👨‍⚕️ Is It Possible to Design Behavioural Strategies to Improve Job Performance? The Health Sector Case

In the last decades, it was possible to assist to a humanism period in the job world: from the emphasis on the neoclassical homo economicus, highly specialised piece of the supply chain to the recognition of peoples’ behavior as a mix of irrationality, passions, subconscious and emotions. According to the Harvard Business Review, “Employee engagement drives health care quality and financial returns”, and not only that: “strong employee engagement promotes a variety of outcomes that are good for employees and customers. For instance, highly engaged organisations have double the rate of success of lower engaged organisations. Comparing top-quartile companies to bottom-quartile companies, the engagement factor becomes very noticeable”.

Having stated that, is it possible to design behavioral strategies to improve decision making and sustain motivation among employees?

Diving into the public sphere, some characteristics of the healthcare sector represent themselves as a barrier to many of the job satisfaction factors. Due to the size of the national healthcare machine and the number of interdependent actors, you can often find great degrees of goal ambiguity. For instance, in US federal agencies, goal ambiguity happens to be negatively correlated with management effectiveness. Moreover, you can also find the red tape, i.e., the set of official routine or procedure marked by excessive complexity, which results in delay or inaction. For sure, it is driving up costs: administrative and operational inefficiencies account for nearly $1 trillion each year, roughly one-third of the US healthcare system’s total costs. That massive amount of paperwork forces the doctors to work only 27% of the time directly with the patients. Finally, you may quickly find a low level of linkage between performance and reward: specifically in the healthcare sector, you often see cases of inappropriate bonuses, inadequate rewards, poor timing of dividends, low probability of receiving bonuses, inequity in the distribution of prizes.

So, what is keeping the doctors in the hospitals, after all? According to Cantarelli, Belardinelli, Bellé (2016), doing meaningful work is the top motivator, and this can be easily contextualised in the golden circle theory of Simon Senek. He studied product marketing realities and created the following idea (which can be extended to healthcare workers): People do not buy what you do but why you do it. Most people communicate explaining what they do, then how, and finally why, while successful companies and people do the opposite, starting from the why and then explaining how and what. Apple is the favorite Senek’s case: it is not about selling computers but about thinking differently (why), by designing revolutionary objects (how): Macs, iPhones, iPods, et cetera (what). The theory is neurologically explained that when you present the why behind the existence, you hit the most intuitive and irrational part of our brain, responsible for our behaviour, skipping the “language part” of the brain. Thus the interpretation of the wording cannot distort the message anyhow. In the same way, healthcare managers should always start with why it is essential to do their job. Talking about good leadership, according to Adam Grant, it is crucial not to forget that a good leader is a giver: someone who is willing to give first when the benefits to others outweigh the personal costs, instead of a taker, who is someone helping only if he receives, even more, these conclusions are empirically confirmed by Nicola Bellé (2019).

Another part of human nature to consider is the irrationality that affects many decisions: the brain, to save “mental power,” when asked to choose, uses heuristics that often exclude the optimal solution. Let’s consider this idea together with the nudge theory. People are not always able to make choices in their interest, but also, the architecture of choices is fundamental for the option itself. For instance, in the political election, the first name on the ballot averagely gets an extra 4% of votes more than being in a position further down). Consequently, a consequence is that a good leader should make sure to design an environment where employees are rationally pushed to take a favourable decision. A good choice design:

1. Incentivise the best decisions: there’s a reward once good choices are taken.
2. Understand mappings: the link between cause and effect is apparent, or there is a standardised procedure. One of the most common examples of poor mapping is the kitchen burners.
3. Put best choices on defaults: if there is friction between the actual state and the ideal state, humans cannot get the perfect condition. For instance, organ donation after death is tremendously highly more likely to happen in countries where it is a default, instead of countries where citizens have to ask for it. Same for default saving plans.
4. Give feedbacks: the results of action should be communicated. Good feedback is immediate and informative.
5. Expect errors: it is aware of human irrationality and fixes it.
6. Structure complex choices: it can break down huge brain workloads into smaller tasks to accomplish one by one.

Case practices in the healthcare sector are pretty remarkable: for instance, in the UK, since nine out of ten people say they think screening is worthwhile yet coverage rates remain low, one approach to boost screening is to identify subgroups of non-attenders, such as retired men, who consider themselves at low risk for developing bowel cancer and link the screening test to other procedures that may be more familiar, such as dental checkups or vehicle MOTs (“You check the pipes in your car, what about the one in your body?”). Another exciting piece of evidence is given by Grant & Hoffman (2011): often, healthcare professionals tend to be overconfident about personal immunity, inhibiting the feedback effect. In two field experiments in a hospital, the effectiveness of signs about hand hygiene that emphasised personal safety or patient safety has been compared. Results showed that changing a single word in messages motivated meaningful changes in behaviour: The hand hygiene of health care professionals increased when they were reminded of the implications for patients but not when they were reminded of the impact on themselves.

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Cited in this article:

• John Baldoni (2013), Employee Engagement Does More than Boost Productivity. Harvard Business Review.
• Young Han Chun, Hal g. Rainey (2015). Goal Ambiguity and Organizational Performance in U.S. Federal Agencies. Journal of Public Administration Research and Theory, Volume 15, Issue 4, October 2005, Pages 529–557
• Jane H. and Sean T (2019). Red tape drives up healthcare costs. The Star Online.
• Anca Spau (2019). How Can AI help the Healthcare System with its Increasing Red-Tape Problem? Healthcare Weekly.
• Lawton Burns, Elizabeth Bradley, Bryan Weiner (2011). Shortell and Kaluzny’s Healthcare Management: Organisation Design and Behaviour. Cengage Learning,
• Sinek, S. (2019). Start with Why: How Great Leaders Inspire Everyone to Take Action. London, England: Penguin Business.
• Nicola Bellé et al. (2019). The Effective Leader.
  Kahneman, D. (2015). Thinking, fast and slow. New York: Farrar, Straus and Giroux.
• Thaler, Richard H., 1945- and Cass R. Sunstein. 2009. Nudge: Improving Decisions About Health, Wealth, and Happiness. New York: Penguin Books.
• Donald A. Norman. (2002). The Design of Everyday Things. Basic Books, Inc., USA.
• Grant & Hoffman (2011). It’s not all about me: motivating hand hygiene among health care professionals by focusing on patients. Psychol Sci. 2011 Dec;22(12):1494-9