Overview, Learning Objectives, Reading Assignments, and Resources

Module 9: Choice Architecture and Overuse Reduction

This module helps participants understand how concepts from the field of behavioral economics can be applied to their overuse reduction initiative.



Human behavior is the final common pathway to all health care interventions. Without action by patients, clinicians, and others, no interventions can impact care, regardless of how potentially impactful. As such, reducing overuse requires foundational understanding of concepts from behavioral science that help explain how patients and clinicians make decisions. This understanding can help guide a value champion’s work by helping them (a) design an intervention, (b) anticipate potential resistance or challenges to that intervention, and (c) increase the likelihood that the intervention leads to behavior change.

Learning Objectives

  1. Define the concepts of “choice architecture”, “intervention ladder”, and behavioral economics “nudges”.
  2. Describe the implications of these concepts for designing interventions to reduce overuse.
  3. List three potential objections that clinicians may have to behaviorally-designed nudge interventions, and three corresponding solutions.


Reading Assignments

Choice Architecture

In this paper, the authors describe the concept of “choice architecture,” the role of the choice architect, and show how choice architecture can be used to help nudge people to make better choices.

  • Citation: Thaler RH, Sunstein CR, Balz JP. Choice Architecture. 2010. Available at SSRN: https://ssrn.com/abstract=1583509

Using Nudges to Improve Value by Increasing Imaging-Based Cancer Screening

Patel and colleagues provide a deeper understanding of the concept of “nudges” within health care delivery and provide specific examples of their use from published research on cancer screening activities.

  • Citation: Patel MS, Navathe AS, Liao JM. Using Nudges to Improve Value by Increasing Imaging-Based Cancer Screening. J Am Coll Radiol. 2020; 17(1 Pt A):38-41. doi: 10.1016/j.jacr.2019.08.025. 

How to Overcome Clinicians’ Resistance to Nudges

Access to this article is free but requires registration with Harvard Business Review which limits free access to three articles each month.

This article uses examples from health care to illustrate the challenges of implementing nudges to drive behavior change among professional employees like physicians and offers principles that can be applied to overcome them.

  • Citation: Navathe AS, Lee VS, Liao JM. How to Overcome Clinicians’ Resistance to Nudges. Harvard Business Review. https://hbr.org/2019/05/how-to-overcome-clinicians-resistance-to-nudges



Using Intervention Ladders to Design Behavioral Economic Interventions

This is a 30-minute webinar presented by the author of this Learning Module, Josh Liao, MD. He describes a basic concept in behavioral economics that informs what interventions you might use to influence the behaviors of clinicians when de-adopting a low-value care service, the “intervention ladder.”

  • Citation: Liao, Joshua . “Using Intervention Ladders to Design Behavioral Economic Interventions.” 2019. https://vimeo.com/548632601


This website is worth exploring for additional guides, tools, resources and definitions of common terminology used in the field of behavioral economics.



Last modified: Tuesday, 18 May 2021, 4:01 PM