October 03, 2019
In a session at Health Care Quality Congress 2019, David Asch, MD, MBA, of The Perelman School & Wharton School of the University of Pennsylvania, explained why patterns of behavior can be used to improve outcomes and health care quality.
Dr Asch explained, “many health challenges require the scientific breakthroughs that come from fundamental discovery.”
He further explained that other challenges that require other kinds of breakthroughs include:
- Complexity; and,
“We have been better at supporting breakthroughs in discovery than breakthroughs in productivity,” he noted.
He told conference attendees that health care is different, and it is not only high stakes, but it is highly regulated and capital intensive. However, he said that health care has something to learn from other industries.
“I bet one of you, or maybe all of you, have used Amazon,” he said. “What’s good about them?”
He explained that the company has a huge selection, lower prices, quick searching, payment, and delivery, and many other notable perks. He explained that Amazon enabled the idea of “I want what I want when I want it,” which he said is a goal of health care.
Dr Asch then highlighted the health care transformation equation.
“The health care transformation to me is the combination of technology and behavior,” he said.
He said that the scale is impossible without technology, and technology is useless without engaging human behavior. The total transformation equation is: technology plus an understanding of behavior equals scalable health care change.
He said, “the most persuasive view of health behavior suggests that patients and clinicians will make good decisions when they have the best information in front of them.”
Then he looked at the audience and asked, “can we do better than that?”
According to Dr Asch, there is a shaky foundation with information alone. He said there needs to be shared decision making, health care cost or quality transparency, informed consent, and clinical guidelines.
“Clinicians and patients should get together to achieve patient goals—no one would disagree with that.”
He explained that rationality poorly describes behavior change. Dr Asch said that the old approach to change someone’s behavior was to change their mind. However, he said that a better approach would be to use behavioral “reflexes” to bypass cognition.
He told the audience that the science of motivation has evolved.
“You know what I believe?” he asked, “I believe that the science of motivation has really improved in the last 10-15 years.”
He said that irrationality should be used for the purposes of good.
“Behavioral economics starts from the understanding and recognizing that people are irrational,” he said. “Once you recognize how people are irrational, you are in a better position to help them.”
He recommended that professionals move away from financial incentives to more social incentives. He said that not only are financial incentives expensive and may seem inappropriate, they can also backfire. With social incentives, he said they can harness existing trust relationships, and may become self-sustaining.
Dr Asch ended and highlighted three things that are true today but not 10 years ago. He said that “we now understand human behaviors, wireless devices make it easier to touch people, and health care financing shifts create economic motivation to connect with people when they are not in the hospital or office.”