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Making change happen is central to care improvement and reducing risk. Every quality practitioner should have a toolkit, and one of the tools that needs to be in it is an effective change approach that helps people to get on board, supports behaviour change and re-sets organisational systems to sustain the change. 

The ‘Nudge’ theory of change is one approach.  It aims to help people change their behaviour by making small changes in the environment or the way information is presented. The idea is that people are not always rational decision-makers, and we can be influenced by small things without even realising it. Nudging is not about forcing people to do something, but making it easier for them to do things differently – aligning changes with their values and goals. This involves ‘nudges’ such as:

• Thinking about the change from the staff point of view
• Presenting it based on how it will benefit them
• Treating it as a recommendation more than a command
• Listening to feedback throughout the process. 

An example of nudge theory being used to promote positive change in human services is the increased focus on hand hygiene over the past two decades. Hand sanitisers are now part of life but it wasn’t so long ago that we were trialing them in hospitals as something new.

We learned through that process that it wasn’t enough to just ‘tell’ people they had to use the sanitisers and throw in a bit of training – there was nudging required. We made the case for change and appealed to staff values of preventing infection in their patients – and themselves. We placed sanitisers in prominent and handy locations, based on staff input. Reminders, using visual cues, were everywhere. 

We also provided feedback to staff about their hand hygiene compliance rates and infection rates, which stimulated further improvement. There was growing social proof as staff saw senior staff increasingly using the sanitisers.

Different change approaches are required for different situations.  ‘Nudging’ is one tool that is useful to use in combination with other change tools to help make change less confrontational and more collaborative.

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Accessed on 19/02/23 at:

‘Businessballs’. What is Nudge Theory? https://www.businessballs.com/improving-workplace-performance/nudge-theory/