National Impact of Penn Medicine Nudge Unit Concept Spreads

National Impact of Penn Medicine Nudge Unit Concept Spreads

Report From the 2019 Nudges in Health Care Symposium
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Photos: Hoag Levins

Health services researchers, clinicians, health system and health plan executives from across the country filled the auditorium of the University of Pennsylvania's Biomedical Research Building (BRB) for the two-day 2019 "Nudges in Health Care Symposium." The BRB was one of two Penn venues used to accommodate the gathering sponsored by Penn Medicine, its Nudge Unit, the Penn Center for Health Care Innovation, and the Center for Health Incentives and Behavioral Economics (CHIBE). (Click image for larger)

Probably the best word to describe what the second annual Nudges in Health Care Symposium was about is "impact." Twelve months ago, curious health industry executives and clinicians gathered at the first symposium to learn more about the unique Penn Medicine behavioral insights unit that was the first behavioral research operation ever established inside a health system. This year, several of those 2018 symposium alumni returned to detail how they are building their own health systems' nudge units.

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"We were doing nudge-related and judgement and decision work for a while at our lab but we never had the idea that we could have a nudge unit inside our own health system," said Christopher Chabris, PhD (above, left), Co-Director of Geisinger's new Behavioral Insights Team. "We came to last year's seminar and it made a light bulb go off. We said 'if Penn can have one, why can't Geisinger have one?' A few days after we got home, Michelle Meyer (PhD, JD, now Co-Director of the Behavioral Insights Team) sent off a proposal for a nudge unit to the Chief Scientific Officer who forwarded it to the CEO and the Chief Innovation Officer and within a couple of days they wrote back saying 'Great idea. Let's do it.' And now we have a unit within Geisinger's Steele Institute for Health Innovation."

Attending the 2019 symposium from Sanford Health, Emily Griese, PhD (above, middle), Director of Population Health, said last year's seminar triggered the decision to create Sanford's Nudge Unit. "Last year our CMO, CIO and Chief Quality Officers all attended and came home to give us administrative support for the unit," she said. "We came to the symposium this year with a number of Sanford's front-line research and operations people. They're really thinking through how to take the next step in building our Nudge Unit." Sanford operates hospitals and clinics in 26 states.

"After attending last year's symposium, I was inspired by the work of the Penn Medicine Nudge Unit," said Daniel Croymans, MD, MBA (above, right), a primary care physician and member of UCLA Department of Medicine’s Quality Team. "When I got back to UCLA, I emailed as many people as possible, pointing out that UCLA had all the ingredients needed to form our own unit. We set it up within the Department of Medicine, adopted best practices from Penn, and formed a team with domain experts in patient care, clinical operations and quality, behavioral design, economics and informatics. Our goal is to partner with stakeholders across the health system to design, test, and scale nudges that result in higher value care and better patient outcomes."

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Clinician researchers and health system managers take a break for a group photo. In the front row are David Asch, MD, MBA, Executive Director of the Penn Medicine Center for Health Care Innovation, Mitesh Patel, MD, MBA, Director of the Penn Medicine Nudge Unit, and Kevin Volpp, MD, PhD, Director of the Center for Health Incentives and Behavioral Economics (CHIBE). All three are also Senior Fellows at the Leonard Davis Institute of Health Economics (LDI).

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Penn Nudge Unit head Mitesh Patel (above, right) explained that after last year's symposium, his office continued to get two or three calls a week from institutions interested in understanding how to start nudge units within their own clinical operations. He and Mohan Balachandran, Chief Operating Officer of Way to Health platform, also detailed Penn's new "Nudge Unit Collaborative", a technology platform designed to serve as the central hub of information-sharing and collaboration among the nudge units of member health systems.

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Among the speakers at the two-day event were Lori Melichar, PhD, MA (above, left), Senior Director of the Robert Wood Johnson Foundation and Stacey Chang, MS (above, right), Executive Director of the Design Institute for Health at the Dell Medical School at the University of Texas at Austin. Chang heads a unique organization focused on testing innovative organizational and physical clinical environments to improve health care delivery and patient outcomes in non-traditional ways.

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The most frequent feedback from last year's symposium asked to hear from more scientists actively engaged in researching and using nudge principles in clinical settings. That led to this year's list of speakers from other institutions moving into the nudge area, as well as a special panel of four Penn scientists. Those Penn clinicians (above, left) are using nudge theory and methods in the fields of cancer care, mortality prediction, mental health care delivery, and the reduction of opioid prescribing in the ER. They were (l to r) Justin Bekelman, MD, Director of the Penn Center for Cancer Care Innovation (PC3I), Rinad Beidas, PhD, Director of the Penn Implementation Science Center at LDI (PISCE), Christopher Manz, MD, a Penn Medicine Fellow of Hematology and Oncology; and M. Kit Delgado, MD, MS, Director of the Behavioral Science and Analytics for Injury Reduction (BeSAFIR) Lab. All four were both LDI Senior Fellows and faculty members at the Abramson Cancer Center's new Center for Cancer Care Innovation (PC3I). Above, right, speaking on the next generation of "intelligent" electronic health records was John Glaser, Senior Vice President for Population Health at Cerner, the health care IT company.

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A project manager at the Dartmouth Institute, presenter Maia Crawford, MS (above, left), explained how her organization was taking a different approach in its plans for nudge operations. Instead of the usual behavioral insights focus on changing the behavior of individual patients or clinicians, Dartmouth intends to study how best to nudge large health care organizations toward broader adoption of evidence-based care delivery practices. Above, right, the attendee who traveled the farthest to the symposium, Nuha Alhumaid, DrPH, is the Head of the Saudi Arabian Health Nudging Team (HNT) at the King Saud bin Abdulaziz University for Health Sciences College of Public Health & Health Informatics in Riyadh, Saudi Arabia. Her presentation was about the Team's initial three projects for reducing the number of missed appointments, increasing the hand hygiene compliance rate, and reducing the spread of genetic diseases.

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Speaking on the use of behavioral insights research in areas of care involving elderly patients was John Haaga, PhD (above, left), Director of the Division of Behavioral and Social Research at the National Institute of Aging (NIA). Above, right, William Hanson III, MD, Penn Medicine's Chief Medical Information Officer, addressed the importance of nudge research in the context of the current controversy around the complexity of electronic medical records. "We need to find ways to make it easy to do the desired thing in the EMR even as we reduce cognitive load. That's what our clinicians are crying for," he said.

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A session that got the room buzzing was the Accelerators in Health Care Workshop, a card-game requiring participants to solve dilemmas regularly faced by health care innovation researchers (above, left). Developed at Penn Medicine's Health Innovation Center, it is an intense intellectual exercise designed to increase an understanding of the innovation process. Players use three different kinds of cards that pose health care delivery problems, solutions and "monkey wrench" conditions that thwart proposed solutions. Above, right, discussing their team's strategy are Fatma Uyar Morency, PhD, of the UPMC Health Plan; Tessi Ross, MPA, of Sanford Health; and Julia Chelen, PhD, of Dartmouth Hitchcock Health.

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The Accelerators in Health Care game is both an engaging social experience (above, left) and a problem-solving exercise. Above right, as the two-day symposium ended, attendees and staff adjourned for dinner in the fountain gardens of Penn Museum of Archaeology and Anthropology. The Penn Nudge Unit team: (standing) Chalanda Evans, BS, Project Manager; Ai Leen Oon, BA, Clinical Research Coordinator; Mitesh Patel, Nudge Unit Director; Catherine Reale, BS, Project Manager; Joseph Harrison, MBDS, Project Manager; Michael Fortunato, BS, Clinical Research Coordinator; Sujatha Changolkar, BA, Clinical Research Coordinator; and Ashley Mercede, MPH, Clinical Research Coordinator. (Kneeling) Rebecca Pepe, MPH, Project Manager; Tory Harrington, BS, Clinical Research Coordinator; Jeffrey Lienert, PhD, Advanced Fellow; Rachel Djaraher, MPH, Clinical Research Coordinator; and Charles Rareshide, MS, Data Analyst.