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How a surgeon made breast cancer treatment patient-friendly

If you have been through breast cancer or have accompanied someone’s struggle you may like this story. As all stories on this blog, this story has something to do with behaviour, in this case its about patient behaviour, organizational behaviour change, breast cancer treatment and the change brought about by a surgeon – Laura Esserman.

Let’s first start with the typical process of breast care diagnosis and treatment. The woman first notices a lump on her breast. Anxiously she calls a doctor and meets him/her after a few days by taking an appointment. The doctor confirms that the lump should be examined, so the patient is referred to a radiologist to get a mammogram. Getting the results takes few more agonizing days. The mammogram shows something suspicious, so she is referred to a surgeon who she meets after a few more days spent anxiously. The surgeon verifies that the lump is present, gets a biopsy done at a pathology lab to determine whether the lump contains cancerous cells. Meanwhile the woman is waiting for an answer. If cancer is detected, depending upon the stage, she undergoes treatment, which may involve radiation, chemotherapy and surgery, in whatever order recommended by the surgeon. Different departments of a hospital conduct radiation and chemotherapy typically with different booking procedures and delays. The sequence takes weeks and weeks to unfold, while the woman is wondering, “Am I going to live through this?”

This anxiety-filled process appalled surgeon Laura Esserman. She had a vision of a Breast Care Center where a woman could walk in at the beginning of the day and walk out at the end with an answer. But as an associate professor at University of California at San Francisco (UCSF) at that time she had few resources at her disposal. Plus, radiation oncologists reported to medical oncology, surgeons to School of Medicine, nurses to medical center, psychologists to someone else. So you can imagine the organizational challenge to bring them together. Even if she could start a breast care clinic, she would never be able to hire such talent at such salaries.

Like all big changes, Esserman started small. She set up the Breast Care Center for only four hours one day per week. She would see the patients in the morning, send them off for a break and ask them to come back at 1pm. During that time, she would go to radiology, look through all the images with the radiologist and decide the next steps. In the second year, she expanded to two days per week and soon enough the snowball began. Eventually the Breast Care Center got an entire floor. The number of patients skyrocketed and the Center became a major source of revenue for UCSF. Today when the patient walks into the Breast Care Center, Esserman can look at her films, do a biopsy, and consult a gynecologist, psychologist, and genetic counselor in the same place. “For the first time,” said Esserman, “we put the woman at the center.”

Source: Victoria Chang and Jeffrey Pfeffer 2003, Laura Esserman, Stanford Graduate School of Business Case Study OB-42A and Chip Heath’s interview of Laura Esserman in May 2009.

Behavioural solutions for road safety

This editorial article first appeared in Mint on 21st March, 2017

Making roads better should reduce the number of accidents. Yet that’s exactly the opposite of what’s happening in India. Despite measures being taken by the government on improving roads, there has been a continuous increase in road crash deaths since 2007, with a brief annual reduction in 2012. Between 2010 and 2015, incidence of road accidental deaths increased by an annual average rate of 1.2%. There were over 500,000 road accidents in 2015, up from 489,000 in 2014. More than 500,000 people were injured in road accidents in 2015, up from 493,000 in 2014. A total of 146,000 people died in road accidents in 2015, up from 139,000 in 2014. According to the National Crime Records Bureau, out of 146,000 deaths, only 0.8% of the cases were due to lack of road infrastructure.

Road safety is not just about creating infrastructure. It is about designing behavioural solutions that take human biases and irrational behaviour into consideration. When the roads are smooth, wide and empty, drivers are likely to speed. If the car being driven is big and tough, the driver feels much safer compared to driving say, a small hatchback. That makes drivers over-compensate and take undue risks. Regular speed limit signs are ineffective at getting drivers to slow down, because drivers don’t choose the speed based on speed limit signs. Rather, drivers simply go with the flow depending upon the width and smoothness of the road and traffic conditions.

To get drivers to reduce speeding, there have been several effective behavioural design nudges implemented around the world. At the curve of Chicago’s Lake Shore Drive and Oak Street, a series of horizontal white stripes have been painted on the road, that get progressively narrower as drivers approach the sharpest point of the curve, giving them the illusion of speeding up, and nudging them to tap their brakes.

According to an analysis conducted by the city’s traffic engineers, there were 36% fewer crashes in the six months after the lines were painted compared to the same six-month period the year before. Similar behavioural design nudges are now being applied in China and Israel to curb speeding.

In another trial in the UK conducted by Norfolk County Council, more than 200 trees were planted on the approach roads in north Norfolk which had a history of speeding problems. Results found that drivers reduced their speed by an average of 2 miles per hour. Again, as the car approached the village, the trees, planted closer and closer together, gave the impression that the vehicle was moving faster. This encouraged the motorists to slow down.

In another experiment in the US, the Virginia department of transportation painted zigzag white markings instead of the familiar straight dashed lines, to caution drivers approaching the road-crossing intersection used by pedestrians and bicyclists. They found that zigzag markings slowed average vehicle speeds and increased motorists’ awareness of pedestrians and cyclists. They also noted that the effects of the behavioural design didn’t wear off once motorists became used to it—they still slowed down a year after installation.

Building infrastructure like traffic signals doesn’t mean people will always follow them. But creating behavioural design nudges like displaying the seconds remaining for the traffic signal to turn green, is likely to reduce the number of people who break the signal. Such behavioural design takes into account that people are usually in a rush.

Rationally speaking, people shouldn’t be breaking signals because they wouldn’t be acting in their self-interest by putting themselves in harm’s way. But human behaviour is not rational. Drivers honk even when there is no way that honking could clear a traffic jam. Even when the signal is still red, there are drivers who honk. Therefore, rational ways of changing behaviour like educating people or creating awareness-based campaigns are ineffective. What’s effective at getting people to reduce honking is “bleep”—a red button on the dashboard of a car that beeps and flashes when the driver presses the horn. To switch off the red button, the driver has to press it. This behavioural design nudge breaks the habit of drivers’ honking because now each time drivers want to honk, “bleep” makes them deliberate whether they should honk or not. Bleep has been shown to reduce drivers honking by 61% in a six-month and 3,800km-long experiment in Mumbai.

Behavioural design needs to be applied at pedestrian crossings at traffic-signal junctions. At various traffic junctions, there are two signals in view—one signal placed just after the zebra crossing and the second signal on the other side of the junction once you’ve crossed it. That makes drivers keep inching forward, not stopping at the zebra crossing and thus not allowing pedestrians to cross. So to get cars to stop at the zebra crossing, only one traffic signal needs to be placed just before the zebra-crossing stripes begin, so that drivers have no option but to stop to get a view of the one and only traffic signal.

It’s time authorities stopped relying on ineffective money-draining campaigns, driver education and enforcement of laws. Instead, we should test simple, practical, scientific behavioural design nudges to improve road safety.

Moving towards Swachh Bharat (Mint)

This article written by us appeared in the editorial section of Mint on 30th September 2016

A couple of weeks back, a video made by a private organization promoting the Swachh Bharat Abhiyan, featuring Kangana Ranaut and other Bollywood actors, went viral. The video depicted the picture of goddess Lakshmi disappearing from photo frames when people indulged in littering. The narrator on the video was Amitabh Bachchan, who said that the goddess of wealth lives only where there’s cleanliness. It ended with a plea by Bachchan and Ranaut to keep the country clean by not littering. Though the government didn’t issue this particular video, it has issued other, similar ad campaigns in public interest that promote the use of a public toilet instead of open defecation.

It is largely believed that ad campaigns change public behaviour by creating a change in people’s mindsets, which in turn leads people to take the desired action. But changing behaviour is not so easy. There are too many assumptions for this model of awareness leading to action.

The first assumption is that people can recall the message all the time. The second assumption is that the message is successful in motivating people to such an extent that it prompts them to act. The third assumption is that at the moment of actual behaviour, people would have the right amount of motivation, and also the ability to act in the desired way. That is a tough ask.

This is not the first time that the government has used ad campaigns to try and change public behaviour. In the recent past, campaigns like Save Fuel, Save Money have been aimed at changing driver behaviour by asking them to switch off car engines at traffic junctions to save fuel. Do you remember the campaign? If you don’t, crores of rupees in the form of advertising have been wasted. But let’s assume you are one of the few who do recall this message. Has it changed your behaviour? Do you now switch off your car’s engine at traffic signals?

Most people don’t. It’s a lot of effort. You need to turn the ignition off every time you wait at a traffic signal. And when the signal turns green, you have to turn the ignition on, listen to frantic honking because you haven’t moved immediately, change the gear from neutral to first if you are driving a manual-gear car, get frantically honked at again, put the hand-brake down, and finally get moving. Even for people who are highly cost-conscious or environmentally conscious, it’s too much effort.

That’s why campaigns are a money-draining and time-consuming way of attempting to change behaviour. In the UK, for example, in the 1970s and 1980s, the government spent millions on TV, radio and billboard ads educating people to wear seat belts. Researchers F.M. Streff and E.S. Geller estimated that by the end of the 1980s, 80-90% of British people had seen these ads eight-nine times each.

One would assume that showing people being launched head-first through their windscreens would make people respond. But it turned out that most people weren’t wearing seat belts. It was when the law changed in 1983, along with strict policing, that most people started wearing them.

Behavioural science suggests that a lot of the messaging on educating people to change behaviour seems powerful and emotional in the spur of the moment, but eventually doesn’t change behaviour because mere awareness rarely leads to action.

Changing behaviour is tough. People don’t always behave in the desired way. People should be exercising regularly, but many don’t. People shouldn’t be overeating, yet many do. The traditional way to change behaviour is to make people aware of the pros and cons of a particular act. But this method is ineffective, because most behaviour is instinctive i.e. subconscious. We aren’t always aware of the reasons for our actions. It takes a lot of time, effort and money to make someone aware of their behaviour, convince them that change is necessary and motivate them to change.

Behavioural science, on the other hand, uses subtle on-time nudges to enable the desired action. It focuses more on the ability to perform the desired action in the last mile than on motivating people. These nudges are based on a combination of behavioural economics, cognitive neuroscience and psychology. The nudges are designed to automate the desired action and for it to take place right at the moment of action.

For example, to reduce honking, we conducted an experiment in which a red button called Bleep was fitted on to the dashboard of the car. When the driver pressed the horn, the red button would begin to beep and flash. In order to switch it off, the driver needed to press the button.

The button made the driver conscious of the habit of honking by giving him immediate feedback in order to reduce indiscriminate honking. In a six-month experiment, Bleep reduced honking by 61% on average.

Similarly, a nudge was used in Copenhagen, with green footprints painted on the ground, pointing the way to the nearest garbage bin, that reduced littering by 46% by painting.

Meanwhile, to keep India clean, we first need dustbins that are easily accessible and cannot be stolen. They could be designed to include that extra bit of motivation for use—for instance, by having two sections and a question such as: “Who’s your favourite actress: Kangana or Deepika?”.

If you want something to happen, write it down

Hopefully by now you are beginning to appreciate how a seemingly small design intervention can make a huge difference in behaviour change. Here’s one more story that illustrates this point.

British psychologistsPaschal Sheeran and Sheina Orbell conducted an experiment in two of Scotland’s busiest orthopaedic hospitals. The participants were elderly patients from low and middle class households, who had undergone hip or knee replacement surgeries.

Recovering from a hip or knee surgery is incredibly arduous. While recovering the smallest movements can be excruciating. But it is essential that patients begin exercising almost as soon as they wake from surgery, even before the muscles and skin have healed, or the tissues will clog the joint, destroying its flexibility. But exercising is so painful that many patients skip out on rehab sessions, especially the elderly ones.

So the patients were each given a booklet after their surgeries that detailed their rehab schedule, and in the back were thirteen additional pages – one for each week – with instructions: My goals for this week are _________________? Write down exactly what you are going to do. For example, if you are going to walk this week, write down where and when you are going to walk.

Three months passed. The patients who had written exact plans in their booklets had started walking twice as fast as the ones who had not, as well as, getting in and out of their chairs, putting on their shoes, doing laundry, all of it much faster, than the ones who had not written anything in the booklet. Why did that happen?

The psychologists examined the booklets of those who had filled it and found it filled with specific detailed plans about the most mundane aspects of recovery. Like one patient wrote that he would walk to the bus stop on a particular day to meet his wife coming back from work at 3:30pm and the time he would leave, the route he would walk, what he would wear and which pills he would take if the pain became too much. Someone else who would exercise each time she would go to the bathroom, wrote that she would automatically take the first step right away after standing up from the couch, so that she wouldn’t be tempted to sit down again.

All focused on how they would handle a specific moment of anticipated pain. They built plans around inflection points when they knew their pain – and their temptation to quit – would be strongest.

Patients who didn’t write out any plans were at a significant disadvantage, because they never thought ahead about how to deal with pain. They didn’t deliberately design their habits. So their resolve abandoned them when they confronted the first few steps.

So if you want something to happen, write all the steps down.

Source: Paschal Sheeran and Sheina Orbell – Implementation intentions and repeated behaviour: augmenting the predictive validity of the theory of planned behaviour – European Journal of Social Psychology Volume 29, Issue 2-3, pages 349–369, March – May 1999

Behavioural Design on comedy show Cyrus Says

Human behaviour is funny. That’s why popular comedian Cyrus Broacha invited us to understand what Behavioural Design is all about.

We spoke about why Indian men stare at cleavages, touch inappropriately, spit in public, why we honk indiscriminately, don’t allow pedestrians to cross in India, why we behave irrationally in general and what can be done about it. We spoke about how men look at women’s bodies and how women look at men’s bodies, how to reduce smoking, how to avoid over-eating, why its time for the Indian Government to begin applying behavioural science like the US and UK governments are applying. We spoke about behavioural science principles like social proof and overconfidence and our projects Bleep and People Power. Download Saavn to hear the non-sense – http://www.saavn.com/s/show/Cyrus-Says/2/2mYLF,EZgkk_

Organisations have bad habits too (and they can be changed)

“Individuals have habits; groups have routines. Routines are the organizational analogue of habits”, wrote Geoffrey Hodgson, who spent a career examining organizational patterns. And as we know habits can be good or bad. Not just that, they can be dangerous, because while performing routines, employees yield decision-making to a process that occurs without actually thinking, automatically – habit.

Paul O’Neill who is known to have turned around the fortunes of a company called Alcoa – Aluminum Company of America understood this really well. Alcoa was going through troubled times when it hired Paul O’Neill as CEO. Investors, executives and workers were unhappy. Quality was suffering. And competitors were stealing customers and profits.

O’Neill believed that some habits have the power to start a chain reaction, changing other habits as they move through an organization. These are keystone habits. The habits that matter the most. These are the ones that, when they start to shift, dislodge and remake other patterns.

So O’Neill figured he needed a focus that everybody – unions and executives – could agree as being important, so that he could bring people together. He said, “So I thought everyone deserves to leave work as safely as they arrive, right? You shouldn’t be scared that feeding your family is going to kill you. That’s why I decided to focus on: changing everyone’s safety habits.” So he made SAFETY his top priority and set an audacious goal for a manufacturing company of that size: zero injuries.

The approach was brilliant because unions had been fighting for safety rules for years. And managers were happy since injuries meant low productivity and low morale. What most people didn’t realize was that O’Neill’s plan for getting zero injuries entailed the most radical realignment in Alcoa’s history.

According to O’Neill’s safety plan, any time someone was injured, the unit president had to report it to him within 24 hours and present a plan for making sure the injury never happened again. The reward: people who got promoted, were those who embraced and cracked this system.

If unit presidents had to contact O’Neill within 24 hours with a plan, they needed to hear about the accident from their vice presidents as soon as it happened. So vice presidents had to be in constant communication with floor managers, who in turn needed to get workers to raise warnings as soon as they saw the problem. Meanwhile in those 24 hours everyone in the chain had to generate a list of suggestions for their immediate superior, so that there was an idea box full of possibilities for the unit president to choose from. This changed the company’s rigid hierarchy as communication had to make it easy for the lowliest worker to get an idea to the loftiest executive, as fast as possible.

As Alcoa’s safety patterns shifted, productivity skyrocketed, quality improved, costs came down and autonomy improved. If molten metal was injuring workers when it splashed, then the pouring system was redesigned, which led to fewer injuries. It also saved money because Alcoa lost less raw materials in spills. If a machine kept breaking down, it was replaced, which meant there was less risk of broken gear snagging an employees arm. It also meant higher quality products because, as Alcoa discovered, equipment malfunctions were a chief cause of subpar aluminum.

By the time O’Neill retired after 13 years, Alcoa’s annual income was five times larger than before he arrived. Its market capitalization had risen by $27 billion. Alcoa became one of the safest companies in the world – the keystone habit that changed it all.

Source: The Power of Habit by Charles Duhigg

A new way of boarding that saves time and lowers blood pressure

Warning: This post is the longest we’ve ever written, but we think you are likely to find it rewarding.

There are long queues at boarding no matter which airline you travel by. And once inside the plane, we’re often waiting in line once again for someone in front us whose is trying to keep his/her cabin luggage overhead. Imagine the time that gets wasted for you and the airline. In this industry, more than any, time is money. The quicker the airline can board, the more it will be on-time, the more satisfied will be its customers, the more money it can make. But how can this be made possible?

Southwest Airlines in the US has a unique solution to this problem. Southwest doesn’t have seat assignments. Here’s how it works:

In airlines that assign seat numbers, when you’re trying to get to your seat, you’re not only waiting for someone to find their seat, you’re also waiting for them to put their bag in the overhead bin. So if you’re assigned to say, Seat 26A, you must wait until Seat 22C puts his/her bag in the overhead compartment.

But if you’re on Southwest Airlines, the procedure and behaviour of passengers is completely different.

So let’s say you’re flying on Southwest with a carry-on bag. You’re anxious about getting a window seat and making sure your bag gets in the compartment, so you check-in online 24 hours beforehand (the beginning of the check-in window), and are placed in boarding group A. Group A gets to board first.

Southwest keeps in mind that most people don’t care if they sit in row 10 or row 25, but they are likely to have a strong opinion about having a window or an aisle seat.

Fast forward to the airport. You arrive and get into the queue for group A, confident that there is a very good chance that you’ll get the seat you want and overhead space.

Now you’re walking onto the plane and suggested to move towards the further rows. The person in front of you has a bag and spots an aisle seat in row 25, and stops to put their bag in the bin. You’re a window person, and see one in row 21. The person behind you also wants a window, and stops at row 18. Notice what happened here: no one was held up because of the person in front of them. You all sit down, and the process repeats.

The boarding process becomes similar to a conventional boarding process as the seats fill up – if you’re in Group C (last to board) and say there’s only one window seat left and it’s at the very back of the plane, you have to wait 20 seconds for the person in front of you to claim their aisle seat at the front.

Compare this to a conventional boarding process: not only would you have had to wait for Seat 21C to put his bag in the compartment, Seats 21 A, B and D have to fight with their bags, and the other seats’ bags in order to fit their bags in. Multiply this by 30 rows, and you can see how this adds time to the boarding process.

What Southwest has done is eliminate that 20-to-30 second delay for 80% of passengers and instead limited it to, say, the 30% of passengers at the end of Group C. These passenger-to-seat delays add up quickly; and with roughly 130 seats each at 20 seconds each, that’s potentially 43 minutes of delays during seating! This, among other reasons, means that Southwest can turn around their planes in about 25 minutes, the fastest of any airline.

And not to forget, lower your BP. Travelers who are the most anxious about getting their preferred seat and their bag in the bin are more likely to check-in at the first second, earning them a coveted spot in Group A. But people in group B know there is, say, a 50% chance they’ll get a good seat and space in the overhead bin. Group C knows their chances are slim of getting either. The point here is that everyone has a rough idea of their probabilities and also that the probability is the direct result of their own actions, i.e., how quickly they checked in.

And the best thing I like about this way of boarding: I’ll never be seated in the wrong seat!

Big thanks to Michele Walk, Operations Manager at Engage for the information.

Bleep has been featured in TIME, BBCFast Company, BMW Guggenheim Lab, USA Today, The Strait TimesTimes of India (2), The Economic Times (2), Mint, CNBC Overdrive, Hindustan Times, NDTV, Top Gear, Radio One (2), Mumbai Boss, The Sunday GuardianDNA and TEDxGateway talk.

Indiscriminate honking is a bad habit and a huge irritant in India, parts of Asia and South America, or even by cab drivers in NY. If you are visiting us from a country where the habit of honking is a problem,  share this video on facebook, twitter, linkedin, pinterest and help spread the word.

A big thank you in advance for your support. To get us in touch with a Govt. or NGO representative of your country, write to us at work@brief-case.co

Every share counts. Every little helps.

Anand and Mayur

We are all horny

Honking is so embedded in Indian driving etiquette that Audi India has confirmed, in media, having designed extra loud, ultradurable horns for vehicles sold in India. Meanwhile people face a rapidly growing problem with many side effects of noise pollution. Some of them being increased hyper-tension, blood pressure, hearing loss, increased risk of heart attacks and disturbed sleep patterns. Reports in Indian cities show that noise levels are way beyond the permissible limits. Truly we are all horny.

Honking like other behaviour, over time, becomes a habit. And habits are essentially automatic behaviour where one does not consciously think about the action, but rather, the decision-making happens automatically. So we thought that it was important to shift the driver from an automatic mode of honking as a habit, to make him deliberate on whether the situation really demanded that he honk. We needed to make the driver conscious of the habit of honking by giving him immediate feedback while the driver was still driving the car, so that the next time the driver honked only when he thought it was necessary, rather than honk indiscriminately.

This approach led us to create a ‘Horn Reduction System’ we’ve called Bleep that has proved to reduce honking amongst each and every one of participants by an average of 61%.

Bleep – A horn reduction system

Bleep is a device with a simple red button fitted in an easily accessible place on the dashboard of a car. The red button has a frown sketched on it and when the driver presses the horn, the red button begins to beep and flash. In order to switch the device off, the driver needs to press the red button.

The 6-month long experiment

Bleep has been tested on manual and automatic geared cars amongst 30 people including men, women and chauffeurs of private vehicles, over 6 months and over 3800 kms. The participants were given either of two cars – manually geared Swift or automatic Honda City, with Bleep fitted, to be driven for 4 days during the working weekdays. Two days with Bleep off and the next two days with Bleep on, so that we could compare the number of honks per kilometer in the control situation (pre-Bleep) with the experimental situation (post-Bleep). Bleep has been tested as triggering off every time the horn is pressed, which is a stricter version in the manually geared Swift car, as well as triggering off every third time the horn is pressed, which is more lenient, in the automatic Honda City. In the first phase of the experiment the drivers were not given any information about the experiment. In the second phase they were simply shown how the system works.

The results

We have found a reduction in honking in each and every one of the participants wherein honks per km reduced between 19% to 96% (on an average by 62.5%) when Bleep was triggered every time the horn was pressed (stricter version). A reduction in honks per km was found between 16% to 91% (on an average by 60.3%) when Bleep was triggered every third time the horn was pressed (lenient version). These numbers prove that the reduction in honking relates to indiscriminate honking that drivers can do without.

The science of Bleep

The science behind the effectiveness of Bleep is that it assists the driver in reducing honking by using a visual-cum-sound reminder. The driver gets instant feedback when the red light with the frown beeps and flashes when he honks, making the driver conscious about his inappropriate behaviour of honking and making him deliberate about when he really required to honk. The driver having to physically switch off the reminder further helps in persuading him to honk lesser. The frown on the device is designed to indicate that honking is socially inappropriate behaviour. A study called ‘Overcoming Intuition’ done by Alter, Oppenheimer, Epley and Eyre has shown that frowning helps the brain reduce the reliance on intuition and activates analytical reasoning. Another research at the Stanford University School of Medicine has shown that peak brain activity (arresting attention) occurred during a short period of silence between musical movements, which is evidence that sounds that have a pause in between make you more alert. That’s why a seatbelt reminder like sound was used in the beep.

Bleep comes with many other unique features like recording, displaying and transmission of vehicle data like number of honks, speed at time of honk, location, time, etc., inside the vehicle or at a remote location and many other customised features. Patent pending.

Bleep has been featured in Fast Company, BMW Guggenheim LabTimes of India, CNBC OverdriveRadio One 94.3, Top Gear India’s June issue, Mint-WSJMumbai Boss, The Sunday Guardian and DNA till now.

Should playgrounds be made more child friendly?Dr. Sandster and her co-researcher Leif Kennair from Norwegian University of Science and Technology think that offering children opportunities for thrilling experiences through ‘risky play’ helps to ensure they grow up as normal, well-balanced adults. ‘Risky play’ provides kids with a safer situation to learn about dangers than real life. For example, playing at heights can provide kids with the motor skills and perceptual competencies to better navigate heights as they mature. Instead of short climbing walls, there should be towering monkey bars. Instead of plastic crawl tubes, there should be tall, steep slides. And balance beams. And rope swings.

They say the rationale is that the more we shield children from potential scrapes and sprained ankles, the more unprepared they’ll be for real risk as adults, and the less aware they’ll be of their surroundings.

Kids need places to work out their fears, they say, and challenging playgrounds can provide the perfect opportunity for such growth. They argue that modern society has an exaggerated focus on child safety, at the expense of kids’ needs to figure out their personal limits. (You can read the original article here.)

We’re all for children being exposed to a controlled degree of risk, not for the sake of being risky, but because its fun, challenging and makes them learn and grow. But at the same time we must ensure that our playgrounds don’t become risky because of being designed and maintained poorly.

Illustration by Mayur Teckchandaney

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