Human beings don't always make rational decisions, physicians included.
Time and again, people base decisions on psychological, social, cognitive and emotional factors instead of rational thinking. People tend to participate in organ donation when it's the default option as opposed to something they must sign up for. They are more likely to pay their taxes on time if they’re told how many of their neighbors pay theirs on time. They also tend to engage in preventive health measures, like wearing sunscreen, if the focus is on the benefits of doing so rather than the harm of opting out.
The emerging field of behavioral economics indicates that cultural and social context is important in influencing behavior change. For Sameer Badlani, MD, vice president and chief health information officer for Sutter Health in Sacramento, Calif., behavioral economics may be the key to leading sustainable process improvement among hospital clinicians and employees.
He made the case for applying behavioral economics to the intersection of clinical leadership and health IT during a keynote presentation May 11 at Becker's Hospital Review Health IT + Clinical Leadership 2018 in Chicago. During the presentation, Dr. Badlani shared three stories to illustrate how and why hospital leaders should take sociological factors like culture and mindset into account when designing for long-term process improvement.
Story No. 1: The clicker dilemma
Wireless presentation remotes are inexpensive, popular teaching tools on high school and college campuses nationwide. Yet Dr. Badlani attended a recent health IT conference where a series of high-level engineering and computer science experts forwarded through PowerPoint presentations by waving their hands at an intern offstage to manually click to the next slide.
The manual workaround was not for lack resources, but rather a simple oversight. After fielding recommendations from amused audience members, the conference organizers bought wireless clickers for the next day's speakers. The result: Presenters waved their hands at the offstage intern, who, wireless remote in hand, pointed at his laptop to change slides.
Technology is only as valuable as its effect on an organization's workflow. The clicker anecdote illustrates the problem of adding technology to employees' workflows without considering how employees can use it to achieve the best results and return on investment.
"That is what we do all day long in healthcare," Dr. Badlani said. "How many dollars do we spend [on technology] without knowing the end result?"
Story No. 2: An expensive solution to poor hand-washing rates
Provider handwashing isn't a given in hospitals. Less than half of nurses and other caregivers consistently wash their hands before interacting with patients despite decades of studies affirming the positive benefits to hygiene and infection control.
Some hospitals have opted for a high-tech approach to improve handwashing compliance through radio frequency identification networks and other "monitoring" technology. Motion sensors affixed to rounding clinicians track their hand-washing practices by clinicians' proximity to handwashing stations as well as how long they spend in front of the sink and the motion of their bodies.
RFID systems are expensive and difficult to implement. Hospitals invest serious time, money and manpower in getting this technology up and running, and yet recent studies show these systems have limited impact on clinician behavior, Dr. Badlani said.
"What they found was people would go up to the sink area and spend so much time and move their bodies to mimic hand-washing, but not actually wash their hands," Dr. Badlani said. "It's like when patients [with exercise treatment plans] put their Fitbit on their dog."
Process improvement programs that center on technology rather than people often fall short of delivering anticipated results. Technology alone cannot change behavior if it does not address the underlying sociological factors shaping culture, mindset and action. Meaningful process improvement must start with people, Dr. Badlani said.
Story No. 3: Eurobowl
The men's urinals in Amsterdam's airport occupy an important place in the history and academic literature on behavioral economics. Smaller urinals installed at Schiphol airport in the mid-2000s led to increased "human spillage" on the restroom floors. To address the "sprinkling" problem, designers etched images of house flies in the porcelain near the urinal drains in an experiment on human behavior change.
Appealing to mankind's deep-seated instinct to aim worked. After the flies were added, "spillage" on the bathroom floor fell 80 percent.
As a foil to the previous hand-washing story, Amsterdam's experiment illustrates the powerful effect low-tech approaches to behavior change can have when people consider the social and cultural factors that drive human action.
"If you want to drive behavior change, the first thing to do is focus on and understand your local culture," Dr. Badlani said. "Most of healthcare's problems today are not technology problems but social and behavioral problems. I urge all of you to go to your slush fund and use it to study and understand the culture and mindset at your organization, so you can understand how to change it."