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Freedom of choice is such an unassailable value in America that it is considered a solution in and of itself to social ills, from failing schools to the insolvency of social security. As a society, we view choice as the manifestation of our most exalted ideal: freedom. The value we place on decisiveness was reflected in President Bush’s assertion, “I’m the decider. I make the decisions.” But the proliferation of choice can have unexpectedly negative consequences. Expanding the number of options often comes at the cost of finding solutions. Nowhere is this trend more evident than online—and the stakes have never been higher. Increasingly, our most significant decisions—such as whether or not to have a medical procedure or how to best to plan for retirement—are being made using web-based applications. As it turns out, many are poorly suited to helping us sort through the ever-growing range of possibilities. So why do these interfaces so often fail us when we need them most? And what unique challenges are there in designing systems that help us make high-stakes decisions?
In order to understand how people make decisions online, it is first important to understand how we approach decision-making. Barry Schwartz’s recent book The Paradox of Choice: Why More is Less presents a compelling picture of the proliferation of choice in our society. Schwartz describes a study where shoppers in a grocery store were presented with a selection of jams to sample. One group was presented with six options and another with twenty-four. 30% of those in the six jam group purchased one of the jams while only 3% of those exposed to the wider array ended up purchasing one. The increase in choice made it harder to make a decision. And of those who did end up purchasing a jam, those from the group with six options reported being happier with their selection than those who had twenty-four options, despite the fact that the jams were not qualitatively different.
While this study shows that more options tend to yield a less satisfactory result, the way we approach decision-making varies significantly depending on our individual decision-making styles as well as on the circumstances. Schwartz identifies two styles of decision-making: maximizers and satisficers. A maximizer sees decision-making as the process of finding the one best possible option. The maximizer has to see and compare every alternative, and this quest for an exhaustive review of options dominates the experience. The maximizer’s greatest concern is missing out on a better option that might be just around the corner. The satisificer on the other hand looks for a choice that is good enough. Satisficers do not have low expectations—rather they accept that there is more than one option that will satisfy them. Once the satisficer finds an option that meets their initial criteria they are content to conclude their search, whereas the maximizer has to continue looking for the best of all the options, establishing new criteria as they go. The satisficing mentality can be summed up by a quote from designer Milton Glaser, “Less isn’t more, just enough is more.”
In case after case, Schwartz demonstrates that satisficing tends to make people happier than maximizing. He shows how the effort and stress that go into maximizing offset any increase in the quality of the outcome it may bring. Maximizers may do better objectively, but they do worse subjectively. They feel worse about their decisions and are less happy with the results than satisficers. Schwartz explains that having more options means having more opportunities for regret, and “what if” scenarios.
The trouble is that, when facing high-stakes decisions, all of us are likely to engage in maximizing behavior. Good may be good enough when buying a pair of jeans, but when making decisions about our health or long-term financial security, we don’t just want to make a decision—we want to make the right decision. But how do we decide what the right decision is?
The most difficult challenge in designing interfaces for high stakes decisions is that human beings are not wired to make rational decisions. In their article, “The Hidden Traps in Decision Making,” John Hammond, Ralph Keeney, and Howard Raiffa describe the “bounded rationality” of human decision making. Hammond et al. demonstrate how first impressions anchor all our later analysis and judgments regardless of how accurate or significant that initial impression was. The first piece of information we get in a scenario has a disproportionately large influence on all subsequent information. We humans also subconsciously seek to confirm our existing point of view. We demonstrate a strong bias for the status quo—that is, we look for reasons to do nothing. We make decisions unconsciously that validate our previous choices. We are also overly influenced by events that are more memorable either because they happened recently or because of their vividness.
Cognitive scientists Daniel Kahneman and Amos Tversky have been studying how people make decisions for over twenty-five years. One aspect of the human decision making process they have explored in depth is called the availability heuristic. In one study, college students making course selections were presented with summaries of evaluations by hundreds of students all indicating one course of study and then presented with a single videotaped testimonial by a student advocating the opposite course. The participants were far more likely to be persuaded by the videotaped testimonial than by the written evaluations, even though the opinion of one student was clearly less relevant than the unanimity of hundreds of others. Regardless of its statistical insignificance, the testimonial was vivid and salient to the participants—and therefore more available—so they wrongly gave it more weight.
Our natural tendency to make irrational decisions only increases as those decisions become more important. Schwartz writes, “As the stakes of decisions involving trade-offs rise, emotions become more powerful, and our decision making can become severely impaired.” The combination of high-stakes decisions and a proliferation of choice leads to situations that are not only unsatisfactory, they are potentially disastrous.
In late 2005, the US Senate passed the Medicare Modernization Act (MMA) giving beneficiaries the freedom to choose their drug coverage plan. Several months later the Department of Health and Human Services launched an online tool called The Drug Plan Finder to help people take advantage of this new legislation (commonly referred to as Plan D). Dr. Mark McClellan, head of the federal Centers for Medicare and Medicaid Services, hailed the new online tools as an important means for helping people wade through the complex options. “This will help people make competent decisions,” McClellan said. “They’ll have an unprecedented array of tools that will help them find a drug plan.” As it turns out, however, what the elderly users needed was not an impressive array of tools, but rather one tool that would help them compare the 78 different plans and arrive at a single solution. In an internal audit, the GAO (Government Accounting Office) concluded that the Medicare website was so poorly designed and complicated that seniors were typically able to perform less than half of all simple tasks they attempted on the site. A study by the Kaiser Family Foundation, which found that only a fraction of eligible Medicare recipients have elected to enroll in the program, seems to confirm Schwartz’s assertion that, “being forced to confront trade-offs in making decisions makes people unhappy and indecisive.” The authors note, “Lorraine in Baltimore does not intend to enroll primarily because she finds her choices overwhelming… Many [beneficiaries] just stayed with their current insurer to avoid having to make any decision at all.”
The primary tool featured on the Plan D site is a Personalized Plan Search (PPS) designed to provide customized information based on a form that is filled in with personal information. Even after providing a great deal of personal information, however, The Drug Plan Finder is unable to provide meaningful distinctions between options. For a senior who lives in Syracuse and takes five commonly prescribed drugs, the Medicare website returns 44 different plans that range in annual costs from $2,300 to $11,000. Estimated co-pay ranges are from $0 to $250; estimated drug premium ranges from $9 to $85; and the monthly cost share, which is the payment after meeting the deductible, ranges from $125 to $872. Senator Charles Schumer of New York said of the Plan D website, “This is just way too confusing…Seniors need the Cliff Notes for these choices not the Encyclopedia Britannica.” Even if there is useful information in The Drug Plan Finder database, it is not made any more accessible by the design of the tool.
Ultimately the research by the Kaiser Family Foundation and the Harvard School of Public Health revealed a much more fundamental critique of The Drug Plan Finder website: it probably shouldn’t have been a website in the first place. According to a report issued jointly by the two organizations, 76% of senior citizens have never used the Internet at all, and less than 6% of seniors in the study had ever visited the Plan D site. So even if the site had been 100% accurate and easy to use, it would have failed to get those results to the people who needed it.
So what are our options as designers? The striking thing about most research being done on how design can help enable meaningful decision-making is that it often requires stepping back from specific design problems in order to focus on the question of what to design rather than how to design. Refocusing the mission of design can bring valuable insights into how to make information more useful, and useful information more accessible.
Simplicity has always been revered in design but John Maeda’s recent book The Laws of Simplicity takes this virtue and spins an entire ethos out of it. Maeda argues for a radical agenda of reduction. He bemoans the fact that technological progress is so often associated with adding more features, more complexity, and more functions. For example, the 2000 version of Windows had 20 million lines of source code. Just one year later Windows XP was released with 40 million. He criticizes the evolution from Macpaint to Photoshop, pointing out that the latter has spawned a whole industry of how-to books, online tutorials, and workshops. Embracing simplicity means adopting a new definition of progress, but this decision need not be purely idealistic. In a 2002 study by the Consumer Electronics Association, 87% of respondents ranked ease of use as the most important feature in new electronics. A survey by Philips of over 2,000 of its customers found that nearly 48% had put off buying a digital camera because they thought it would be too complex. Interfaces for high-stakes decisions will have to overcome the negative emotion created by complexity in order to be effective.
Peter Morville’s book Ambient Findability is focused on how to make useful information more accessible and present in our environment. He observes how technologies like GPS, RFIDs and meta-tagging are changing how we think about accessibility. With his background in information science, Morville is committed to finding ways to make meaningful, accurate information more findable. He acknowledges the effectiveness of the “fast food approach to information consumption” but believes that the bounded rationality of human decision-making can be harnessed just as easily as it can be exploited. He introduces the work of Ambient Devices whose motto is “information everywhere.” Ambient Devices has a small line of products that seamlessly insert bits of useful information into everyday life. For example, they are developing an umbrella that glows when rain is forecast and a watch that reminds you when to take medications.
The 2006 Simplicity Event One held this October by Philips brought together many of these strains of research. The expo featured exploratory designs for products aimed at promoting healthy lifestyles. The concept products take the narrative context of the user’s life as their starting place. For example In Form is a set of motivational body measurement tools, linked to an information display. The display keeps people better informed about their physical condition—weight, fat, hydration and body shape—through personal history records, and tailored advice. Body Cycle is a thermometer linked to a display mirror, which provides interactive advice to help women monitor and manage ovulation, fertility, and menstruation. Making this useful information vivid and findable means that it is likely to play a significant role in the user’s decision-making process.
These projects build on the work Philips is already doing in its CareLab. According to Ivo Lurvink, CEO of Philips Consumer Healthcare Solutions, “The whole idea of the lab is to deepen our insight into how the elderly and chronically ill deal with the new medical technologies.” By conceiving of their customers as protagonists in their own lives, Philips was able to see how important the role of context and setting is in decision-making. Carelab makes recommendations by emitting a steady stream of information into the user’s environment rather than delivering a huge glut of data when the user is least equipped to deal with it. This allows the user to make simple decisions in context rather than tackling a complex, overwhelming decision at a moment of crisis. This narrative of integrated decision-making lowers the anxiety surrounding these high-stakes decisions.
Humans have a complicated relationship to choice and decision-making. On the one hand, we cherish our freedom and value free will. On the other hand, our innate decision-making instincts are irrational and easily manipulated. In order for interfaces and applications to truly help people make more responsible, abiding decisions, designers need to acknowledge that different types of decisions require different solutions. This point was made particularly salient by a recent RAND Corporation study of web sites providing medical information, which found that, “with rare exceptions they are doing an equally poor job.” Most interfaces either encourage maximizing that leads to discontent and uncertainty, or they reinforce the human brain’s expedient but irrational decision-making tendencies. Interfaces designed specifically for high-stakes decision-making like health care need to transcend these shortcomings by being simple, addressing the narrative of use, and making useful information findable.
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