The Analytical ApproachQuestion: How do we use data to make informed content decisions across digital channels? In 2008, about five months before the Lehman Brothers collapsed as a result of the subprime mortgage market, Richard Thaler and Cass Sunstein published Nudge: Improving Decisions about Health, Wealth, and Happiness. It was the first formal use of the term “choice architecture.” Nudge, (pronounced like fudge), is the design of different ways choices can be presented to consumers related to decision-making. Taking the concept further, Daniel Kahneman published the best seller, Thinking, Fast and Slow, questions our general confidence in natural, human judgement.
An effective 'Nudge' theory example is the push to gain more acceptance and an increase of organ donation rates in the United States. A 'choice program' was put in place as part of driver's license renewal. Opting in as an organ donor could also be prodded by a wider community support of people who have become organ donors, as well.
Decision making has various levels. Not every decision takes deep thought or rational processing. Majority of our decisions are made quickly. The brain finds ways to make rapid decisions to navigate life and often with inadequate information. Fast and automatic decision making can almost be on ‘auto-pilot’ or unconscious, in a way. It is about efficiency; energy efficiency. As the decisions become more habitual, it takes less focus and active thinking. Important to note is that as we consider these easier decision habits there is also a lack of focus. This is a natural brain reaction for habitual decisions. As such, it can be prone to bias and error. On the other hand, a decision that is unique and requires cognitive energy, can be slower and more effort is given. It can become overtaxing and as Kahneman referred in his book, Thinking, Fast and Slow, human cognitive capacity has limits which can lead to error. Thaler and Sunstein referred to 'nudge' being effective through 'choice architecture.' The choice architecture is a way to design and structure options to make the decision easier for the decider. An example would be inside the school cafeteria, putting the healthier snack choice at eye level versus the unhealthier choice harder to reach and not in line of sight. In that case, and with the experiment referred to in the nudge study, kids chose those healthier snacks. Clinicians’ and patients’ are also influenced by subtle design of information and choices to effect decisions and behavior. When the “choice architecture” is designed to influence behavior in a predictable way but without restricting choice, it is often called a “nudge.” Inside the EHR, physician nudges are influential. The direction and force must be aligned with professional standards, regulations and those standards may evolve over time.