Table 2.

Examples of behavioral economic principles in Neonatology: pros and cons.

Principle	Example	Pro	Con
Goal gradient (target neither too easy nor too hard)	Incentives for a modest reduction in empiric antibiotic use in the NICU	Gradual promotion of positive behavior with metrics that can be accurately analyzed	Extreme reduction may harm patients Ability to achieve target may depend on patient risk factors beyond the purview of the provider
Weber-Fechner law (incentive should be proportional to base)	The magnitude of performance-based bonus is proportional to base salary	Providers will notice and pay attention to targets/goals	Senior providers and Chiefs benefit more than junior providers for the same task
Immediacy (incentives paid close to work completion)	Work RVU based productivity bonus paid monthly instead of yearly	Immediate gratification	Increased administrative work Variable pay (withholding a portion of base compensation if metrics are not met in subsequent months) may negatively impact morale
Nudging	Incentives to improve documentation and attendance at procedures	Increase divisional revenue	May lead to therapies that are not medically indicated
Loss aversion	Withholding a portion of bonus for poor chart completion rate	Penalty is more effective in changing behavior	Negative effect on faculty morale
Social ranking	Public display of top performer of the year (highest % of discharge orders by 10 am)	Intrinsic motivation at minimal cost	Providers with consistently low performance may perceive this as social shaming