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The Medical Professionalism Blog

Choosing Wisely®: Can Stories and Emotions Produce Change?

At the recent annual meeting of the Institute of Healthcare Improvement (IHI), Fred Hafferty of the Mayo Clinic and I gave a presentation on the effect systems have on the professional behaviors of clinicians. I asked the 100 or so attendees if they thought intrinsic (i.e., personal satisfaction and mastery) or extrinsic (i.e., payment) motivators were most effective in changing clinician behavior. Only five or so voted for extrinsic motivators. The same poll the previous year yielded an even split between extrinsic and intrinsic. What had changed from 2011 to 2012 to turn the results of this poll from neutral to overwhelmingly favoring intrinsic motivators?

I’d love to believe that it was a result of the Choosing Wisely® campaign that brought clinician’s attention to the specialty societies putting the interests of patients over their self-interest through the identification of five tests or procedures that should be questioned by patients and clinicians because of the lack of clinical benefit. Or, perhaps it was a result of clinicians’ negative feelings about pay-for-performance programs.

I think Dan Heath, on faculty of Duke University and co-author — along with his brother, Chip — of Made to Stick: Why Some Ideas Survive and Others Die and Switch: How to Change Things When Change is Hard, hit the nail on the head in his speech just prior to our session. Heath spoke about why change is hard and that economic incentives can’t be expected to produce changes in behavior. He made the case that emotions and feelings make people care which then spurs them to change; if emotions are moved, there are clear directions given and environmental changes are present, real change can happen.

 “When people think analytically, they’re less likely to think emotionally,” the Heath brothers write in Made to Stick. Stories not only provide us with knowledge about new behavior being sought but emotions inspire action.

As the Choosing Wisely™ campaign turns its focus from identifying unnecessary tests and procedures to the implementation of these concrete recommendations, the Heath brothers have good advice to communities and delivery systems wanting to advance the campaign:

1)      Focus on “bright spots” — things that are working already to reduce unnecessary care — and investigate how they achieve results.

2)      Develop changes in the environment that will make it easier for an individual to change (e.g., medical decision support or digital applications).

3)      Tell stories of successful implementation of the recommendations to inspire others to address overtreatment and harm from unnecessary care.

We would love to hear your stories of successful implementation of the Choosing Wisely® campaign. Send them to choosingwisely@abimfoundation.org.

1 Comment to Choosing Wisely®: Can Stories and Emotions Produce Change?

  • January 22, 2013 at 7:34 pm | Permalink

    Great post and topic! Even in academic medical centers, one good story can be worth 1000 scientific papers in terms of motivating changes in behavior. At Costs of Care we have found that the stories we collect not only give us great new ideas about opportunities to provide value, but provide the necessary emotional valence to make acting on these opportunities imperative. Stories also allow us to convey the nuance in the challenges we face such as the excellent story from an Emory Medical student named Erin Plute, who described the difficulty of being an informed patient when deciding to avoid an unnecessary CT scan: http://www.costsofcare.org/uncertainty-and-the-challenge-of-being-an-informed-patient/

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