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How to nudge your clinicians toward better behavior

December 4, 2017

    In early October, economist Richard H. Thaler was awarded the Nobel Memorial Prize for Science in Economics for his work in behavioral economics. Specifically, Thaler found that humans don't make decisions as rationally as was previously thought.

    Thaler claims that as humans, we are actually consistently irrational beings who are impulsive, have strong personal preferences, and are heavily guided by emotional considerations when faced with decisions. The good news is that, although this makes human behavior less predictable, Thaler's work proves that we can predict our own unpredictability and present decisions in a way that "nudges" people toward a certain choice while still retaining their autonomy.

    Design the environment to alter behavior

    We're surrounded by nudges in our daily life. Some of them are subtle—putting the $150 dollar wine bottle at the top of the menu to make the $70 dollar bottle seem far more reasonable. Others are less discrete, such as the text alert from your bank every time you swipe your credit card for another morning coffee. Whether driving us to spend money on wine or encouraging us to save money on coffee, these nudges work because they are designed to fit seamlessly into our daily routines, not to fight against them.

    Health care isn't far behind our out-of-industry peers. In fact, from posting calories on menus to putting vending machines out of sight (and out of mind) behavioral economics can be a powerful tool to inflect health behavior. Even insurers have caught the bug, using nudges to lead consumers to pick the right plan for them.

    So, what about inside the hospital? How can we leverage the power of the nudge to help our clinicians navigate the countless decisions they encounter day in and day out? It all starts with understanding where they're most likely to go off track.

    Nudging clinicians toward better decisions

    Rolling out a new care standard usually requires clinicians to change their daily behavior in a significant way. And, as hospital leaders, you've all come face-to-face with the change fatigue that plagues most practicing clinicians, which making it increasingly difficult to implement and sustain new initiatives.

    One of the best ways to mitigate change fatigue comes to us from Texas Health Resources. Before they roll out any new standard, they use a process map to systematically anticipate critical points where clinicians are most like to "fail". They then create enablers—people, processes, or technologies—to nudge them in the right direction at each of those points. Enablers can include additional questions within an EHR order set, a sign in the break room to remind clinicians of a new protocol, or requiring sign off by a specific party. By intentionally positioning enablers at pivotal points in a new workflow, Texas Health Resources makes is easier (and more realistic) for their clinical staff to change their daily practice.


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