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

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