Changing Provider Behavior: Are we Kidding Ourselves by Trying or Can Understanding How We Make Decisions Help?

Nobel Laureate Daniel Kahneman explains that most of our decisions are made by a fast intuitive process, system 1, which uses past experience and information that is immediately available; the other process is slow and deliberate, system 2, which uses known facts and further questioning to find answers. Many of our medical decisions are made using the more comfortable system 1, even though we often have the tools of best practice and education to make more educated decisions using system 2. So why is it, as medical professionals, we do not change our behaviors even though we have all the information needed to follow clinical guidelines and best practices? How is this best accomplished? There has been substantial research on how to change physician behavior. In reviewing the literature, it is clear that both active interventions and multifaceted educational strategies can be effective in changing provider behaviors. However, the most compelling method in changing provider behavior we found was the Implementation Intention Strategy described by Daniel Ssaddawi-Konefka, MD, and Daniel Schumacher, MD. This method implements an If/Then strategy for making medical decisions and solidifies the link between a clinical situation and the response. Ideally, such systems will be integrated into provider-facing electronic decision aids as uptake of technology increases in PALTC.