How to Overcome Clinicians’ Resistance to Nudges

Managerial nudges aren’t always perceived as helpful. Regardless of intentions, they can feel patronizing or subtly manipulative. This is a particularly relevant problem for medical professionals because three important traits they possess — a strong sense of purpose, a desire for autonomy and a commitment to mastery — can be barriers to accepting nudges.

Health care organizations have begun using nudges to improve physicians’ clinical decisions. For example, nudges have recently been used to decrease inappropriate antibiotic prescriptions , reduce opioid prescriptions in the emergency room setting and improve influenza vaccinate rates . However, in our experience implementing change across different institutions, many managers have shared reservations about nudges as things being done to physicians rather than done with them — i.e., a hidden noodge (as in to harass) rather than a transparent nudge.

How can managers overcome such perceptions of manipulation? Drawing on our collective insight from clinical practice, health system leadership and behavioral economics research, we offer three principles that can guide a more effective use of nudges:

TRANSPARENCY OF PURPOSE: One misconception about behavioral economics strategies is that they must be hidden to be effective. In fact, transparent nudge interventions can work just as well as hidden ones. In health care, such transparency means that managers must communicate that the purpose of the nudges is in sync with the physicians’ sense of purpose and their roles as patient advocates, practitioners of evidence-based medicine and stewards of societal resources. Managers can acknowledge that nudges are needed not to trump professional purpose or medical evidence but exactly because unwarranted variation in care remains despite these things.

CO-CREATION OF CONTENT: Another misconception about nudges is that they must be passively received to change behavior. In reality, co-creating nudges with recipients may be more effective because the process of doing so itself can be helpful in reinforcing mastery of skill, sense of purpose and autonomy. It also helps prioritize solutions, avoid missteps and identify situations where additional input is required. For example, hospitals and physicians have worked with information technology experts to create software that nudges clinicians toward ordering imaging scans only when they’re really needed. The process helped harness internal expertise while reducing the risk of erroneous orders, informing clinicians about the financial implications of their decisions and reducing waiting time for some patients.

CONSTRUCTIVE FRAMING: Early efforts to implement nudges in healthcare have focused on helping physicians avoid mistakes (e.g., inappropriate antibiotic or opioid prescribing). While this is a starting point, nudges that champion professional ideals may be even more effective. Some healthcare organizations have used the behavioral-economics principle of social comparisons to nudge physicians through the use of “dashboards” that provide them with feedback about their performance compared with that of their colleagues. A health insurer in Hawaii, for example, is using a performance dashboard that it designed together with primary care practices to nudge primary care clinicians to reduce cost while improving quality metrics like better blood glucose control for patients with diabetes.

Nudges can be effective management tools for guiding behavior among skilled employees. The trick is to ensure that professionals see them as something positive — and not pesky or manipulative.

Copyright 2019 Harvard Business School Publishing Corp. Distributed by The New York Times Syndicate.