Nudging in health: the UK experience
11 May 2015
Dan Berry
UK Government Department of Health: behavioural insights team
Email: [email protected]
Twitter: dan_berry79
What I’ll talk about
1. Why the UK government and National Health Service
(NHS) is increasing applying behavioural insights
2. Examples from across health services and public health
3. A game…
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DH – Leading the nation’s health and care
About 1 in every 10 NHS outpatient
appointment is missed
This leads to poor patient care
It wastes NHS resources:
one estimate put this at £225 million
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Your challenge is to
reduce missed hospital
appointments by a quarter
- without spending any
money
- without retraining staff or
introducing complex
system changes
- without penalising
patients
Appt at St Barts
Hospital on Sep 26 at
2.30. To cancel or
rearrange call the
number on your
appointment letter.
Appt at St Barts
Hospital on Sep 26 at
2.30. To cancel or
rearrange call
02077673200.
Percentage of appointments
that are missed
Existing message
Easy Call
We are expecting you
at St Barts Hospital on
Sep 26 at 2.30. 9 out of
10 people attend. Call
02077673200 if you
need to cancel or
rearrange.
Social Norms
We are expecting you
at St Barts Hospital on
Sep 26 at 2.30. Not
attending costs NHS
£160 approx. Call
02077673200 if you
need to cancel or
rearrange.
Specific Costs
Effect of messages on missed appointments (N = 10,111)
12
10
8
11.1
9.8
10
Easy call
Social Norms
8.4
6
4
2
0
Existing Message
Specific Costs
Hallsworth M, Berry D, et al: Stating appointment costs in SMS reminders reduces missed hospital appointments. (2015: publication pending)
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DH – Leading the nation’s health and care
Benefits of behavioural insights
Understanding how people actually behave helps us
design effective policy and implementation programmes.
Behavioural insights can inform interventions that are:
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•
Cheap: often optimising existing processes or materials
•
Scalable: do not require intensive training or system
reorganisation
•
Light touch: limited burden on those who wish to continue as
they are
DH – Leading the nation’s health and care
Three examples of nudge
interventions targeting
patients or the public
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DH – Leading the nation’s health and care
Attendance rate %
35
30
33
25
29
20
15
10
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Old letter
‘Commitment
device’ letter
Bonus A, Berry D: Increasing Uptake of the NHS Health Check . Report of research with Medway Council
to optimise the invitation letter . 2013. available at www.healthcheck.nhs.uk/document.php?o=588
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DH – Leading the nation’s health and care
0
old letter
nudge
letter
8
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Current NHS prescription form: state eligibility for
free prescription before the honesty declaration
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DH – Leading the nation’s health and care
New NHS prescription form: honesty declaration
first, then state eligibility for free prescription
Three examples of nudge
interventions targeting
clinicians
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DH – Leading the nation’s health and care
Simple and timely feedback
Fogarty AW, Sturrock N, Premji K, Prinsloo P. Hospital clinicians’ responsiveness to assay
cost feedback: a prospective blinded controlled intervention study. JAMA Intern Med
2013;173:1654–5.
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DH – Leading the nation’s health and care
The revised chart led to much more accurate information (and less errors)
90.0%
80.0%
70.0%
60.0%
50.0%
40.0%
30.0%
20.0%
10.0%
Proportion of medication orders
100.0%
Existing chart (n=174)
Improved chart (n=163)
0.0%
Dose entered correctly
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Prescriber's contact
number entered
DH – Leading the nation’s health and care
Frequency of medications
entered correctly
King et al. (2014)
Redesigning the
‘choice architecture’
of hospital
prescription charts.
Forthcoming.
Test your knowledge…
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DH – Leading the nation’s health and care
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Cabinet Office and DH : Applying Behavioural Insights to Organ Donation: preliminary results from a randomised controlled trial
http://www.behaviouralinsights.co.uk/publications/applying-behavioural-insights-organ-donation
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DH – Leading the nation’s health and care
Recap of the benefits
Behavioural insights can inform interventions that are:
•
Cheap: often optimising existing processes or materials
•
Scalable: do not require intensive training or system
reorganisation
•
Light touch: limited burden on those who wish to continue as
they are
Great framework: search for ‘behavioural insights EAST’
Email Dan Berry: [email protected]
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DH – Leading the nation’s health and care