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Abstract
BackgroundHealthcare organisations are in constant need of improvement and change. Nudging has been proposed as a strategy to affect people’s choices and has been used to affect patients’ behaviour in healthcare settings. However, little is known about how nudging is being interpreted and applied to change the behaviour of healthcare professionals (HCPs). The objective of this review is to identify interventions using nudge theory to affect the behaviour of HCPs in clinical settings.MethodsA scoping review. We searched PubMed and PsycINFO for articles published from 2010 to September 2019, including terms related to “nudging” in the title or abstract. Two reviewers screened articles for inclusion based on whether the articles described an intervention to change the behaviour of HCPs. Two reviewers extracted key information and categorized included articles. Descriptive analyses were performed on the data.ResultsSearch results yielded 997 unique articles, of which 25 articles satisfied the inclusion criteria. Five additional articles were selected from the reference lists of the included articles. We identified 11 nudging strategies: accountable justification, goal setting, suggested alternatives, feedback, information transparency, peer comparison, active choice, alerts and reminders, environmental cueing/priming, defaults/pre-orders, and education. These strategies were employed to affect the following 4 target behaviours: vaccination of staff, hand hygiene, clinical procedures, prescriptions and orders. To compare approaches across so many areas, we introduced two independent dimensions to describe nudging strategies: synchronous/asynchronous, and active/passive.ConclusionThere are relatively few studies published referring to nudge theory aimed at changing HCP behaviour in clinical settings. These studies reflect a diverse set of objectives and implement nudging strategies in a variety of ways. We suggest distinguishing active from passive nudging strategies. Passive nudging strategies may achieve the desired outcome but go unnoticed by the clinician thereby not really changing a behaviour and raising ethical concerns. Our review indicates that there are successful active strategies that engage with clinicians in a more deliberate way. However, more research is needed on how different nudging strategies impact HCP behaviour in the short and long term to improve clinical decision making.
Highlights
Healthcare organisations are in constant need of improvement and change
We find that the synchronous/asynchronous and active/passive dimensions provide a practical way for non-experts to reason about nudging interventions and how they may be implemented in a clinical setting
The purpose of this scoping review was to identify how nudging, as described by Thaler and Sunstein, is influencing the design of interventions to affect Healthcare professional (HCP) in clinical settings. This is one of the first reviews to consider nudging as a general strategy to affect the behaviour of healthcare professionals, not limited to particular application areas nor a specific type of intervention
Summary
Healthcare organisations are in constant need of improvement and change. Nudging has been proposed as a strategy to affect people’s choices and has been used to affect patients’ behaviour in healthcare settings. Over the last two decades, behavioural economics has gained momentum among scholars because of its innovative and controversial ways of explaining processes and mechanisms underpinning individuals’ judgements and decision making It was with their seminal book entitled Nudge: Improving decisions about health, wealth, and happiness in 2008 that the behavioural economists Richard Thaler and Cass Sunstein [1] coined the concept of nudging, which they define as: “any aspect of the choice architecture that alters people’s behaviour in a predictable way without forbidding any options or significantly changing their economic incentives.”. Nudging quickly gained ground in several countries as a new and better method to change people’s behaviour in order to improve their health and well-being [2] Both private and public institutions showed interest in the use of nudges because they generally cost little and have the potential to promote economic and societal goals, such as public health [3]. The promise of these nudge units is to use the findings of behavioural and social sciences to improve the effectiveness of government policies for modest costs and with little effort [9]
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