Getting Doctors to Make Better Decisions Will Take More than Money and Nudges


Jun 21, 2018

Group of doctors at a table

Photo by Hero Images/Getty Images

Photo by Hero Images/Getty Images

By Yusuke Tsugawa and John N. Mafi

This commentary originally appeared on Harvard Business Review on June 18, 2018.

Research has repeatedly shown that U.S. patients receive recommended care only half of the time. It is also known that patients receive non-recommended or “low-value” care as much as 20% of the time. Despite the proliferation of evidence-based guidelines to improve clinicians' practice patterns, clinicians often don't respond to them. So healthcare leaders have long wondered: what's the best way to change clinicians' behavior and improve their quality and efficiency of care?

In recent years, there has been a lot of enthusiasm about approaches like financial incentives and behavioral “nudges” to help clinicians offer more evidence-based care. But clinical decision-making is far too complex to be consistently improved by applying these frameworks. When it comes to changing clinician behavior, leaders have to think more broadly about the local organizational culture clinicians work in.…

The remainder of this commentary is available on

Yusuke Tsugawa is an assistant professor at the David Geffen School of Medicine at the University of California, Los Angeles. John N. Mafi, M.D., M.P.H., is an assistant professor of medicine at the David Geffen School of Medicine at UCLA and an affiliated adjunct in health policy at the RAND Corporation. He also practices and teaches general internal medicine at UCLA.