No Need to Reinvent the Nudge

A Boston Globe article explains how “positive deviance” — a way to change behavior by using “nudges” that already exist in a community, rather than imposing them from the outside — substantially decreased malnutrition in a Vienamese village: researchers observed children who looked more nourished than others, found that their families were feeding them crabs — considered a low-class food — and encouraged neighbors to follow the family’s good example. The method has also worked in hospitals, in place of extensive outside educational campaigns, to reduce infections from bacteria by, for example, applauding and encouraging imitation of nurses who boldly remind doctors to wash their hands. [%comments]


I guess the researchers who were doing the nudging in this example where residents of the community and not from the outside? Also, why do I get the visual impression from this article of a group of researchers clapping and shouting words of encouragement in unison to a group of doctors to wash their hands as nurses do? No wonder it is effective.

Kevin H

I think the researchers were outsiders, but the novel idea is to reinforce (from outside) the good things that are generated internally. It seems to me this does two things.

First your less likely to run into taboos or other social norm problems because the behaviors witnessed inside a society are more likely to come from within that society's acceptable norms.

The second is visibility. With the malnutrition/crab scenario, you could actually point to a local, believable example of the benefits. You can say, 'look how healthy that child looks' and the individual can see the results first hand. Technically your being a bit biased in your selection, which should exaggerate the effects of the treatment, but the direction of the effect should remain, so I'd still call it ethical.


Also- ask the docs to wipe their stethoscopes. My roommate is an ER nurse, she rarely sees her docs wipe the scopes.


Of course as a phsyician boldly reminding a nurse to wash her hands is likely to end up with a "friendly" interview with the hospital administration...