As important as individual solutions and team-based solutions are, there is a critical third level of potential solutions that can and should be implemented, namely, system-level solutions. Some of these broader solutions can be implemented fairly directly by leaders in local healthcare systems, including individual practices and hospitals. One especially important “local systems” solution is workflow analysis and workflow simplification. As valuable as improving workflow is, it is a challenge to persuade leaders to engage in such a change process, and it is a challenge to persuade those who would benefit from workflow simplification to actually change their behavior. The pandemic is providing a major “reset” opportunity, the chance to rethink how we do things in general and, more particularly, in healthcare.

This chapter provides a framework for how incentives affect behavior change. Economic theory is built on the premise that incentives matter, but empirical evidence shows the effect of incentives on behavior is more complicated than predicted by the basic law of demand. Our framework highlights four potential “channels” through which incentives can affect behavior change: First, incentives can help create “desirable” or “adaptive” habits by building up the stock of behavior. Increasing recent experience makes current behavior less costly and more enjoyable. Second, incentives can help “kill” undesirable or maladaptive habits by reducing the stock of behavior. Decreasing recent experience makes current behavior costlier and less enjoyable. Third, incentives can help counter present bias. Using frequent and regular incentives helps change behavior. Fourth, incentives can help remove barriers to change. Using incentives to reduce switching costs makes uptake of the desired behavior or activity cheaper or even free. These four channels and the supporting empirical evidence for them have implications for how incentive-based interventions work and provide guidance on how best to design them for optimal efficacy.