ABSTRACT
The field of "behavioral economics", which incorporates insights from psychology to explain decision-making, has been the subject of growing interest. To understand how behavioral economics is used, or can be used, in quality improvement, it helps to review current approaches that are implicitly based on the rational theory of choice. While pay-for-performance has shortcomings, perhaps the most widely argued theory of behavioral economics' negative impact on medical decision-making is physicians' unconscious susceptibility to industry marketing. These results, taken together, suggest that it may be effective to approach clinical quality improvement using behavioral insights, or "nudges", particularly with interventions that appeal to social concerns and target habitual ordering behaviors that drive inappropriate care. This chapter discusses several randomized experiments of applications of behavioral economics to curtail inappropriate prescribing of antibiotics. Accountable justification can be used to address any quality improvement problem for which there are established best practices, because physicians should always be able to justify their actions in such cases.
