ABSTRACT
This is the first of two essays that describe “nudging” as a method for implementing evidence-based practice. This essay explores the behavioural paradigms that underpin nudging. Effective implementation design builds on a fundamental approach to behaviour change. Nudging is based on the premise that intrinsic human needs and circumstantial pressures will override rationality and decision-making deliberation in some contexts. In clinical environments, for example, pressures such as timeliness, patient and peer expectation, organizational constraints, administrative requirements, and even hunger and tiredness may drive healthcare providers to make automatic decisions. Given the burdens of such circumstances, these decisions may rely on habitual thinking, entrenched behaviours, and inherent and learned biases rather than the conscious application of new knowledge gained through education and practice guidelines. The choices made in these contexts may be adequate, not optimal. Nudge designs predict this behavioural response. They provide simple, sanctioned, evidence-based pathways for decision-making in demanding circumstances. In the second essay on nudging, we review some of the decision-making tools and workflow practice designs used to nudge evidence-based performance in clinical practice.
