Wanting a gold star of approval is not a desire we outgrow after grade school, new research on motivational messages found. In a letter to the Journal of the American Medical Association, a team of medical researchers outlined how an email telling you that “you are not a top performer” could be the most effective message to change your behavior.
Survey: peer shaming email was greatest motivator for behavior change
Researchers were trying to find effective ways to try and stop physicians from overprescribing antibiotics for diagnoses that did not need them — such as most acute respiratory illnesses — using “nudges,” or modest changes that would not affect physicians’ financial incentives or stop them from making a choice on their own.
They tested their intervention strategies on 248 doctors and nurse practitioners at 47 facilities in Los Angeles and Boston. In one intervention group, a pop-up screen on an electronic record told the clinician that “antibiotics are not generally indicated for [this diagnosis].” In another intervention, doctors were required to write an “antibiotic justification note.” In the third intervention, the researchers used electronic health records data to rank the clinicians by their antibiotics overuse. The clinicians received a monthly email informing them that they were either a “top performer” or “not a top performer.” In their shaming email, the low performers were shown how many prescriptions their top-performing peers handed out and were given a link of prescribing guidelines to review.
Although the feedback and audit interventions caused an initial change in behavior, the peer shaming email had the longest and most lasting effect on clinicians’ behavior, suggesting that the need for approval from one’s peers can be a more powerful incentive than other forms of feedback. No one wants to feel like you’re being left behind by your colleagues, especially when you’re a health care professional in a competitive field.
A year after the initial intervention, the peer comparison group remained the only group who still had a statistically significant lowered rate of inappropriate prescriptions being made. The researchers speculated that a social shaming intervention could go where medical feedback interventions could not. “Peer comparison might also have led clinicians to make judicious prescribing part of their professional self-image,” the authors wrote in JAMA. When you have built your career on being successful, being told you are not can spur you to change more quickly than other incentives, the research suggests.
The benefits of peer recognition
The power of peer comparison can not only be used to stop behavior, it can also be used to start new habits. When our colleagues praise and recognize us for our work, we feel motivated. Take the case study of JetBlue’s peer feedback system as an example. JetBlue reported a three percent increase in retention and a two percent increase in employee engagement after starting a peer-to-peer recognition program where coworkers could nominate a person for their everyday contributions to the company. The nominated person’s success story would be shared on an internal newsfeed for all employees to see.
By sharing the employee’s success publicly, the system created a positive feedback loop: “not only does the recipient receive extra congratulations from others who see the post, but other employees in the company also hear stories of positive behavior that can serve as a model,” Harvard Business Review explained.
The human impulse to measure our progress against our peers can be both a force for good and a deterrent against bad behavior. To change an employee’s behavior, you do not necessarily need to dangle the carrot of salary raises or the stick of probationary periods. Sometimes, the most immediate change in behavior can come from telling an employee whether or not they are doing a good job compared to their peers.