How to Change: The Science of Getting from Where You Are to Where You Want to Be

by Katy Milkman

Penn Medicine’s miraculous success rested squarely on people’s tendency to take the path of least resistance. During a routine system upgrade, an IT consultant working on the software that Penn physicians used to send prescriptions to pharmacies made a small change to the user interface: he added a new checkbox to the system. From then on, unless a physician checked that box, whatever drug they prescribed would be sent to the pharmacy as a generic. Since doctors, like the rest of us, tend to be a little lazy, they only rarely checked the box: just 2 percent of the time. As a result, Penn’s generic prescription rate shot up to 98 percent. Behavioral scientists would describe what happened at Penn Medicine by saying the IT consultant changed the prescription system “default,” or the outcome the system delivered if no one actively chose another option (such as the standard factory settings that come with a new computer). If defaults are set wisely, you’ll still end up making the best decision even if you don’t lift a finger—an opportunity most of us relish, thanks to our efficiency-loving operating systems. For years at Penn Medicine, Mitesh and his colleagues had been lobbying to change the prescription interface to automatically order generics unless doctors opted out. But final approval was still pending. In the end, a lone IT developer, knowing that good defaults matter, took it upon himself to make the change when Penn Medicine’s software system needed updating anyway. A...