Health Tech Reads: Nudge

Our selected reading this week, Nudge, comes to us from the recommendation of Joe Babaian. Joe is one of the co-founders of Healthcare Leader (#hcldr), a weekly blog and chat that centers around the cutting edge of healthcare, patients and the innovations leading change. The chat occurs each Tuesday at 8:30pm Eastern Standard Time and brings together doctors, patients, entrepreneurs, consultants and innovators who wish to learn, engage and collaborate. Healthcare Leader chat is one of the foremost healthcare chats on Twitter, so please join in, if you have yet to partake in this excellent academia based event.


Nudge Health by Megan Janas, Joe Babaian, & Melanie Hilliard
The book we have just engaged with, Nudge, can be applied to almost any area where humans
might need a little extra information, a little more knowledge, or a little more incentive to act. However, there is enormous opportunity to engage people with their health and even the healthcare system itself, by offering guidance and direction. Humans are not designed to be omniscient. We make mistakes, we err, we lean into our habits. (A lot.) We understand that we should exercise, or eat more vegetables- but very often, we fail to do so. And this process just repeats and repeats. Our collective failure, (through our individual habits), are coming at an enormous cost to us in America. We are increasingly overweight, are suffering cardiovascular problems, have diabetes, cholesterol issues and our sedentary lifestyles are only exacerbating these ailments. We are at a critical juncture where healthcare costs are skyrocketing and we are increasingly sicker, at younger ages. These problems seem severe, but there is hope to alleviate our health epidemics. We can “Nudge.”
Nudges cannot just happen- they must be constructed within a framework. We need a guide, a
device, a program, or direction. We need a “Choice Architect” to assist us with discovering the nudges. A choice architect is anyone who has the responsibility for organizing the context in which people make decisions. Choice architects are doctors, designers, employers, software systems, forms, apps- anything that helps someone make a decision, is described as a choice architect.


Thaler and Sunstein define Nudge as any aspect of the choice architecture that alters people’s
behavior in a predictable way without forbidding any options or significantly changing their economic incentives. To count as a mere nudge, the intervention must be easy and cheap to avoid. Nudges are not mandates.


By a nudge we mean anything that influences our choices. A school cafeteria might try to nudge
kids toward good diets by putting the healthiest foods at front. We think that it’s time for institutions, including government, to become much more user-friendly by enlisting the science of choice to make life easier for people and by gently nudging them in directions that will make their lives better.

Increasingly, we are witnessing something quite amazing happening with companies like Apple
and Fitbit. Both the Apple Watch and Fitbit have entered the health and wellness space to assist us with our physical activity. These choice architecture devices are nudging us- through notifications- to walk, stand up, take more steps, complete challenges and engage with our everyday movement like never before. These devices are making it easier for us to engage directly with our activity, daily. This is just a glimpse leading to a whole new frontier of devices nudging us to take action with our health. The future is ripe with possibility to shape and direct health- the question is, what will we do with our newfound choice architecture? How will we nudge people into their best health? How will we nudge healthcare into tomorrow?
“Nudge.” by Richard H. Thaler & Cass R. Sunstein. Penguin Books (2008, 2009)

Questions:
1. Do you agree with the author’s assertion that choice architecture can be used to nudge us in
beneficial directions without restricting freedom of choice?
2. What is the responsibility of providers to help patients make better health decisions?
3. What are some of the pre-existing biases that the healthcare industry believes about
patients (that may or may not be correct)?
4. How can nudges be used to improve population health?
5. How does choice overload affect a person’s ability to make healthy life choices?
6. Where do you see the most promise for choice architecture and healthcare? Apple?
Wearables? Devices? Something else?