When Behavioral Nudges Harm Well-Being: Evidence From a Peer Comparison Intervention Targeting Physicians

70 Pages Posted: 12 Oct 2021 Last revised: 1 Dec 2021

See all articles by Joseph Reiff

Joseph Reiff

University of California, Los Angeles (UCLA) - Anderson School of Management

Justin Zhang

University of California, Los Angeles (UCLA) - David Geffen School of Medicine

Nathaniel Pedley

University of California, Los Angeles (UCLA) - UCLA Health System

Jana Gallus

UCLA Anderson

Hengchen Dai

University of California, Los Angeles (UCLA) - Anderson School of Management

Sitaram Vangala

University of California, Los Angeles (UCLA) - Division of General Internal Medicine

Richard Leuchter

University of California, Los Angeles (UCLA) - UCLA Health System

Gregory Goshgarian

Central Michigan University

Craig R. Fox

University of California, Los Angeles (UCLA) - Anderson School of Management

Maria Han

University of California, Los Angeles (UCLA) - UCLA Health System

Daniel Croymans

University of California, Los Angeles (UCLA) - UCLA Health System

Date Written: November 30, 2021

Abstract

To motivate behavior change, policymakers and business leaders are increasingly relying on seemingly subtle interventions that do not alter economic incentives or limit freedom of choice—often referred to as “nudges”. Despite their widespread use, the potential impact of nudges on recipients’ well-being is still largely unknown. We conducted a field experiment involving 199 primary care physicians and 44,287 patients to examine the impact of a commonly used nudge—providing peer comparison information—on both physicians’ job performance and psychological well-being. We varied whether physicians received information about their preventive care performance compared to that of other physicians. Our analyses reveal that the nudge did not significantly improve physicians’ preventive care performance, but it did significantly decrease job satisfaction and increase burnout, even four months after the intervention was discontinued. Quantitative and qualitative evidence on the mechanisms underlying these unanticipated negative effects suggest that the nudge inadvertently signaled a lack of support from leadership. Consistent with this account, providing leaders with training on how to support physicians mitigated the negative effects. Our research uncovers a critical downside of peer comparison nudges, highlights the importance of evaluating the psychological costs of behavioral nudges, and points to how a complementary intervention—leadership support training—can mitigate these costs.

Note:

Funding: UCLA Health Department of Medicine

Declaration of Interest: None to declare.

Ethics Approval Statement: This research was reviewed by the UCLA Institutional Review Board and was found to not meet the definition of human subjects research as defined by federal regulations for human subject protections. Therefore, neither certification of exemption nor approval were required by the UCLA Institutional Review Board.

The first two authors contributed equally to this work. Trial Registration: clinicaltrials.gov numbers: NCT04237883

Keywords: nudges, well-being, peer comparison information, healthcare, field experiment

JEL Classification: I12

Suggested Citation

Reiff, Joseph and Zhang, Justin and Pedley, Nathaniel and Gallus, Jana and Dai, Hengchen and Vangala, Sitaram and Leuchter, Richard and Goshgarian, Gregory and Fox, Craig R. and Han, Maria and Croymans, Daniel, When Behavioral Nudges Harm Well-Being: Evidence From a Peer Comparison Intervention Targeting Physicians (November 30, 2021). Available at SSRN: https://ssrn.com/abstract=3941507 or http://dx.doi.org/10.2139/ssrn.3941507

Joseph Reiff

University of California, Los Angeles (UCLA) - Anderson School of Management ( email )

110 Westwood Plaza
Los Angeles, CA 90095-1481
United States

Justin Zhang

University of California, Los Angeles (UCLA) - David Geffen School of Medicine ( email )

1000 Veteran Avenue, Box 956939
Los Angeles, CA 90095-6939
United States

Nathaniel Pedley

University of California, Los Angeles (UCLA) - UCLA Health System ( email )

10833 Le Conte Avenue
17-165 CHS
Los Angeles, CA 90095-1730
United States

Jana Gallus

UCLA Anderson ( email )

110 Westwood Plaza
Los Angeles, CA 90095-1481
United States

HOME PAGE: http://www.janagallus.com/

Hengchen Dai

University of California, Los Angeles (UCLA) - Anderson School of Management ( email )

110 Westwood Plaza
Los Angeles, CA 90095-1481
United States

Sitaram Vangala

University of California, Los Angeles (UCLA) - Division of General Internal Medicine ( email )

Los Angeles, CA
United States

Richard Leuchter

University of California, Los Angeles (UCLA) - UCLA Health System ( email )

10833 Le Conte Avenue
17-165 CHS
Los Angeles, CA 90095-1730
United States

Gregory Goshgarian

Central Michigan University ( email )

Craig R. Fox

University of California, Los Angeles (UCLA) - Anderson School of Management ( email )

110 Westwood Plaza
Los Angeles, CA 90095-1481
United States

Maria Han

University of California, Los Angeles (UCLA) - UCLA Health System ( email )

10833 Le Conte Avenue
17-165 CHS
Los Angeles, CA 90095-1730
United States

Daniel Croymans (Contact Author)

University of California, Los Angeles (UCLA) - UCLA Health System ( email )

10833 Le Conte Avenue
17-165 CHS
Los Angeles, CA 90095-1730
United States

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