Our mission
The Penn Medicine Nudge Unit is the world's first behavioral design team embedded within a health system. We leverage insights from behavioral science and implementation science to design, implement, evaluate, and disseminate scalable nudges to steer medical decision-making toward higher-value care, improved patient outcomes, and more equitable health care delivery.
What is a nudge?
The goal of a nudge is to improve outcomes without restricting choice. Successful nudges change the way choices are presented or the way information is framed. They should be transparent and aligned with the welfare of the person being nudged and offer an easy way for people to opt-out if they want to. Examples of effective nudges include:
- Changing default settings in the electronic health record increased Penn Medicine's generic medication prescribing rates by 23 percentage points, leading to an estimated savings of $32 million over 2.5 years.
- Reminding patients twice to get their flu shot at an upcoming doctor's appointment and stating that the shot was "reserved" for them increased vaccine adoption by an estimated 11 percent.
What is implementation science?
Implementation science promotes the systematic uptake of evidence-based strategies in health care. At the Penn Medicine Nudge Unit, we embed these principles into each stage of our work. Early in the design process for a nudge, we use insights from implementation science to ensure that our interventions will scale. Then, when nudges are successful, we employ strategies from implementation science to promote uptake by clinicians and patients to maximize impact and ensure sustainment. To learn more about the full breadth of our work in this space, visit the Penn Implementation Science Center (PISCE@LDI) website.
Why are nudges and implementation science important?
Human behavior is the final common pathway for most advances in medicine. No matter how effective a medication, protective a vaccine, or beneficial a lifestyle modification, they help only if clinicians recommend them and patients engage with them. Successful nudges align decisions and behaviors with long-term health goals, and implementation science promotes their uptake and sustainment at scale.
Our key project domains
We maintain a diverse portfolio of projects. Our key project domains include the following:
- Nudges to care teams: The design of any practice environment heavily influences medical decision-making within it. We aim to design and implement nudges that improve workflow and steer decision-making toward evidence-based care.
- Nudges to patients: Daily health behaviors significantly impact long-term patient outcomes. We design and implement interventions that lead to significant and sustained changes in patient engagement and daily behaviors.
How we work
Projects at the Nudge Unit move through four phases:
- Design: We co-design nudges in partnership with care teams, health system leadership, and patients.
- Implementation: We implement interventions in a pragmatic and measurable manner to inform larger-scale implementation.
- Evaluation: We conduct rigorous evaluations of the intended and unintended impact of interventions
- Dissemination: We share findings across multiple channels, including peer-reviewed publications, social media, conferences, and our annual symposium.
Key partnerships
- The Nudge Unit is supported by the Penn Medicine Center for Health Care Innovation and the Penn Center for Health Incentives and Behavioral Economics.
- PISCE@LDI and the Nudge Unit operate as sister entities that inform one another bidirectionally. PISCE@LDI builds capacity in implementation research and education, and the Nudge Unit applies insights from PISCE@LDI to optimize the effectiveness of nudges within the health system. Many faculty and staff at the Nudge Unit do work in both entities.
Nudges in Health Care Symposium
The history of the Nudge Unit
The Penn Medicine Nudge Unit was launched in 2016 by founding director Dr. Mitesh Patel. The team began with two people and, within three years, grew to more than 20. From 2016 to 2021, the Penn Medicine Nudge Unit worked on more than 100 projects, including more than 25 randomized trials resulting in over 75 publications in leading medical journals such as NEJM, JAMA, Nature, and PNAS.
In 2018, the team launched an inaugural Nudges in Health Care Symposium to bring together health systems interested in using nudges or developing nudge units to improve health care. The first two symposiums were hosted on Penn's campus and brought together leaders from 30 health systems. In 2021, the symposium took place virtually, and we broadened the audience to include health plans and other organizations working on using nudges to improve health care. More than 400 people representing over 200 organizations from around the world attended.
In June 2021, Dr. Patel left Penn Medicine to pursue an executive leadership role at the national level for Ascension Health. Soon after, Dr. Rinad Beidas, an internationally recognized leader in implementation science, succeeded Dr. Patel as director of the Nudge Unit. Under the leadership of Dr. Beidas and deputy directors Drs. Sri Adusumalli and Kit Delgado, the Nudge Unit continues to achieve impact at scale by applying expertise at the intersection of implementation science and behavioral economics.
