Eleanor Feldman Barbera, Ph.D.

Standing by the salad bar in the newly opened restaurant, I recoiled at the sign that read, “Please don’t use your hands.” I suggested to the manager that the notice should instead advise diners to “Please use the serving spoons.” My recommendation for that short-lived establishment followed what’s known as “nudge principles.”

What are nudge principles?

Nudge principles use basic human tendencies to encourage people to engage in positive behavior. One aspect of nudge is to craft messages, like how to use the salad bar, in ways that are more likely to result in positive action.

Another aspect, according to Tori DeAngelis in Coaxing Better Behavior, is to harness “our less laudatory traits — short-sightedness, inertia, inflated optimism and our tendency to submit to peer pressure.”

Research shows people have a “default bias” which makes them more likely to choose the first option in front of them. Putting fresh fruit before the desserts in a cafeteria line would be one way of making positive use of this bias. Another is creating a default option that enrolls employees in a retirement account rather than requiring them to opt into the program.

Care must be taken to create good default options, though, or they can backfire. One poorly constructed automatic retirement account enrollment, for instance, resulted in more individuals contributing, but fewer dollars set aside overall. Why? The default choice set aside less money than what people might have chosen if they’d given it more thought.

Starting with the end result

Some “nudge” researchers identify the outcome they want to see and then look at what methods are most successful in achieving that outcome. In one study, the British government sent letters to delinquent taxpayers, saying, for example, “You are one of the few who have not paid us yet.” They altered the wording of the letters to see which phrasing would result in the greatest collection of outstanding funds — and retrieved an extra $15 million overall.

Applying nudge principles in LTC

Long-term care providers are already using nudge principles when they place hand-sanitizing dispensers in locations where staff is most likely to use them. We can harness the power of nudge in LTC in other ways as well. Here are some ideas — feel free to add your own in the Comments section below this article:

·      Reduce the likelihood of slips and falls by offering bags/covers for wet umbrellas at the front door in inclement weather.

·      Encourage family members to create successful visits with loved ones by posting information on how to do so rather than requiring them to seek out guidance. (Get a free download of tips for families at MyBetterNursingHome.com.)

·      Make use of peer pressure, taking a cue from the British government, and let employees who consistently arrive late to work know that they “are one of the few who are regularly arriving late to work.”

·      Or, find out why employees are arriving late — childcare responsibilities? Transportation problems? Craft solutions such as on-site day care services or a carpooling group.

·      Enhance paperwork compliance by sending out automatic reminders to staff members before documentation such as quarterlies or year-end reports are due.

·      Set up systems to auto-fill as much information as possible and keep paperwork simple, whether for employees documenting care or family members admitting a loved one. Data show that “people absorb simple, attractive, social and timely information far more easily than complex, difficult-to-process information.”

The basic philosophy underlying this type of social psychology research is that people want to do the right thing. Applying nudge principles makes it easier for them to do just that.

Eleanor Feldman Barbera, PhD, author of The Savvy Resident’s Guide, is a 2014 Award of Excellence winner in the Blog Content category of the APEX Awards for Publication Excellence program. She also is the Gold Medalist in the Blog-How To/Tips/Service category of the 2014 American Society of Business Publication Editors Midwest Regional competition. A speaker and consultant with nearly 20 years of experience as a psychologist in long-term care, she maintains her own award-winning website at MyBetterNursingHome.com.