you so much, Jakob.

Jakob: Thanks. Bye-bye.

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