“If you’re a woman coming to the ER, you’re less likely to receive pain medication for the same type of pain for the same complaint, compared to a man,” says Prof. Shoham Choshen-Hillel, a professor of organizational behavior and vice-dean for teaching at the Hebrew University Business School. After conducting extensive research in over 150 medical centers worldwide, she found consistent bias against women.
“A woman with a headache that she gauges as nine out of 10 on the level of pain is less likely to be treated with any type of analgesic compared to a man coming to the ER with the same complaint,” says Choshen-Hillel. “We built on findings from the psychological literature and pain perception that shows that among lay people, women’s pain is seen as hysterical and exaggerated.” She adds that the tendency to under-prescribe for women was observed among both doctors and nurses, regardless of gender. “We have seen in actual medical decisions that physicians are prescribing less analgesics for the same reported pain score and type of pain for women than for men.”
Choshen-Hillel and her team brought this bias to the attention of physicians who were previously unaware of it and are attempting to change it by using reminders for doctors in the system. When a doctor is about to discharge a patient, a pop-up screen will appear, notifying them that the patient reported a high enough pain score to receive a prescription for medication, which will “nudge” them to prescribe it.
In recent years, her research on real-world decision-making situations such as these has received international recognition. A professor of organizational behavior and vice-dean for teaching at the Hebrew University Business School, she is a member of the Federmann Center for the Study of Rationality at the Hebrew University and serves as an associate editor at the journal Management Science. Her award-winning work, published in PNAS (Proceedings of the National Academy of Sciences) and Management Science, examines everything from bias in physicians’ decisions to sleep and resilience during war.
Choshen-Hillel’s research explores how people make decisions, which biases shape their choices, and how fairness and honesty influence behavior. “Decision-making is the foundation of human behavior,” she says. “Without decisions, nothing would happen in the business world or the social world.”
A second notable research project led by Choshen-Hillel focuses on honesty in decision-making. “From the literature of dishonest behavior and decision-making,” she says, “we know that people tend to tell small lies.” In a typical study, she explains, participants rolled a die and placed it under a cup so that only they could see the result. Participants in the experiment were paid based on their reported responses. If they said that the die landed on two, they would receive $2. For a six, they would get $6. “There’s a clear incentive to overreport the outcomes,” she says. “The chances of getting one, six, and any other number are the same. But we see that people underreport small numbers like 1 and 2 that aren’t profitable and overreport to get the high reward. We know that when people cannot be seen, and no one can tell whether they lied, then they overreport their outcomes. That’s one finding. The second finding is that when you can observe them, and they know that someone will scrutinize their decision, they don’t lie as much.”
From a real-life perspective, she explains, employees who work from home and report their hours may inflate the actual hours they worked, because no one can tell how long they actually worked. On the other hand, if their supervisor can check how many hours they were actually on the system, they will be more careful in reporting their work hours.
Interestingly, she explains, there are cases in which workers lie to appear more honest. “We asked Israeli lawyers to imagine a case where they told a client that a certain case would take them between 60 and 90 hours, and they would bill them according to the number of hours they worked. In the control condition, we told them that they estimated the number of hours to be between 60 and 90. They ended up working 60 hours. We asked these lawyers, ‘How many hours would you ask them to pay?’ The lawyers told us that they would ask for about 70 hours, even though they only worked for 60.
“For another group of lawyers, we told them that they estimated that they would need between 60 and 90 hours, and ended up working 90 hours. We asked them, ‘What would you bill the client?’ In this case, they told us they would only bill them for 85 hours. When we asked why, they said that the client would think that they did not really work for 90 hours, and in this case, it is more important for them to appear honest than actually being honest.” In essence, they underreport their outcomes because they don’t seem believable and think people will not believe them.
A native Jerusalemite, Choshen-Hillel has deep roots in the Hebrew University community. Both her mother and her father earned their PhDs at Hebrew University, and Choshen-Hillel received her undergraduate and graduate degrees there. After completing her PhD in social psychology, she was a visiting scholar and a postdoctoral fellow at the University of Chicago’s Booth School of Business.
Her interest in human behavior and decision-making dates to her undergraduate studies at Hebrew University. “I studied psychology in the university’s Amirim program, which is a special honors program in the humanities, and I became very interested in social psychology and the social context of human behavior, especially in decision-making. How people make decisions and whether there are specific patterns that we can use to predict people’s decisions is what caught my attention.” Choshen-Hillel was intrigued by the decisions people make that affect others, and by how the prospects of their outcomes shape those decisions. “When do I decide to sacrifice some of my resources to help other people? When do I give out some of my money, even though I know it is not beneficial to me in any way, but I do know that it may benefit others?” Her research showed that when people retain agency and control over the decision, they will likely be more generous than when the decision of allocation is made for them.
One real-life manifestation of this, she explains, is when a manager is tasked with giving a bonus to an employee. “Much of my work has looked at managers’ decisions in cases where they can’t allocate bonuses equally among all employees,” says Choshen-Hillel. “It can be parking spots, or it can be bonuses. The manager is in a very difficult position. Everyone expects them to be fair and impartial, but they don’t want to waste the resources. If they have to be completely fair, they wouldn’t give the extra parking spot to anyone because they can’t split the parking spot.”
Choshen-Hillel says that sometimes managers prefer not to give bonuses to anyone to avoid conflict, complaints, and dissatisfaction. Based on her research, she suggests that managers allow employees to decide who will receive the bonus. “We have shown that even if the employee decides to give the extra parking spot to someone else, they’re still happy several weeks later. That’s because they know that they decided to enable their colleague to enjoy this parking spot. Everybody wins. The manager seems fine because no one complains that they were unfair. The employee who received the parking spot, of course, is happy, and the one who gave it is also happy because they know that they did a good thing that their partner will thank them for.”
Choshen-Hillel says the business school at Hebrew University is top-notch, despite having far fewer resources than American universities. She lauds its interdisciplinary nature, pointing to her experience as a psychologist at a business school. “Obviously, we have many economists, but many of my colleagues come from different areas. We have people from computer science and physics, as well as sociology and psychology, and we’re very well integrated.”
She adds that the student body, which includes both Arab and Jewish students, is also remarkably diverse. “In my class, we have people who are computer science majors, Bible students, psychologists, and economists taking my decision-making classes and negotiation classes.”
In her eyes, what stands out is the unique nature of the Hebrew University community. “We are close to each other in a way that I haven’t seen in leading international business schools. We’re actually friends with each other. We meet each other not just as colleagues but also as friends, including the community; not only the professors but also the staff, the administrative staff, and the students. We have a personal touch and connection that I haven’t seen in other universities. We really care about students on a personal level. I think the last two years have even emphasized that more than before. And that is special to me as a human being, not just as an academic.”
This article was written in cooperation with Canadian Friends of the Hebrew University.