Nudging Public Employees Through Descriptive Social Norms in Healthcare Organizations

• Published date: 01 July 2021
• Author: Nicola Belle,Paola Cantarelli
• Date: 01 July 2021
• DOI: http://doi.org/10.1111/puar.13353

Research Article

Nudging Public Employees Through Descriptive Social Norms in Healthcare Organizations 589

Abstract: We draw on the focus theory of normative conduct and nudge theory to experimentally test the effect of

descriptive social norms on desired behaviors that public employees may engage in at suboptimal levels, namely,

vaccination and help-seeking. Through a series of framed randomized controlled trials with 19,984 public healthcare

professionals, we demonstrate that descriptive norms—doing what the majority of others do—trigger conformity.

Specifically, employees are more likely to get a flu shot and advocate vaccination when knowing that the majority of

their colleagues get vaccinated against the seasonal influenza compared to when most colleagues do not. Similarly, the

probability of making help requests on the job is noticeably higher when asking colleagues for advice is the norm rather

than not. We discuss the theoretical and practical implications of these experiments for scholars and policy makers

interested in predictably altering high-stakes behaviors among public employees through low-powered incentives.

Evidence for Practice

• Public organizations and their managers can leverage social norms to fuel desired behaviors that employees

may otherwise engage in at suboptimal levels.

• Public organizations with high vaccination coverage rates can promote vaccination by informing their

employees that the majority of their colleagues get the flu shot.

• Public organizations with low vaccination coverage rates must implement interventions to increase

vaccination coverage before they can take advantage of the effect of descriptive social norms.

• Explicitly communicating that asking colleagues for help is a desirable social norm can foster widespread

adoption of this behavior, which in turn can trigger helping at work.

If choice architects want to shift behavior and to do so

with a nudge, they might simply inform people about

what other people are doing.

Thaler and Sunstein(2008)

Vaccination has proven to be a highly cost-

effective means of improving world health,

yet “every year throughout the world… two

to three million people die from diseases that can

be prevented with vaccines” (Banerjee et al.,2010,

1). Seasonal influenza alone, for example, causes

up to 650,000 deaths (Organization for Economic

Cooperation and Development,2019). According to

the World Health Organization (WHO), “health-care

workers are an important priority group for influenza

vaccination [and their immunization] should be

considered part of a broader infection control

policy” (WHO,2012, 475). Therefore, promoting

vaccination among their workers should be a priority

for public healthcare organizations. However, this

is easier said than done and vaccination campaigns

often fall short of expectations because they fail to

factor in the human factor. Leveraging descriptive

social norms could be a viable approach to overcome

this challenge because “people like to do what most

people actually do” (Thaler and Sunstein,2008, 191).

Consequently, the wise use of social nudges may be

crucial to encourage employees to get a flu shot (Van

Bavel et al.,2020) and to advocate vaccination among

colleagues. In addition to effects on others, advocacy

has proven to trigger self-persuasion, a mechanism

whereby individuals who advocate for a behavior

become more likely to engage in that behavior

themselves (Aronson,1999). By using the “social

norm itself [as] a nudge” (Thaler and Sunstein,2008,

259), campaigns that emphasize that most colleagues

get a flu shot can induce more workers to adopt the

same behavior, thus triggering a virtuous cycle.

Similar mechanisms may extend beyond vaccination

to fuel other desired behaviors that public employees

may otherwise engage in at suboptimal levels. In

a series of meetings with over one hundred public

professionals holding managerial responsibilities,

asking for help from colleagues emerged as a

quintessential example of this type of behavior.

Nudging Public Employees Through Descriptive Social

Norms in Healthcare Organizations

Nicola Belle

Paola Cantarelli

Scuola Superiore Sant’Anna

Paola Cantarelli is an Assistant

Professor at Scuola Superiore Sant’Anna

(Management and Healthcare Laboratory,

Institute of Management and Department

EMbeDS, Pisa, Italy). Her research focuses

on behavioral human resource management

and work motivation in mission-driven

organizations.

Email: paola.cantarelli@santannapisa.it

Nicola Belle is an Assistant Professor at

Scuola Superiore Sant’Anna (Management

and Healthcare Laboratory, Institute of

Management and Department EMbeDS,

Pisa, Italy). His research focuses on

behavioral public administration and

management.

Email: nicola.belle@santannapisa.it

Public Administration Review,

Vol. 81, Iss. 4, pp. 589–598. © 2021 by

The American Society for Public Administration.

DOI: 10.1111/puar.13353.