For years it was "Reach the Summit." Then, at about 40, came "Hold the Line." Now, as I approach another post-50 birthday, I have my hands full with "Slow the Decline." It's getting tougher, folks!
Since my college years I have hit the gym several times a week. And there are always days when it is harder than usual to step on the stair climber or lift the bar bells. That's when a little friendly competition works miracles.
If you exercise with a partner you know that friendly workouts inevitably ratchet up to a contest of relative might and pain threshold, usually without either party even realizing it. When my friend finishes a set of bench presses, I'll casually add 5 pounds on either side before I lift. Likewise, when he sees me in a lather of sweat after 30 agonizing minutes on the treadmill, he'll run for 45.
This spirited game of one upmanship we play in the gym closely parallels the classic pattern of Behavioral Economics, i.e., using tools like simple reminders, social pressure, and rewards to gently nudge us to behave in desired ways.
I most recently read about the pattern in the Harvard Business Review Insight Center report (March 2010) entitled Health Care Innovations. The report highlights the impact that peer pressure played on a large practice in Boston.
A group of doctors were shown data revealing a large variation in how much each of them used certain radiology tests. It "called out" those who used radiology in excess and in turn empowered more moderate users to question these colleagues about their more indulgent diagnostic and treatment protocols. This peer-to-peer interaction led to a 15% decline in radiology use by this physician group.
We know of a similar example from a large, geographically dispersed hospital system where the price and lack of standardized physician preference items were a particular challenge. In an initial effort to rein in spending without resorting to strong arming physicians, the materials managers made a list of preference items for a particular procedure and then, each week, printed out usage and price by physician. They placed these charts above the scrub station for each surgeon to see.
The conclusions were obvious and significant. Physicians saw that, while most were using lower-cost items effectively, there was a subset using high-end (and high dollar) PPIs with no better outcomes. Over the next few weeks these high-end outliers began moving toward their lower-priced peers. And nobody had to say it! It just happened!
An additional benefit: physicians considering using a more expensive equivalent product offered by a competitor knew that that product's price and their name would soon appear above the scrub sink for all to see. A very effective counterbalance to the sales skills of the product company rep!
This subtle form of peer pressure has been around a long time and very few of us are immune to its power. Yet it is non-confrontational and instead leverages our common human nature. I highly recommend it to complement other methods you may use to convince surgeons to standardize. The same Behavioral Economics that drive me to match or exceed the performance of my workout buddy can be a major cost reducer in the OR.
