Using the Nudge Theory to Enhance Attending Anesthesiologist Breaks

It is well understood that human behavior can be influenced, often by the most subtle of factors. Otherwise known as "nudging", these attempts to affect human decision making in a predictable manner are possible due to individual cognitive boundaries, biases, routines, and habits. This quality improvement study analyzes the impact of a norms nudge on compliance of attending anesthesiologists providing breaks to the providers they are working with under the care team model. The nudge displays the top performing attendings as well as the top performing hospital to all attendings. Each individual can also view where they fall in relation to the department average as well as their deidentified partners. Implementation of the norms nudge was associated with a significant increase in the percentage of breaks given in the accepted time frame. Morning break compliance increased from 75.0 to 78.1% (p = 0.0002), lunch breaks increased from 83.0% to 86.3 (p < 0.0001), and afternoon breaks increased from 61.8 to 65.3% (p < 0.0001). The present study suggests that norm nudges may be able modify intraoperative practices with regards to breaks without significant cost, education, or other investment.