Empowering Patient Adherence: The Art of ‘Nudging’ in Healthcare

In the realm of healthcare, the success of treatment often hinges not only on the clinical skills of healthcare professionals but also on the willingness and ability of patients to adhere to prescribed interventions. 

“Nudge,” a groundbreaking book by Richard H. Thaler and Cass R. Sunstein, introduces the concept of a ‘choice architect,’ an individual responsible for organising the context in which people make decisions. This concept is transformative when applied to the clinical setting, where physiotherapists and other healthcare clinicians can guide patients towards positive health behaviours and treatment adherence. 

The Power of Context

The environment in which patients make decisions about their health can either support or hinder their treatment progress. 

As choice architects, clinicians have the power to design an environment that makes the right choices the easy choices. For example, simply presenting an exercise regimen in a clear, straightforward manner can significantly impact a patient’s willingness to engage with it. By reducing complexity, you make adherence seem less daunting for the patient.

Creating Effective Nudges

A nudge is a subtle change in the environment that can lead to a significant change in behaviour without restricting choice. In the clinical setting, nudges can take many forms:

  • Simplification: Break down exercises into simple steps that a patient can easily remember and follow. For instance, providing a checklist or a visual guide can help patients incorporate their exercises into daily routines without feeling overwhelmed.
  • Defaults: Set positive behaviours as the default option. For instance, scheduling the next appointment before a patient leaves the clinic or setting up a default follow-up call can ensure continued engagement.
  • Feedback: Provide immediate feedback on performance. Use apps or devices that track and display progress during exercises, giving patients a sense of achievement and encouraging them to continue.
  • Social Proof: Humans are inherently social beings and are influenced by the actions of others. Sharing success stories of other patients who adhered to their treatment can motivate individuals to follow suit.
  • Incentives: Small rewards for completing exercises or reaching milestones can be powerful motivators. These need not be material; verbal praise or recognition of progress can also serve as effective incentives.
  • Getting started: Design a way to make starting one exercise easy. Continuing with the exercise program may then become more likely.

Applying ‘Nudge’ in Practice

Consider a patient who struggles with adherence to an exercise regimen. By applying the principles from “Nudge,” a clinician might:

  • Arrange the clinic so that educational materials on the importance of adherence are readily visible and accessible.
  • Use a tablet with an app that illustrates exercises and tracks completion, providing that crucial feedback loop.
  • Set up a system where patients can log their daily exercise completion, potentially leading to a monthly ‘most consistent patient’ recognition.


Adapting the insights from “Nudge” to the clinical environment empowers healthcare clinicians to foster treatment adherence through thoughtful, patient-centric choice architecture. 

By crafting nudges that fit the unique needs and lifestyles of patients, clinicians can transform the daunting task of exercise adherence into a manageable and even enjoyable part of their patients’ daily routines. 

The result is a greater chance of treatment success and improved health outcomes, demonstrating the profound impact of subtle, strategic nudges in healthcare.

Contact me to find out when I’m coming to your state for communication skills workshops: annettetonkin@gmail.com

CS4CS Communication Skills 4 Client Success Level 1 Workshop Adelaide 13th and 14th September 2024. 

Contact us for details on this unique course run by myself and Bill McTigue

Annette Tonkin on annettetonkin@gmail.com

Bill McTigue on billm@mgolf.com.au

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