Management and Performance in Mission Driven Organizations by Paola Cantarelli

Author:Paola Cantarelli
Language: eng
Format: epub
ISBN: 9783031404900
Publisher: Springer Nature Switzerland

Electronic Records and Their Settings

Electronic health records can certainly be considered part of the most complex information systems, not least for the nature of the data, the impact of potential errors, and the privacy rights that must be protected. As to the managerial focus of the current monograph, electronic health records can be characterised as an environment in which people make decisions. Any change in such an environment, i.e., the electronic health record, can predictably alter the healthcare professional’s and the patient’s behaviours. Under the reference point dependence depicted in prospect theory, the anchoring and adjustment effect plays out when we are asked to estimate unknown quantities and when we need to pick an option from a set of alternatives. In the latter case, the default option is the anchor that is possibly mostly widespread, powerful, and overlooked in organisational procedures. The default option paves the way for both good and bad consequences equally. The default option pre-selected for us qualifies beautifully as the anchor we are unlikely to change. More precisely, the default effect is a cognitive mechanism whereby decision-makers who are asked to make a choice among alternatives tend to stick to the status quo or any choice pre-populated for them or automatically selected in the absence of action. Defaults are “the most powerful nudge we have in our arsenal” because they represent “what happens if [we] do nothing, [which] we’re really good at” (Thaler, 2017, 26.10).

The default settings in electronic health records abound to the point that the best-performing public or private healthcare organisations have created monitoring units and programs. As the most notable example, the Penn Medicine Nudge Unit—launched in 2016 as the world’s first behavioural design team embedded within a health system to design, implement, evaluate, and disseminate scalable nudges to steer decision-making towards high-value care, improve patient outcomes, enhance public health, and increase health equity—has two lines of applied research dedicated to whether and how default setting in electronic records can increase (i) the prescription of generic medications and (ii) the compliance with opioid prescribing guidelines and lower the number of pills prescribed (https://​healthcareinnova​tion.​upenn.​edu/​nudge-unit). Recent work in three hospitals monitored the number of pills of opioid prescribed after surgery and noted a modal (that is recurring) figure that was too high: 30. Thirty was the pre-populated number in the electronic medical record; professionals could certainly modify it, but they tended not to. Managers in these hospitals decided to replace 30 with 12, thus modifying the default options. Namely, 12 was the number of prescribed opioids unless clinicians entered a different number. In fact, 12 was a more appropriate number of pills based on scientific evidence. The effect was astonishing: a remarkable reduction in the number of opioids prescribed. In other words, a pre-post intervention conducted across hospitals demonstrates that lowering prescription defaults for postoperative opioids in the electronic health records from 30 to 12 pills decreases the number of opioids actually prescribed by more than 15% (Chiu et al., 2018).

Along the same lines, a

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