Alliance 2019: Making It Stick

Learning as Rationality or Behavior Reflex?

One of the highlights of the 2019 Alliance Annual Meeting in National Harbor, Maryland was David Asch’s keynote address on behavioral economics. It’s probably safe to say that much of  education in the continuing professional development (CPD) field is premised on the assumption that building knowledge provides a foundation for clinicians to make rational decisions about their clinical work.

But Asch presented Alliance members with a challenge to that assumption, as well as to the idea that the more comprehensive the information people have, the more likely they are to make rational decisions or behave in rational ways.

Instead, he argued, educators need to pay more attention to behavior reflexes, on the grounds that people behave irrationally, albeit in ways that are often predictable. It’s this predictability that educators can harness to their advantage, through an array of interventions that make learning stick by shaping habits, behaviors, and practices. Such interventions use tools such as nudges, choice architecture, and social incentives to influence the choices that people make.

At first glance, this argument seems as though it is privileging behavioral economics versus individual learning science, as outlined in Make It Stick, and debunking the value of continuing education.

But these are not necessarily mutually exclusive modalities. We probably need both behavioral economics and learning science to build knowledge and skills that ground clinically relevant, evidence-based behaviors and decisions.

How Can CPD Professionals Use Behavioral Economics?

There are at least two implications for CPD professionals to consider when thinking about how to leverage behavioral economics in the design and implementation of ‘sticky’ education for healthcare providers (HCPs).

We need to think about different starting points for identifying educational needs and clinical/performance gaps. In addition to identifying gaps in competence and performance, we should probably pay more attention to the social contexts in which healthcare is delivered; the emotional pathways through which clinicians process information and make decisions; and the cognitive/psychological biases that inform decision-making and keep people anchored to old and out-dated ways of thinking. Attention to these parameters could help educators to better frame their interventions.

The health services research and social science literatures offer a rich seam to mine for this kind of information. And we could ask qualitatively different kinds of questions in our needs assessments and gap analyses.

We may need to cultivate new and distinct partnerships with organizations that understand both behavioral economics and individual learning science. The advent of quality improvement (QI) has already grown partnerships between educators and QI experts. Indeed, since before and after the publication of the Quality Improvement Education Roadmap, many Alliance members have collaborated with QI organizations to deliver education as an adjunct to QI, both onsite and online.

In the same way, the CPD field can partner with stakeholders that understand and value both behavioral economics and learning science (e.g., patient safety, risk management).

Technology is Key

As Daniel Kraft minded conference participants, technology is accelerating both in its possibilities and volume, from digitization to genomics to connected health and beyond. And technology no doubt has a role to play in blending behavioral economics and learning science in ways that make it stick and sustain behavioral change.

For instance, as HCPs from Kaiser Permanente (KP) shared during a Large Health Systems Learner Panel at the 2019 meeting, the electronic health record (EHR) can be a vital tool that supports ‘stickiness’. At KP, the EHR flags up both best practice alerts and proactive care alerts at each point-of-care use which encourage individual reflection about one’s own practice and reinforce evidence-based clinical practice. But because KP takes a whole team approach to learning and has structurally embedded  technology throughout its organizational culture, EHR alerts and other tools create opportunities for discussion, connection, and, if necessary, change across the entire healthcare team.

There’s work to be done, for sure. But that’s always cause for optimism.