Beth Radecki, MSN, RN, ACNS-BC

Innovation and Implementation Science Graduate Spotlight

Lessons in Agile Implementation

Beth Radecki, a Clinical Nurse Specialist (CNS) at Indiana University Health Methodist, is a change agent making a difference in healthcare quality through behavioral economics, a fundamental element of Agile Implementation.  If you are not familiar with the term “behavioral economics,” let us turn to Beth’s expertise for an introduction to the concept.  Drawing upon her education in nudging and Agile Implementation, Beth has been able to design innovative solutions for common healthcare problems, such as fall prevention and hand hygiene at Indiana University Health. 

What is a “Nudge”?

Behavioral economics is the study of human behavior and the consequent architecture of the environment to affect decision-making.  A common strategy in seeking to change behavior is by using “nudges.”  A nudge, as defined by PG Hansen, is “any aspect of a choice architecture that should not influence behavior in principle…, but does in practice.”¹ Nudges require an implementation scientist to analyze existing mental models and behaviors of a given population, and then change the physical environment to motivate people towards a different one.  Using nudges can be extremely impactful when leveraged in healthcare for improving health outcomes and the safety of care. 

Real-world Examples in Practice

• Beth noticed 35-40% of hand hygiene opportunities missed every day. The hospital launched a Hand Hygiene Campaign to raise awareness and encouraged staff to have crucial conversations when observing missed opportunities.  However, it was not necessarily a knowledge problem.  Patient care is a cognitively tasking process.  Clinicians are not “thinking” about whether or not to clean their hands; they are involved in dynamic, complex decision making in their non-predictable work environment.  Observations of the current process revealed the sanitizer dispensers are tan, which is nearly the same color as the wall; thus, they are not salient.  Using cues from our external environment, the team experimented placing red arrows on the dispensers to seize clinician attention. 
• After a medication error where the wrong syringe administered insulin resulting in a 10-times dose increase, Beth took a cognitive behavioral approach to solving the problem. She listened to the nurse’s story and observed the environment to identify the current state and existing process gaps.  After analyzing the behavioral pattern, Beth used choice architecture to design the context in which nurses prepare insulin. Since the nurse draws insulin into the syringe at the time of removal from the Pyxis Medstation, the insulin syringe was placed on top of the Pyxis, away from other look-alike syringes. Creating this default eliminated the chance other nurses would inadvertently select the wrong syringe. 

Overview of Successful Change

Becoming a master of nudging takes considerable practice, as well as a strong moral compass.  Beth has been able to implement successful nudges to solve simple problems for patients, and the results speak for themselves. 

• In the Hand Hygiene example described above, the units’ hand hygiene scores improved from 85% to 94% and sustained for a four-month period.
• Since the insulin syringe change, there have not been any reported medication errors related to using the wrong syringe to administer subcutaneous insulin.

As a CNS, Beth has great opportunity to make an impact through quality improvement of daily processes within the complex system of healthcare.  As a certified AI Change Agent, she is making the most of those opportunities because she has equipped herself with the tools to make positive change for her patients through Behavioral Economics.  To learn more about how you can become a change agent in healthcare and leverage the concepts of Agile Implementation and Behavioral Economics to improve care delivery, visit the website of the Indiana University School of Medicine’s Center for Health Innovation and Implementation Science here: http://www.hii.iu.edu/.

• Hansen, PG (2016) The definition of nudge and libertarian paternalism: Does the hand fit the glove? The European Journal of Risk Regulation)