Practical Wisdom - Why checklists and incentives might not be the answer
There is a "collective dissatisfaction" with our healthcare system; there are two types of responses we can make when things aren't going right - the first is that we can make more rules or checklists to follow, so that even if we don't care or know what to do, we can just follow the script. The other is incentives, so that even if doing the right thing isn't in our interest, we make it beneficial by providing carrots and/or sticks that encourage the best behavior.
We have spent the past several years attempting to prevent hospital infections using these same two responses: checklists and incentives (payment restructuring and public reporting). While these efforts are well intentioned, each is fraught with problems.
Unfortunately, there are no sets of rules that can get us where we need to go. Why? Because people can always find ways to beat the system or avoid the rules. Barry Schwartz and Kenneth Sharpe through wonderful and insightful stories in their new book called Practical Wisdom, explain how the wise person knows when to and how to bend the rules to achieve the right thing. Too many rules de-moralize the intelligent person and incentives create people that just follow incentives...
Their book (and the TED video below) are a kind of anti-Freakonomics and an anti-Checklist Manifesto. It is not that they are telling us to get rid of rules entirely, but suggest that rules are not enough. Additionally, they suggest that when we live by incentives, they crush our ability to do the right thing. Enjoy the video (if you aren't at a location that has a "rule" blocking TED videos!)
We have spent the past several years attempting to prevent hospital infections using these same two responses: checklists and incentives (payment restructuring and public reporting). While these efforts are well intentioned, each is fraught with problems.
Unfortunately, there are no sets of rules that can get us where we need to go. Why? Because people can always find ways to beat the system or avoid the rules. Barry Schwartz and Kenneth Sharpe through wonderful and insightful stories in their new book called Practical Wisdom, explain how the wise person knows when to and how to bend the rules to achieve the right thing. Too many rules de-moralize the intelligent person and incentives create people that just follow incentives...
Their book (and the TED video below) are a kind of anti-Freakonomics and an anti-Checklist Manifesto. It is not that they are telling us to get rid of rules entirely, but suggest that rules are not enough. Additionally, they suggest that when we live by incentives, they crush our ability to do the right thing. Enjoy the video (if you aren't at a location that has a "rule" blocking TED videos!)
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