Nudge: finding clues and using cues to shift clinician behaviour

This is the second of two essays that describe the use of “nudging” in clinical practice environments. Nudging predictably and promptly guides decision-makers towards a preferred option, without removing the right to choose otherwise. A nudge design is useful in contexts where entrenched behaviours and circumstantial stresses, such as time pressures and resource shortages, create barriers to the application of new knowledge and research findings. Nudge designs predict and address these barriers. Default nudges, offering pre-set or guided choices, are commonly built into computerized decision-making tools and prescribing menus, offering the intrinsic gains of being time efficient, evidence based, and clinically authorized. Defaults suit a range of medical environments; they can be applied at scale, and they can be made more effective in particular communities of practice with the implementation of supplementary workflow and sociocultural nudges. Stocking a default medication in an emergency department dispensing machine, for example, prompts and strengthens reliance on the prescribing menu default. Delivering feedback to clinicians comparing their prescribing or disease-screening behaviours to their peers is a status quo nudge that endorses and reinforces decision support tool defaults. In appropriate clinical contexts, nudging offers implementation scientists wide-ranging prospects for accelerating shifts to evidence-based performance.