Abstract
Each year, tens of millions of antibiotic prescriptions in the United States are likely not warranted; they are ordered for indications (e.g., viral infections) that do not respond to these medications. Strategies to improve antibiotic stewardship are greatly needed. In a recent study, two behavioral interventions – accountable justifications and peer comparisons – successfully achieved that objective. Both strategies are based upon behavioral economics, an interdisciplinary field that utilizes insights from economics, marketing, and psychology to enhance individual decision-making. These two interventions are presented along with their potential mechanisms of action. In addition, this chapter highlights specific design considerations when implementing accountable justifications and/or peer comparisons to improve clinical practice. The timing, phrasing, and acceptability of accountable justifications are discussed. Benchmarks, frequency of feedback, modality of feedback, audience for feedback, target behaviors, and target clinicians for peer comparisons are discussed. This chapter concludes by acknowledging the empirical limitations of these promising strategies and by encouraging further evaluation of these behavioral economic interventions with regard to driving improvements in patient safety and quality improvement.
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Abbreviations
- EMR:
-
Electronic medical record
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Chapter Review Questions
Chapter Review Questions
- 1.
Describe accountable justifications and peer comparisons.
Answer: Accountable justifications feature asking healthcare providers to document a rationale for making questionable clinical decisions. Peer comparisons feature giving a target clinician periodic feedback regarding his/her performance relative to the behavior of similar healthcare providers.
- 2.
Discuss why each of these strategies might improve clinical practice.
Answer: Accountable justifications may work because they make inappropriate behavior more difficult, attract attention to desired behavior, use social influences, and/or provide timely reminders. Peer comparisons may work because they demonstrate that target behavior is acceptable and feasible. Additionally, peer comparisons may work because people want to compare favorably relative to others.
- 3.
What are three important design considerations for accountable justifications?
Answer: Timing, phrasing/content, and acceptability.
- 4.
What are some important design considerations for peer comparisons?
Answer: Benchmarks, signaling approval for high achievers, frequency of feedback, modality of feedback, audience for feedback, target behaviors, target clinicians, and target unit (individual clinicians versus teams).
- 5.
From an empirical perspective, describe the limitations of the two behavioral economic strategies discussed in this chapter.
Answer: Accountable justifications have little empirical data. Peer comparisons have often not been successful in other studies. Both interventions should be evaluated relative to other behavioral economic strategies.
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Stevens, J. (2021). Accountable Justifications and Peer Comparisons as Behavioral Economic Nudges to Improve Clinical Practice. In: Shah, R.K., Godambe, S.A. (eds) Patient Safety and Quality Improvement in Healthcare. Springer, Cham. https://doi.org/10.1007/978-3-030-55829-1_15
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