Promises, promises: How to get people to follow through on their commitments

When it comes to training, people make lots of promises. And because training is usually non-urgent, many of these promises get broken. Apologetic managers cancel or postpone scheduled training, pleading that critical deals are hanging in the balance. Salespeople say they’ll engage in self-directed training but then never get around to it. They say they’ll incorporate new techniques into their work, but then fall back into old habits. Their bosses say they’ll follow up to make the training stick. But something always seems to come up.

So when it comes to important but non-urgent activities like training, how can you help ensure that people will do what they say?

Many organizations have used formal learning “commitments” or “contracts.” A new study suggests that they can be far more effective — if they’re public.

The research
The research comes not from sales, but from medicine. The goal was to train physicians to stop overprescribing antibiotics. It’s an issue where education alone hasn’t proved to be especially effective. Most physicians are aware that unnecessary antibiotics are not only expensive, but potentially harmful to patients and to public health. Yet more than 2.5 million inappropriate prescriptions are written every year.

So in five Los Angeles clinics, researchers tried a simple intervention. They asked doctors to sign a letter that detailed their commitment to stop prescribing unneeded antibiotics.

Here’s the twist: The letter was the size of a poster. And once the doctors had signed it, the researchers attached head shots of each doctor and put the letter on the wall of the examining room, where the doctors would see it all day, every day.

Compared with a control group of doctors who hadn’t signed, the docs who had their mug shots and John Hancocks on display prescribed 20% fewer antibiotics.

The study also found that this was real behavior change. In an earlier effort, which involved financial incentives, some doctors fudged the paperwork to make it look like the were complying. Where money prompted cheating, social pressure prompted doctors to do the right thing. With the letter in plain view of patients and colleagues, doctors felt obligated to do what they’d pledged.

Source
Meeker, D., et al. (2014). Nudging guideline-concordant antibiotic prescribing: A randomized clinical trial. JAMA Internal Medicine, 174(3), 425-431.