Rationale for this Module
In our fellowship program, the fellows found the insights and understandings provided by Josh Liao, the author of this module, very helpful in understanding why specific approaches to changing behaviors that lead to a reduction in use of a service might be effective, or even more important why they failed. For example, one principle in behavioral economics is that as humans, it is much harder for us to relinquish something is nothing is offered in return. As a result, several of our fellows thought through what might be offered as a replacement service as part of their intervention design. It is important to prepare future Value Champions for understanding why certain intervention designs they choose, or combinations of interventions do or do not work, so that they can make a more informed decision about what to tweak or how to redesign their approach.
As with other modules, perhaps the most important preparation is to read the assignments and make notes of where in the assignments you find passages that are most relevant to the discussion questions. In addition, it is highly recommended that you watch the 30-minute video by Dr. Liao included in the Resources section for this Learning Module. To prepare for the small group exercise, make sure each group has a copy of their scenario, and the discussion questions that follow. During the debrief, a few suggested questions are provided for you to ask after the group reconvenes.
Suggested Agenda for this session:
- Welcome & Introductions (5 minutes)
- Large group: introduction to the module + discussion of readings (25 minutes)
- Overview of rationale for the module (5 minutes)
- Discussion of required readings (20 minutes)
- Small group: break out exercise (15 minutes)
- Reconvene & Debrief (10 minutes
Small Group Exercise
In groups of 3, have the clinical value champions role play one of the following scenarios:
- The leadership in your clinic has asked you, as a clinical value champion, to lead an initiative that would discourage your clinician colleagues from routine prescribing of antibiotics for uncomplicated, likely viral acute upper respiration infections
- The leadership of a hospital medicine division has asked you to serve as a value champion for a project that seeks to reduce “routine” daily labs ordered by clinicians as part of the care on hospitalized patients
- A surgery service line chief has asked you to develop and implement a program that would reduce the use of IV acetaminophen for post-operative pain
- Questions for discussion in each small group:
- In your scenario, what are key features of the choice architecture surrounding a clinician’s decision-making process?
- As a value champion, how might behavioral economics nudges be used as interventions to achieve the decision-maker’s goal(s)?
- If you believe a nudge could be used, how can an intervention ladder framework inform the selection and design of the nudge?
- What major resistance or barriers can the decision-maker anticipate in designing this type of intervention? How can the decision-maker design the intervention in a way that helps overcome or avert that resistance?
Reconvene & Debrief (10 minutes)
- What behavioral economic concepts might be most applicable to your overuse project?
- How might an understanding of these concepts/principles help you if and when a strategy you use to reduce overuse does not seem to be working?