And Beatitudes installed a rectangle of black carpet in front of the dementia unit’s fourth-floor elevators because residents appear to interpret it as a cliff or hole, no longer darting into elevators and wandering away.

“They’ll walk right along the edge but don’t want to step in the black,” said Ms. Alonzo, who finds it less unsettling than methods some facilities use, bracelets that trigger alarms when residents exit. “People with dementia have visual-spatial problems. We’ve actually had some people so wary of it that when we have to get them on the elevator to take them somewhere, we put down a white towel or something to cover it up.”

When elevator doors open, Beatitudes staff members stand casually in front, distracting residents with “over-the-top” hellos, she said: “We look like Cheshire cats,” but “who’s going to want to get on the elevator when here’s this lovely smiling person greeting you? It gets through to the emotional brain.”

Alabama will receive a $55 million bonus, more than twice as much as any other state, for having 133,000 more children on its Medicaid rolls than projected by a formulated base line, according to the Department of Health and Human Services.

To make enrollment easier, Alabama has eliminated asset tests for children, ended requirements for an in-person interview and allowed children to remain eligible for a year without renewal. It also sends out renewal forms with blanks filled in when data is known, and allows applicants to verify their forms with an electronic signature. The state has adopted “express lane eligibility” so that Medicaid application processors can use income findings from other safety net programs to validate eligibility.

Hat tip: Benjamin Littenberg.

2) People spend more when it’s sunny. Are retailers going to start experimenting with artificial sun lamps? Hat tip: Five Minute Economist.

3) The Department of Health and Human Services releases a computer widget to help you find affordable health insurance.

4) Why is your garage, your pantry, or your office filled with stuff you never use? Overconfidence.

5) When financial executives offer a range for stock market returns with 80 percent confidence, they turn out to be right just one-third of the time.

There’s a provision in the new health care law that strikes me as intriguingly similar to the (Toxic Release Inventory), and that’s the Physician Payments Sunshine Act, which establishes that doctors must reveal payments from drug companies. We already know, primarily from a series of articles in the New England Journal of Medicine, that this troubling practice has been going on for some time. Someday soon, we’ll know how widespread it is.

2) What behavioral economics can add to the health care debate.

3) Talk of the Nation’s Science Friday asks how nudges can help people save energy. Segment runs 13 minutes.

4) Automatic enrollment coming to Canada?

5) A subscription service for lazy guys that will send fresh socks, t-shirts, and underwear every three months. Hat tip: Raj Shah.

6) In the U.K., casinos require memberships. Once you fill out the paperwork, you have to wait 24 hours before going to the casino.

We clearly don’t need any more distractions from the two main issues of health care reform: how to deal with our large uninsured population and how to make the entire system more cost effective. So, for now, let’s ignore the shouted rhetoric about whether “death panels” want to kill off Grandma or whether President Obama wants to turn the country into a socialist state.

But even if we discard these absurdities, and tune out the raucous scenes at town-hall meetings, one big distraction remains: the question of whether a “public option” should be part of the health care solution. To me, the issue is a red herring, and is getting in the way of genuine reform.

Continue reading here.

And here’s my two cents for human engineering. Dental patients wear a bib around their neck. How about if the (dental) office purchased a Sharpie, and had each doctor write down how many injections he/she gave the patient, and their exact location. Better still, how about if this was pre-marked on the bib?

Read the full post as Psychology Today.

Changemakers, an initiative by the non-profit social entrepreneurship group Ashoka, is preparing to launch a competition to generate medical nudges (more on that in a later post), and the contest organizers have selected the checklist as one of their case study examples. They remind us why the checklist is such a brilliant idea. It’s not the six simple steps. It’s the observing nurses who provide instant feedback ensuring that the medical checklist is followed.

Pronovost’s masterstroke came next: asking ICU nurses to observe doctors’ behaviors after the lists were posted. If they didn’t follow the list, nurses should intervene. Nurses were also to ask doctors daily whether lines ought to be removed, so as not to leave them in longer than necessary.

“When we first said it, the nurses said, ‘Hey, I’m gonna get my head bit off’,” recalls Pronovost. “And docs said, ‘You can’t have nurses second-guessing me in public’. So I pulled all the teams together and said, ‘Is it acceptable that we can harm patients here in this country?’ And everyone said, ‘No’.”…

(Provonost) made the nudge public – involving nurses and reframing the issue as one about harming patients, not authority, Provonost created a cultural shift, empowering everyone in ICU to nudge each other toward right choices to preventing infections.

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