In 2016, the Penn Medicine Nudge Unit became the first behavioral design team embedded in a health care system. The unit’s founders had seen government agencies’ apparent success at applying behavioral science in the public policy realm, and they realized “that there’s no reason why we can’t be doing this in the health care system,” said the group’s current director Kit Delgado.
“Some of our most successful interventions have been clinician-focused and have been related to making the right thing to do, sort of the easy or default thing. When we do that, it’s often through the electronic health record,” Delgado said. By modifying the system where choices are being made, “you don’t have to go out and prompt people to do things the right way or motivate them,” he added. “It’s just going to happen because you’ve modified the environment.”
Outside the confines of academia, it can be difficult to predict how even a tried and tested nudge will fare. That’s a lesson University of Pennsylvania economist Harsha Thirumurthy learned when he teamed up with researchers in South Africa in 2020 to launch Indlela, an initiative to apply behavioral science to pressing public health problems in low- and middle-income countries.
To Thirumurthy, the [initative] revealed how important it is that nudges be “aligned with what is actually going on in the patient’s mind or in the patient’s life.” Strategies that succeed in one country might fail in another, he explained, simply because of differences in people’s individual circumstances or cultural norms.